Anemia is a decrease in red blood cells or hemoglobin levels, resulting in a lower ability of blood to carry oxygen to tissues. There are several types and causes of anemia. Iron deficiency anemia, the most common type, is caused by inadequate iron intake or absorption. Megaloblastic anemia is caused by deficiencies in vitamin B12 or folic acid, which are needed for red blood cell formation. Hemolytic anemias involve the premature destruction of red blood cells, and can be hereditary, autoimmune, or due to infections. Diagnosis involves blood tests to measure red blood cell counts and hemoglobin levels, and determine the size and content of red blood cells to identify the type of anemia present

1. Anemia
By: Dr.Nancy

2. • What is anemia
• What are symptoms and signs of anemia
• What is classification and different types of anemia
• What are causes of different types of anemia
Learning Objectives

3. Anemia ( An-without, emia- blood ) is a decrease in the RBC count,
hemoglobin and/ or Hematocrit values resulting in a lower ability for
the blood to carry oxygen to body tissues.
PATHOPHYSIOLOGY:
Decrease in RBCs , Hb or Hct level
Diminished 02 carrying capacity
Hypoxia and hypoxia induced effect on organ function
Sign and symptoms of anemia.

4. Anaemia
• Significant reduction (at least 10 %) in
circulating red cell mass or their
hemoglobin content appropriate for the
age and sex, leading to corresponding
decrease in the Oxygen - carrying capacity
of blood.
• WHO criteria - Hb < 13 gm/dl in men & Hb <
12 gm/dl in women
Normal Appearance
Pallor due to Anemia

5. •Normal Values
Category values Reference
Men >13g/dl
women >12g/dl
Pregnant women >11g/dl
Infant from 2 to 6 months >9.5g/dl
Children from 6 month to 24 months >10.5g/dl
2yrs to 11yrs >11.5g/dl
Children from 12 years >12g/dl

6. Grades of Anaemia

7. Classification of Anaemias:
1. On the basis of cause
-Blood Loss
-Inadequate production of normal blood cells
-Excessive destruction of blood cells
2. On the basis of morphology
- Microcytic
- -Marcocytic
- -Normocytic

8. • Types of Anemia
Based on the clinical picture-
1.Iron Deficiency anemia – Excessive loss of iron , women at high risk- menstrual blood and
growing fetus.
2.Megalobastic anemia- Less intake of vitamin B12 and folic acid- Red bone barrow produce
abnormal RBC eg Cancer drugs
3. Pernicious anemia- inability of stomach to absorb vitamin Bb12 in small intestine
4.Hemorrhagic anemia-Eexcessive loss of RBC through bleeding, stomach ulcers,
menstruction.
5.Hemolytic anemia-RBC plasma membrane ruptures
- Thalassemia anemia- Less synthesis of hemoglobin. Found in population of Mediterranean
sea.
- Sickle cell anemia- Hereditary blood disorder, characterized by red blood cells that assume
an abnormal, rigid, sickle shape
6. Aplastic anemia- Destruction of red bone marrow

9. Risk Factors
1. Poor socio economic class
2. Multiparity
3. Teenage pregnancy
4. Menstrual problem
Symptoms
1. Easy fatigue and loss of energy
2. Unusally rapid heart beat
3. Shortness of breath and headache
4. Difficulty concentrating
5. Dizziness
6. Pale skin
7. Leg cramps
8. Insomnia

10. • Anemia Caused by Iron Deficiency
People with an iron deficiency may experience these symptoms:
1. A hunger for strange substance such as paper, ice, or dirt
2. Upward curvature of nails, referred to as koilonychias
3. Soreness of the mouth cracks at the corners
Anemia Caused by vitamin B12 deficiency
People whose anemia is caused by a deficiency of Vitamin B12 may have
these symptoms:
1. A tingling , “ pins and needles” sensation in the hands or feet
2. Lost sense of touch
3. Dementia
4. Hallucinations
5. Stiffnes of the arms and legs

11. Signs of Anmeia:
1. Brittle nails
2. Koilonychia ( Spoon shaped nails)
3. Brittle hair
4. Dysphagia and glossitis
5. Plummer vinson/ Kelly Patterson
Investigations
The red cell population is defined by:
1. Quantitative parameters: 2. Qualitative Parameters
- Volume packed cells- the hematocrit - Mean corpuscular volume
- Hemoglobin concentration - Mean corpuscular hemoglobin
- Red cell concentration per unit volume - Mean corpuscular hemoglobin conc

12. Iinvestigations:
Hemotocrit ( Packed cell Volume) : it is the proportion of the volume of
blood sample that is occupied by RBC
Men – 42-52% Women – 36-48%
Cell Volume Hemoglobin Concentration :- It is the amount of hemoglobin per
unit volume of blood
Men- 14-17 gms/dl Women- 12-16 gms/dl
Red cell count: Total number of Red cells per unit volume of blood sample.
Men- 4.2- 5.4 * 10 6 / mm3
Women – 3.6- 5.0 * 10 6/ mm3
Mean Corpuscular volume : it is the average volume a RBC
Normal 82-98 mm3

13. Management:
Care Objectives
1.Determine the cause of iron deficiency
The etiology os often multifactorial; even when there is an obvious
cause
Aim of treatment
Normalize hemoglobin level and rell cell
Lifesytle management
It is recommended that patients with iron deficiency receive dietary
advice.

14. Non- Pharmacological Management:
1. Tea and Coffee inhibit iron absorption when consumed with meal or
shortly after a meal
2. Vitamin C (ascorbic acid) is also powerful enhancer of iron
absorption
3. Promote and support exclusive breastfeeding for about 6 months
followed by breastfeeding with appropriate complementary foods,
including iron- rich through the secondary year of life.

15. Approach to diagnosis for a case of anemia- Understanding Anemia
• What are patients complaints- (Symptoms)
• What are findings in patients on examination- (Signs)
• Probable diagnosis of anemia
• Investigations – RBCs count, Hb esti. and PCV –
Hematological Indices to reach to near the diagnosis
- Specific tests for final diagnosis

16. Presentation of Anemia
What are patients complaints- (Symptoms)
What are findings in patients on examination- (Signs)
In anemia, body lacks oxygen, so following signs & symptoms may be experienced:

17. Fe++ is required for Heme Synthesis (↓ Haemoglobin)
Decreased Red Cell Production- Nutritional Deficiency- Iron Deficiency
Causes of Iron deficiency anemia:

18. Clinical Features:
During Early Phase- General for anemia
Iron Therapy :
Decreased Red Cell Production- Nutritional Deficiency- Iron Deficiency

19. Pathophysiology
•
Decreased Red Cell Production- Nutritional Deficiency- Maturation factors Deficiency
(Megaloblastic Anaemia)

20. Causes:

21. Megaloblastic anaemia
Clinical feature:
Management/Treatment:

22. Decreased Blood Cells Production - Dysplastic / Aplastic Anaemia
Primary
Secondary
Causes:
Bone marrow is the site of Blood cells production

23. Dysplastic /Aplastic Anaemia
Presentation-
Management-

24. Decreased Red Cell Production - Anaemis of chronic disease
Pathophysiology
Causes

25. Decreased Red Cell Survival - Hemolytic anemia-
Intracorpuscular Defect-Hereditary Disorders
Pathophysiology
Causes

26. Pathophysiology -
Decreased Red Cell Survival - Hemolytic anemia-
Hereditary Spherocytosis

27. Pathophysiology
Decreased Red Cell Survival - Hemolytic anemia-
Glucose-6-PO4 – Dehydrogenase Deficiency

28. Most common of haemoglobinopathies- Sickle Cell Anaemia
Thalassemia
Decreased Red Cell Survival - Hemolytic anemia-
Globin chain Synthesis abnormality-

29. Decreased Red Cell Survival - Extra corpuscular Hemolytic Anemia
-Acquired disorder-Nonimmune hemolytic anemias
Chemicals and drugs -
Animal venoms –
Infectious agents –
Caused by physical injury to RBCs

30. Autoimmune hemolytic anaemia (AIHA) :
▪ Warm antibody hemolytic anemia -▪ Cold antibody hemolytic anemia
Decreased Red Cell Survival - Extra corpuscular Hemolytic Anemia
-Acquired disorder-Immuno hemolytic anemias

31. Decreased Red Cell Survival - Extra corpuscular Hemolytic Anemia
-Acquired disorder-Immuno hemolytic anemias

32. Acute blood loss anemia, also called hemorrhagic anemia, occurs due to acute
hemorrhage (bleeding).
Decreased Red Cell Survival - Post hemorrhagic anemia

33. Significant reduction (at least 10 %) in circulating …………or their ……………………appropriate for the age
and sex, leading to corresponding decrease in the …………………………of blood.
WHO criteria - Hb < ……. gm/dl in men & Hb < ……. gm/dl in women.
……………………………….type of Anemia includes Iron deficiency, Thalassemia, lead poisoning
MCV-……………the causes include Vit B12 and/or Folic acid Deficiency
Chronic blood loss leads to…………………………………………………………………
................................................. anemia is a type of megaloblastic anemia there is decreased availability of IF
Tuberculosis may cause anemia ……………………………………………………….
Self Assessment

34. Thank you