This document provides an overview of anaemia, including its objectives, a review of red blood cells and haemoglobin, definitions of anaemia, risk factors throughout the lifecycle, causes, types, signs and symptoms, assessment methods, and interventions for prevention and control. It describes the anatomy and physiology of red blood cells and haemoglobin, defines anaemia, outlines the major types including their causes, and discusses methods for assessing and managing anaemia through laboratory investigations, history taking, and potential interventions.

1. ANAEMIA
PRESENTED BY
NAKAYE ANNET OMARA (Mrs)
BME 2

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

3. Red blood cells

4. Review of red blood cells
Red blood cell (RBC) production (erythropoiesis) takes
place in the bone marrow under the control of
the hormone erythropoietin (EPO).
Juxtaglomerular cells in the kidney produce
erythropoietin in response to decreased oxygen delivery
(as in anemia and hypoxia) or increased levels of
androgens

6. Red blood cells contain a protein called hemoglobin that gives
blood its red hue.
 Hemoglobin contains iron, which makes it an excellent vehicle
for transporting oxygen and carbon dioxide.
As blood passes through the lungs, oxygen molecules attach to
the hemoglobin.
When the blood passes through the body’s tissue, the
hemoglobin releases oxygen to the cells.
The empty hemoglobin molecules then bond with the tissue’s
carbon dioxide or other waste gasses to transport them away

8. Haemoglobin consists of four polypeptide sub-units; 2 alpha
chains and two beta chains each of which is a polypeptide
A polypeptide is a single linear chain of many amino acids
(any length), held together by amide bonds.
A protein consists of one or more polypeptides (more than about
50 amino acids long)
Polypeptides help make up proteins by bonding numerous
amino acids together.

Proteins are created by the bonding of two or more polypeptides,
which are then folded into a specific shape for a particular protein

9. Polypeptides help make up proteins by bonding numerous
amino acids together.
Proteins are created by the bonding of two or more polypeptides,
which are then folded into a specific shape for a particular protein
The sequence of amino acids comprising each type of
polypeptide chain, is determined by genes within DNA
Note 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.

11. The Haemoglobin has embedded with it, iron which permits the
molecule to bind (reversibly) with oxygen to transport the gas to
the different tissues.
It can be said that the chemical environment provided by the
polypeptides chains permits this reversible binding of oxygen to
the iron in Haemoglobin
Hemoglobin is produced in bone marrow by
erythrocytes and is circulated with them until their
destruction.
 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
Anemia—a 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 individual’s physiological need.
Over 273 million children under – five, suffer from anaemia
worldwide.
The 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. Iron deficiency is the most common micronutrient deficiency in
the world affecting 1.3 billion people i.e. 24% of the world
population.
In comparison only 275 million are iodine deficient and 45
million children below age 5 years are Vitamin A deficient.
 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

16. Risk of anemia using life cycle approach
Conception to birth
Birth – 2 years
6months – 5 years
School Age Children
Adolescents
Pregnant and lactating women
Adults especially people on blood thinners like asprin,wafarin
Elderly

17. Predisposing factors for anemia
Poor diet consistently low in iron and vitamins such as folate
which increase the risk of developing anaemia
Intestinal disorders that affect the absorption of nutrients in the
small intestine, such as Crohn's disease and Celiac disease
Menstrual disorders with increased blood loss — 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 cont’d
Pregnancy increases the risk of iron deficiency anaemia
because of increased blood volume during pregnancy, as
well as developmental demands from the growing foetus
Chronic conditions like cancer, kidney or liver failure and
rheumatoid arthritis increase the risk of developing
anaemia of chronic disease
Family history of inherited anaemia also increases the
risk of developing anaemia
Poor socio economic class

20. Causes of anemia
Increased requirements
Increased loss (blood loss, high rates of red blood cell
destruction)
Decreased intake (lack of red blood cell production)
Decreased absorption

21. Increased requirements of blood
Menstruating females
Pregnancy
Lactation
Growing infants and children
Erythropoietin

22. Persistent Hematuria
Regular blood donor
Parasitic infections
Menorrhagia is heavy or prolonged menstrual
bleeding. It is a common problem in women
Gastrointestinal bleeding (GI bleed), also called
gastrointestinal hemorrhage (GIB), is all forms of
bleeding in the gastrointestinal tract, from the
mouth to the rectum

23. Decreased intake
Vegetarian diet
Socio economic factors- examples

24. Decreased absorption
Upper pathology eg celiac disease, Crohn’s disease
Gastrectomy
Medications such as tetracyclines: antibiotics that include doxycycline
(vibramycin),minocycline (Minocin)and tetracycline
Quinolones:antibiotics that include ciprofloxacin(cipro),norfloxacin,and
levofloxacin(Levaquin)
Antacids ,*zantac* (ranitidine),Pepcid (famotidine), Tagamet
(cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole) and
Prilosec(omeprazole)

25. Types of anemia
Iron deficiency anaemia: the most common form of
anaemia that is caused by a deficiency of iron in the body
 Vitamin B12 and folate deficiency anaemia: also
known as megaloblastic anaemia
Anaemia 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
Aplastic 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 cont’d
Fanconi anemia is a rare disease passed down
through families (inherited) that mainly affects the
bone marrow.
It results in decreased production of all types of blood cells.
This is the most common inherited form of aplastic anemia.
Fanconi anemia is different from Fanconi syndrome, a rare
kidney disorder

27. Types of anemia cont’
Anaemia associated with bone marrow diseases,
such as leukaemia
Haemolytic anemia: this develops when red blood cells
are excessively destroyed.RBC plasma membrane raptures.
This may be due to parasites,toxins or antibodies.
Sickle 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 cont’
Haemorrhagic anaemia: excessive loss of RBCs through bleeding
stomach ulcers, menstruation, PPH etc.
Thalassemia : less synthesis of haemoglobin.
Found in the people found near Mediterranean sea
 Two major types of thalassemia
Alpha and Beta Alpha thalassemia: a condition in which the body does not
produce enough alpha globin (a component of hemoglobin).
 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?
Thalassemia occurs most frequently among people of Italian, Greek,
African, Southern Asian, and Middle Eastern descent
Treatment
The type of treatment a person receives depends on how severe the
thalassemia is.
The more severe the thalassemia, the less hemoglobin the body has,
and the more severe the anemia may be.
 One way to treat anemia is to provide the body with more red blood
cells to carry oxygen.
This can be done through a blood transfusion

30. Frequent blood transfusions can result in too much
iron in the blood called iron overload.
 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.
Iron overload can result in early death from organ
failure.

34. MCHC stands for mean corpuscular hemoglobin
concentration.
It's a measure of the average concentration of hemoglobin
inside a single red blood cell
Mean corpuscular volume (MCV) is the average size
(volume) of the red blood cells in body
A low MCV indicates that the red blood cells are small,
or microcytic
a high MCV level, their red blood cells are larger than
usual, and they have macrocytic anemia

37. Signs and symptoms of anemia

40. Signs and symptoms of anemia

42. Symptoms of anaemia caused by iron deficiency and
vitamin B12 deficiency

43. Assessment and diagnosis for anemia
 History taking
 Physical examination
 Laboratory investigations

44. History taking
Carefully obtain a history and perform a physical
examination in every patient with anemia, because the
findings usually provide important clues to the underlying
disorder.
From the standpoint of the investigation of the anemia,
asking questions in addition to those conventionally
explored during a routine examination is important
Duration of anemia can be established by obtaining a
history of previous blood studies and, if necessary, by
acquiring those records.

45. History taking con’t
History of rejection as a blood donor or prior
prescription of hematinics provides clues that anemia
was detected previously.
Careful family medical history
For women check for menstrual history , parity, child
spacing.
Occupation ,hobbies and previous medications

46. History taking con’t
Obviously, seek a careful history of gastrointestinal complaints
that may suggest gastritis, peptic ulcers, hiatal hernias, or
diverticula.
Abnormal urine color can occur in renal and hepatic disease
and in hemolytic anemia.
Dietary history must include foods that the patient eats and
those that he/she avoids, as well as an estimate of their quantity.
Specifically question patients regarding consumption of either

47. History taking con’t
Patients with iron deficiencies frequently chew or suck
ice (pagophagia).
 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.
In vitamin B-12 deficiency, early graying of the hair, a burning
sensation in the tongue, and a loss of proprioception

48. History taking con’t
Paresthesia or unusual sensations frequently described
as pain also occur in pernicious anemia.
The relation of dark urine to either physical activity or
time of day can be important in march hemoglobinuria
and paroxysmal nocturnal hemoglobinuria.
Explore the presence or the absence of symptoms
suggesting an underlying disease, such as cardiac,
hepatic, and renal disease; chronic infection;

50. Laboratory investigations
• List laboratory investigations for anemia

52. Anemia is a laboratory diagnosis
Men Women
Hemoglobin (g/dL) 14-17.4 12.3-15.3
Hematocrit (%) 42-50% 36-44%
RBC Count (106/mm3) 4.5-5.9 4.1-5.1
Reticulocytes 1.6 ± 0.5% 1.4 ± 0.5%
WBC (cells/mm3) ~4,000-11,000
MCV (fL) 80-96
MCH (pg/RBC) 30.4 ± 2.8
MCHC (g/dL of RBC) 34.4 ± 1.1
RDW (%) 11.7-14.5%

53. Laboratory investigations
For Iron Deficiency Anaemia (IDA)
Microcytic hypochromic anaemia
Low Hb level (< 11.0 g/dl)
Low MCV, MCH, MCHC
Low serum ferritin
High iron binding capacity
High erythrocyte protoporphyrin

54. Class activity
Outline interventions for anaemia prevention and control

55. Interventions for anaemia prevention and
control
Provision of micronutrient supplements to vulnerable
populations
Iron and folic acid (IFA) supplementation to pregnant
women.
Iron and Folic acid supplementation to adolescent girls
(age 10-19 years)
IFA for women of reproductive age (age 15-49 years
Vitamin A supplementation in children 6 – 59
months/6months to 5years)
Micronutrient powders (MNPs) for 6-23 months of age

56. Interventions for anaemia prevention and
control
Fortification of staple foods
Mass fortification of foods with iron and associated nutrients
for-example flour (wheat and maize etc.), salt, sugar, millet, fats
and oils, rice etc.
Bio-fortification of foods with iron and associated nutrients,
for-example (maize, beans and sweet potatoes)

57. Interventions for anaemia prevention and control
Disease control
Malaria: 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
Worm infestations: deworming in pregnancy and children1-14
years
Treatment of common conditions and infections that cause anaemia
Infectious diseases e.g.(HIV, T.B, diarrheal diseases, measles)

58. Interventions for anaemia prevention and control
Prevent childbirth (PPH) and trauma
NCDs (Cancer, Diabetes)
Drugs that cause anaemia
Screening and counselling for Genetic disorders
Diet Diversification
production and consumption of diverse foods rich in Iron and
other nutrients

59. Interventions for anaemia prevention and control
Importance of school and backyard gardens.
Infant & Young child feeding (IYCF)
• Early Initiation of Breastmilk within one hour of delivery
• exclusive breastfeeding (EBF) for the first 6 months
• Complementary feeding practices after 6 months of the infant’s
age while they continue breastfeeding for up to 2 years or
beyond.
• Delayed Cord Clamping of the baby between 1-3 minutes

60. Interventions for anaemia prevention and control
Water, Sanitation and Hygiene (WASH)interventions
Safe water supply
 Hygiene and sanitation facilities
Behavioural interventions to promote hygiene and use of
sanitation facilities
Prevention of environmental enteropathy/enteric
dysfunction (EED)

61. Interventions for anaemia prevention and control
This should be done across all interventions
Strengthening 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.
Policy and legal framework, guidelines and information on
anaemia prevention and control

62. Class activity
• Summarize what we have covered today

63. • Janz TG, Johnson RL, Rubenstein SD (November 2013). "Anemia in the
emergency department: evaluation and treatment". Emergency
Medicine Practice. 15 (11): 1–15, quiz 15–16. PMID 24716235.
Archived from the original on 2016-10-18
•What Is Anemia? – NHLBI, NIH". www.nhlbi.nih.gov. Archived
from the original on 2016-01-20. Retrieved 2016-01-31.
•Stedman's medical Dictionary (28th ed.). Philadelphia: Lippincott
Williams & Wilkins. 2006. p. Anemia. ISBN 978-0-7817-3390-8.