Anemia is a decreased level of red blood cells or hemoglobin in the blood, causing hypoxia in tissues. It is usually diagnosed based on decreased hematocrit and hemoglobin levels. There are three main types of anemia characterized by red blood cell size: normocytic, microcytic, and macrocytic. Microcytic anemia is caused by disorders of hemoglobin synthesis or iron deficiency, while macrocytic anemia results from bone marrow abnormalities. Symptoms of anemia include paleness of the skin, eyes, weakness, and fatigue. Anemia can be caused by blood loss, disorders of red blood cell production or destruction, or nutritional deficiencies such as iron or vitamin B12/folate.

1. Anemia
Anemia; is a decreased red blood cells and deficiency in oxygen and body tissues hypoxia.
•
Anemia is usually diagnosed with a decrease in Hematocrit and Hemoglobin values.
•
Three types red cell size; Normocytic (Hypochromic), Microcytic, Macrocytic
•
Microcytic hypochromic anemias are caused by disorders; Hemoglobin synthesis and iron deficiency
•
Macrocytic Anemia abnormalities in Bone marrow
•
Clinical findings:
Eyes; Yellowing
•
Central; Fainting
•
Muscular; Weakness
•
Heart; Heart Attack
•
Skin; Yellowing
•
Anemias of Blood loss
1) Acute blood loss; occurs due to loss of intravascular blood volume; may result in shock and/or death.
•
Symptoms; tachycardia, Hypotension
•
2) chronic blood loss; occurs when iron reserves and iron deficiency are depleted
•
Symptoms; weakness and Anorexia
•
Hemolytic anemias
A shortened life span (
•
Elevated erythropoietin with increased erythropoiesis
•
Accumulation of hemoglobin (Process of red cell hemolysis)
•
1) Extravascular hemolysis; occurs in macrophages of the spleen.
•
Clinical; Anemia, splenomegaly and Jaundice
•
2) Intravascular hemolysis; occurs when red blood cells are ruptured by mechanical injury,
•
complement fixation, intracellular parasites or extracellular toxins.
Clinical;Anemia, hemoglobinemia and Jaundice. splenomegaly Is not seen.
•

2. causes of Hemolytic anemia;
Hereditary Spherocytosis; is caused by cytoskeletal or red cell membrane protein defects.(morp;
•
central zone of pallor, splenomegaly,)
Glucose-6-phosphate dehydrogenase; This enzyme functions in the hexose monophosphate
•
shunt or glutathione metabolism to reduce NAPD to NADPH with against oxidative injury.
Sickle Cell Disease; This is a hereditary hemoglobinopathy resulting from substitution of valine
•
for glutamic acid at the sixth position of the Beta-globin to generate HbS. (Chronic hemolysis ,microvascular
occlusion and Tissue damage).
Morphology; target cells, reticulocytosis.
•
Clinic; reticulocytosis, hyperbilirubinemia, hemolytic anemia (Lung, bones, liver, brain, spleen)
•
Symptoms; anemia, renal disease, eye involvement, bone marrow, leg ulcers, GI tract symptoms
•
Thalassemia Syndromes; it is a heterogeneous group of inherited disorders caused by
•
mutations that reduce alpha or beta global chain synthesis. (Chromosome 16 and Chromosomes 11)
Beta thalassemia; are characterized by deficient synthesis of which global B.
•
Beta-thalassemia major; manifests between 6-9 months after birth as hemoglobin synthesis moves
•
from HbF to HbA.
Beta thalassemia minor; heterozygotes are usually asymptomatic due to sufficient Beta global
•
synthesis.
Beta thalassemia intermedia;
•
Alpha thalassemia; is due to reduced alpha global synthesis; gene deletion is the most
•
common genetic cause.

3. Silent carrier state; has one deletion.
•
Alpha thalassemia trait; has two deletions
•
hemoglobin H disease; has three deletions
•
Hydrops fetalis; has 4 deletions
•
Immunohemolytic anemias; is caused by antibodies that bind to red blood cells and
•
cause their premature destruction.
Warm antibody type; Most commonly, immunoglobulin G (IgG) anti-RBC antibodies coat the RBC and
•
act as opsonins, and are eventually destroyed completely in the spleen.(systemic lupus, lymphoid neoplasms)
Cold agglutinin type; is caused by IgM antibodies that agglutinate RBCs at low temperatures. It can be
•
acute (viral etiology) or chronic (setting of B-cell neoplasms).
Cold hemolysin type; occurs in paroxysmal cold hemoglobinuria and is capable of causing substantial
•
intravascular hemolysis.(IgG) (viral infection)
trauma; Prosthetic heart valves - mechanical prosthetics, Microangiopathic hemolytic anemia with diffuse
•
microvascular narrowing owing to fibrin or platelet deposition.
anemias of diminished eryropoiesis; Megaloblastic anemias, Iron Deficiency anemia, Anemia of
•
Chronic disease, Pure Red Cell aplasia, Other forms of marrow failure
Megaloblastic anemias; is due to a deficiency of vitamin B12 or folate and results in
•
abnormally large RBCs and erythroid precursors (megaloblasts).
Anemias vitamin B12 deficiency; Pernicious anemia so caused by autoimmune gastritis and
•
attendant loss of intrinsic factor production.
Atrophic glossitis; (shiny, glazed, red tongue), and a virtual absence of parietal cells. ( pale skin, memory
•
loss, Depression, muscle weakness)
Achlorhydia - impairs vitamin B12 release from R bindersj, Gasterectomy - causes loss of intrinsic factor,
•
Pernicious anemia, Resection is distal ileum - prevents intrinsic factor-vitamin B12 absorption, Malabsorption
syndromes, Increased requirements - pregnancy
Anemia of Folate Deficiency; Deficiency induces a megaloblastic anemia hematological
•
indistinguishable from that seen in B12 deficiency; gastric atrophy and CNS defects do not occur
Causes; decreased intake, increased requirements, impaired utilization.
•
Neural tube defects; Malformations of brain and spinal cord , Occurs early in uterine development.
•

4. Causes; Genetic and environmental components and Folic acid.
•
Types; Encephalocele, Anencephaly, Spina Bifida)
•