2. OBJECTIVES
By the end of this lesson learners should be able to:
1) Review the anatomy and physiology of the red blood cells
2) Describe anaemia
3) Describe the types of anaemia
4) Classify anaemia with its causes
5) Assess for anaemia
6) Manage anaemia
4. Review of red blood cells
īRed blood cell (RBC) production (erythropoiesis) takes
place in the bone marrow under the control of
the hormone erythropoietin (EPO).
īJuxtaglomerular cells in the kidney produce
erythropoietin in response to decreased oxygen delivery
(as in anemia and hypoxia) or increased levels of
androgens
5.
6. īRed blood cells contain a protein called hemoglobin that gives
blood its red hue.
ī Hemoglobin contains iron, which makes it an excellent vehicle
for transporting oxygen and carbon dioxide.
īAs blood passes through the lungs, oxygen molecules attach to
the hemoglobin.
īWhen the blood passes through the bodyâs tissue, the
hemoglobin releases oxygen to the cells.
īThe empty hemoglobin molecules then bond with the tissueâs
carbon dioxide or other waste gasses to transport them away
7.
8. īHaemoglobin consists of four polypeptide sub-units; 2 alpha
chains and two beta chains each of which is a polypeptide
īA polypeptide is a single linear chain of many amino acids
(any length), held together by amide bonds.
īA protein consists of one or more polypeptides (more than about
50 amino acids long)
īPolypeptides help make up proteins by bonding numerous
amino acids together.
ī
īProteins are created by the bonding of two or more polypeptides,
which are then folded into a specific shape for a particular protein
9. īPolypeptides help make up proteins by bonding numerous
amino acids together.
īProteins are created by the bonding of two or more polypeptides,
which are then folded into a specific shape for a particular protein
īThe sequence of amino acids comprising each type of
polypeptide chain, is determined by genes within DNA
īNote that in certain medical conditions like sickle cell anaemia, due
to a mutation the polypeptide sequence changes and this affects the
way the molecule folds, and the 3-D structure of red blood cells.
10.
11. īThe Haemoglobin has embedded with it, iron which permits the
molecule to bind (reversibly) with oxygen to transport the gas to
the different tissues.
īIt can be said that the chemical environment provided by the
polypeptides chains permits this reversible binding of oxygen to
the iron in Haemoglobin
īHemoglobin is produced in bone marrow by
erythrocytes and is circulated with them until their
destruction.
ī It is then broken down in the spleen, and some of its
components, such as iron, are recycled to the bone marrow.
12. Definition of anemia
īAnemiaâa condition in which hemoglobin (Hb) concentration
and/or red blood cell (RBC) numbers are lower than normal (for
age and sex) or a lowered ability of the blood to carry oxygen to
meet an individualâs physiological need.
īOver 273 million children under â five, suffer from anaemia
worldwide.
īThe Sub-Saharan Africa is one of the most affected regions -
with more than half (53.8%) of children under - 5 years old
suffering from anaemia
13. īIron deficiency is the most common micronutrient deficiency in
the world affecting 1.3 billion people i.e. 24% of the world
population.
īIn comparison only 275 million are iodine deficient and 45
million children below age 5 years are Vitamin A deficient.
ī Despite the burden of anemia in Uganda, the 2016 Uganda
Demographic and Health Survey (UDHS) reported that the
prevalence of anemia was 53% in children age 6-59 months
14.
15.
16. Risk of anemia using life cycle approach
īConception to birth
īBirth â 2 years
ī6months â 5 years
īSchool Age Children
īAdolescents
īPregnant and lactating women
īAdults especially people on blood thinners like asprin,wafarin
īElderly
17. Predisposing factors for anemia
īPoor diet consistently low in iron and vitamins such as folate
which increase the risk of developing anaemia
īIntestinal disorders that affect the absorption of nutrients in the
small intestine, such as Crohn's disease and Celiac disease
īMenstrual disorders with increased blood loss â women are at
greater risk of iron deficiency anaemia because of blood loss
during menstrual periods, especially for those with heavy periods
18. Predisposing factors for anemia contâd
īPregnancy increases the risk of iron deficiency anaemia
because of increased blood volume during pregnancy, as
well as developmental demands from the growing foetus
īChronic conditions like cancer, kidney or liver failure and
rheumatoid arthritis increase the risk of developing
anaemia of chronic disease
īFamily history of inherited anaemia also increases the
risk of developing anaemia
īPoor socio economic class
19.
20. Causes of anemia
īIncreased requirements
īIncreased loss (blood loss, high rates of red blood cell
destruction)
īDecreased intake (lack of red blood cell production)
īDecreased absorption
21. Increased requirements of blood
īMenstruating females
īPregnancy
īLactation
īGrowing infants and children
īErythropoietin
22. īPersistent Hematuria
īRegular blood donor
īParasitic infections
īMenorrhagia is heavy or prolonged menstrual
bleeding. It is a common problem in women
īGastrointestinal bleeding (GI bleed), also called
gastrointestinal hemorrhage (GIB), is all forms of
bleeding in the gastrointestinal tract, from the
mouth to the rectum
24. Decreased absorption
īUpper pathology eg celiac disease, Crohnâs disease
īGastrectomy
īMedications such as tetracyclines: antibiotics that include doxycycline
(vibramycin),minocycline (Minocin)and tetracycline
īQuinolones:antibiotics that include ciprofloxacin(cipro),norfloxacin,and
levofloxacin(Levaquin)
īAntacids ,*zantac* (ranitidine),Pepcid (famotidine), Tagamet
(cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole) and
Prilosec(omeprazole)
25. Types of anemia
īIron deficiency anaemia: the most common form of
anaemia that is caused by a deficiency of iron in the body
ī Vitamin B12 and folate deficiency anaemia: also
known as megaloblastic anaemia
īAnaemia of chronic disease: this may be due to cancer,
kidney failure, rheumatoid arthritis, Crohn's disease and
other chronic inflammatory diseases which interfere with the
production of red blood cell
īAplastic anaemia: a life-threatening type of anaemia
caused by a decrease in the bone marrow's ability to produce
red blood cells, white blood cells and platelets. This is due to
destruction of bone marrow due to gamma radiations and
toxins
26. Types of anemia contâd
īFanconi anemia is a rare disease passed down
through families (inherited) that mainly affects the
bone marrow.
īIt results in decreased production of all types of blood cells.
This is the most common inherited form of aplastic anemia.
īFanconi anemia is different from Fanconi syndrome, a rare
kidney disorder
27. Types of anemia contâ
īAnaemia associated with bone marrow diseases,
such as leukaemia
īHaemolytic anemia: this develops when red blood cells
are excessively destroyed.RBC plasma membrane raptures.
This may be due to parasites,toxins or antibodies.
īSickle cell anaemia: an inherited form of anaemia which
is caused by a defective form of haemoglobin that forces red
blood cells to assume an abnormal crescent (sickle)
28. Types of anemia contâ
īHaemorrhagic anaemia: excessive loss of RBCs through bleeding
stomach ulcers, menstruation, PPH etc.
īThalassemia : less synthesis of haemoglobin.
īFound in the people found near Mediterranean sea
ī Two major types of thalassemia
īAlpha and Beta Alpha thalassemia: a condition in which the body does not
produce enough alpha globin (a component of hemoglobin).
ī Beta thalassemia: a condition in which the body does not produce enough
beta globin (another component of hemoglobin).
29. Ethnic groups at risk for Thalassemia?
īThalassemia occurs most frequently among people of Italian, Greek,
African, Southern Asian, and Middle Eastern descent
Treatment
īThe type of treatment a person receives depends on how severe the
thalassemia is.
īThe more severe the thalassemia, the less hemoglobin the body has,
and the more severe the anemia may be.
ī One way to treat anemia is to provide the body with more red blood
cells to carry oxygen.
īThis can be done through a blood transfusion
30. īFrequent blood transfusions can result in too much
iron in the blood called iron overload.
ī Because there is no natural way for the body to
eliminate iron, the iron from transfused blood cells
builds up and becomes toxic to tissues and organs,
particularly the liver and heart.
īIron overload can result in early death from organ
failure.
31.
32.
33.
34. īMCHC stands for mean corpuscular hemoglobin
concentration.
īIt's a measure of the average concentration of hemoglobin
inside a single red blood cell
īMean corpuscular volume (MCV) is the average size
(volume) of the red blood cells in body
īA low MCV indicates that the red blood cells are small,
or microcytic
īa high MCV level, their red blood cells are larger than
usual, and they have macrocytic anemia
43. Assessment and diagnosis for anemia
ī History taking
ī Physical examination
ī Laboratory investigations
44. History taking
īCarefully obtain a history and perform a physical
examination in every patient with anemia, because the
findings usually provide important clues to the underlying
disorder.
īFrom the standpoint of the investigation of the anemia,
asking questions in addition to those conventionally
explored during a routine examination is important
īDuration of anemia can be established by obtaining a
history of previous blood studies and, if necessary, by
acquiring those records.
45. History taking conât
īHistory of rejection as a blood donor or prior
prescription of hematinics provides clues that anemia
was detected previously.
īCareful family medical history
īFor women check for menstrual history , parity, child
spacing.
īOccupation ,hobbies and previous medications
46. History taking conât
īObviously, seek a careful history of gastrointestinal complaints
that may suggest gastritis, peptic ulcers, hiatal hernias, or
diverticula.
īAbnormal urine color can occur in renal and hepatic disease
and in hemolytic anemia.
īDietary history must include foods that the patient eats and
those that he/she avoids, as well as an estimate of their quantity.
īSpecifically question patients regarding consumption of either
47. History taking conât
īPatients with iron deficiencies frequently chew or suck
ice (pagophagia).
ī Occasionally, they complain of dysphagia, brittle
fingernails, relative impotence, fatigue, and cramps in
the calves on climbing stairs that are out of proportion
to their anemia.
īIn vitamin B-12 deficiency, early graying of the hair, a burning
sensation in the tongue, and a loss of proprioception
48. History taking conât
īParesthesia or unusual sensations frequently described
as pain also occur in pernicious anemia.
īThe relation of dark urine to either physical activity or
time of day can be important in march hemoglobinuria
and paroxysmal nocturnal hemoglobinuria.
īExplore the presence or the absence of symptoms
suggesting an underlying disease, such as cardiac,
hepatic, and renal disease; chronic infection;
55. Interventions for anaemia prevention and
control
Provision of micronutrient supplements to vulnerable
populations
īIron and folic acid (IFA) supplementation to pregnant
women.
īIron and Folic acid supplementation to adolescent girls
(age 10-19 years)
īIFA for women of reproductive age (age 15-49 years
īVitamin A supplementation in children 6 â 59
months/6months to 5years)
īMicronutrient powders (MNPs) for 6-23 months of age
56. Interventions for anaemia prevention and
control
īFortification of staple foods
īMass fortification of foods with iron and associated nutrients
for-example flour (wheat and maize etc.), salt, sugar, millet, fats
and oils, rice etc.
īBio-fortification of foods with iron and associated nutrients,
for-example (maize, beans and sweet potatoes)
57. Interventions for anaemia prevention and control
Disease control
īMalaria: Intermittent preventive treatment in pregnant women
(IPTp); Sleeping under Long lasting insecticide treated nets (LLINs);
indoor residual spraying; prompt diagnosis and effective treatment
of malaria infections;prompt diagnosis and malaria case
management during pregnancy and environmental control measures
īWorm infestations: deworming in pregnancy and children1-14
years
īTreatment of common conditions and infections that cause anaemia
īInfectious diseases e.g.(HIV, T.B, diarrheal diseases, measles)
58. Interventions for anaemia prevention and control
īPrevent childbirth (PPH) and trauma
īNCDs (Cancer, Diabetes)
īDrugs that cause anaemia
īScreening and counselling for Genetic disorders
īDiet Diversification
īproduction and consumption of diverse foods rich in Iron and
other nutrients
59. Interventions for anaemia prevention and control
īImportance of school and backyard gardens.
īInfant & Young child feeding (IYCF)
âĸ Early Initiation of Breastmilk within one hour of delivery
âĸ exclusive breastfeeding (EBF) for the first 6 months
âĸ Complementary feeding practices after 6 months of the infantâs
age while they continue breastfeeding for up to 2 years or
beyond.
âĸ Delayed Cord Clamping of the baby between 1-3 minutes
60. Interventions for anaemia prevention and control
īWater, Sanitation and Hygiene (WASH)interventions
īSafe water supply
ī Hygiene and sanitation facilities
īBehavioural interventions to promote hygiene and use of
sanitation facilities
īPrevention of environmental enteropathy/enteric
dysfunction (EED)
61. Interventions for anaemia prevention and control
īThis should be done across all interventions
īStrengthening of child survival strategies such as Maternal and
new born health care, appropriate treatment of major childhood
diseases, Vaccination against preventable diseases, Nutrition
interventions, Malaria and HIV prevention and treatment and
WASH interventions.
īPolicy and legal framework, guidelines and information on
anaemia prevention and control
63. âĸ Janz TG, Johnson RL, Rubenstein SD (November 2013). "Anemia in the
emergency department: evaluation and treatment". Emergency
Medicine Practice. 15 (11): 1â15, quiz 15â16. PMID 24716235.
Archived from the original on 2016-10-18
âĸWhat Is Anemia? â NHLBI, NIH". www.nhlbi.nih.gov. Archived
from the original on 2016-01-20. Retrieved 2016-01-31.
âĸStedman's medical Dictionary (28th ed.). Philadelphia: Lippincott
Williams & Wilkins. 2006. p. Anemia. ISBN 978-0-7817-3390-8.
Editor's Notes
Zantac (ranitine) was found to be causing cancer and should be out of shelf