Classification of Anaemia Etiology, clinical features and Laboratory diagnosis of Iron deficiency anaemia

1. PRESENTED BY:
RITIKA BAJRACHARYA

2. CONTENT
1. INTRODUCTION
2. CLASSIFICATION OF ANEMIA
3. IRON DEFICIENCY ANEMIA
4. REGULATION OF IRON ABSORPTION
5. IRON BALANCE
6. PATHOPHYSIOLOGY
7. ETIOLOGY
8. CLINICAL FEATURES
9. LABORATORY FINDINGS
10. DIFFERENTIAL DIAGNOSIS OF HYPOCHROMIC ANEMIA
11. SUMMARY
12. REFERENCE

3. INTRODUCTION
• Anemia is defined as qualitative or quantitative
diminution of RBC and/or haemoglobin
concentration in relation to standard age and sex,
clinically manifested by pallor.
• Anemia refers to a state in which the level of
haemoglobin in the blood/ hematocrit is below the
reference range appropriate for age and sex.

4. ETIOLOGICAL CLASSIFICATION
A. Blood Loss:
• Acute: Trauma
• Chronic: GI lesion, gynaecological disturbances
• B. Increased Destruction ( Hemolytic anemia):
• 1. Intrinsic abnormalities ( Intracorpuscular)
• Hereditary
• Membrane abnormalities :
• -Membrane skeleton proteins: spherocytosis,
ellipticytosis

5. • - Membrane lipids: abetalipoprotinemia
• Red cell enzyme deficiency: G6PD, Pyruvate kinase, Hexokinase
• Hb synthesis disorders
• Acquired membrane defect: paraoxysmal nocturnal
hemoglobinuria
• 2.Extrinsic abnormalities ( Extracorpuscular):
• Antibody mediated: Isohemagglutinins : transfusion reactions,
erythroblastosis fetalis
• Mechanical trauma
• Infection: Malaria, Hookworm
• Chemical injury: Lead poisoning
• Splenomegaly

6. • C. Impaired Red Cell Production:
• Stem cell defects ( proliferation and differentiation) : Aplastic
anemia, pure red cell aplasia
• Disturbed proliferation and maturation of erythroblast
• - Defective DNA synthesis: Vit B12 / folic acid deficiency
( megaloblastic anemia)
• - Defective hemoglobin synthesis: Defective heme
synthesis ( Iron deficiency anemia), defective globin
synthesis ( thalassemia)
• Unknown or multiple mechanisms: sideroblastic anemia,
anemia of chronic infection and myelophthisic anemiasdue
to marrow infiltrations of tumors.

7. MORPHOLOGICAL
CLASSIFICATION

8. IRON DEFICIENCY ANEMIA
• An anemia with increased red cell production and an MCV
<80fl characterized by hypochromic cells and low levels of
stored iron in the body.
• Most common nutritional disorder in the world.

9. REGULATION OF IRON
ABSORPTION

10. IRON BALANCE
• Normal iron content of the body
- 3-4g ( Hb, myoglobin, cytochromes)
• Iron is best absorb as ferrous ( Fe2) form in the
duodenum, and to a smaller extent in jejunum.
• Daily recommended allowance:
Adult male/ post- menopausal females: 8 mg
Menstruating female: 18 mg

11. • Iron sources:
Heme iron( 2-3 times absorbable ) :meat, fish and
poultry
Non- heme iron: vegetable , fruits, dried beans,
nuts, grain products and dairy supplements
• Gastric acid/ ascorbic acid increases non- heme iron
absorption whereas phytates ( in brain), tannins (in
tea), calcium (in dairy products ) forms insoluble
complexes.

12. PATHOPHYSIOLOGY
Initial stage ( Storage iron depletion):
• Iron stores reduced without reducing serum iron levels
and can be accessed with serum ferritin measurement .
• Iron stores can be depleted without causing anemia
( Once iron stores are depleted, there still is adequate iron
from daily RBC turnover for Hb synthesis )

13. Second stage ( Iron deficient erythropoiesis):
• Iron deficiency occurs, Hb falls just above the lower
limit normal.
Third stage ( Frank iron deficiency anemia):
Considered as IDA and occurs because of Hb falls to
less than normal values .

14. Stages of development of iron
deficiency anemia

15. ETIOLOGY
1. Increased demand for iron or hematopoiesis:
• Rapid growth in infancy and puberty
• Pregnancy
• Lactation
• Erythropoietin therapy
2.Increased iron loss:
• Chronic blood loss Eg. Occult gastric or colorectal malignancy, peptic
ulceration, IBD, polyps, Hookworm infestation
• Acute blood loss Eg .trauma, menstrual blood loss
• Phlebotomy for the treatment of polycythemia vera

16. 3. Decreased iron intake or absorption:
• Inadequate diet
• Malabsorption from the disease: celiac disease,
tropical sprue, Crohn's disease
• Malabsorption from surgery: post gastrectomy
• Acute or chronic inflammation
• High level inhibitors ( phylates or PPIs)

17. CLINICAL FEATURES
Symptoms:
• Fatigue
• Headaches
• Breathlessness
• Faintness
• Angina
• Intermittent claudication
• Palpitations
• Reduced exercise capacity

18. Signs:
• Pallor
• Tachycardia
• Systolic flow murmur
• Cardiac failure
• Rarely papilloedema and retinal haemorrhages after
an acute bleed ( can be accompanied by blindness)

19. FEATURES OF IRON DEFICIENCY
1. Cheilosis: Features at corner of mouth
Brittle nails Koilonychia Glossitis

20. 1. Plummer Vinson Syndrome (Paterson-kelly):
Chronic iron deficiency anemia + Glossitis +
Dysphagia
Brittle hair Pica

21. LABORATORY FINDINGS
1. Peripheral blood smear:
Hematologic Indices Normal Range IDA
Hb 70-160 g/L Low
Mean corpuscular
volume (MCV)
75-95 fl. Low
Mean corpuscular
hemoglobin ( MCH)
24-30pg Low
Hematocrit 0.320-0.47 L/L Low
Mean corpuscular
hemoglobin
concentration (MCHC)
290-370g /L Low
Red cell distribution
width (RDW)
11-15% High(early)

22. • Red cells:
a. Hypochromic, Microcytic ( increased central pallor)
b. Anisocytosis and poikilocytosis
c. Target cells, elliptical forms and polychromatic cells
present.
• Reticulocyte:
a. Normal or decreased, but increased after
haemorrhage.
• Platelets: normal but decreased after bleeding

23. IRON PROFILE (BIOCHEMICAL
FINDINGS)

24. BONE MARROW FINDINGS
• Done only in complicated cases
a. Marrow cellularity: Increased
b. Myeloid: erythroid ratio decreased
c. Erythropoiesis: normoblastic with mainly small
polychromatic normoblast
d. Megakaryocytic cells, Myeloid, lymphoid cells :
normal
e. Marrow iron: decrease

25. DIFFERENTIAL DIAGNOSIS OF
HYPOCHROMIC ANEMIA

26. SUMMARY

27. REFERENCE
 N.Beck: Diagnostic Hematology (2009), Springer
Science and Business Media, London.
 F.Firkin, C.Chesterman, D.Penington and B.Rush: de
Gruchy's Clinical Hematology in Medical Practice ( 5th
Ed) 1989, Oxford University Press, Delhi
Vinay Kumar, Abul K. Abbas, Jon C. Aster: Robbins Basic
Pathology ( 9 Ed) 2013, Elsevier Inc., India.