Anaemia
What is anaemia?
Anaemia is decrease of Hb for that age and sex.
Can be different reasons.
Clinical features
Fatigue, Headache, Faintness, Breathlessness,
Pallor, tachycardia, murmurs, …
Classification
Different types of classifications
Depend on red cell indices
Cause
Depend on MCV
Hypochromic microcytic – low MCV <80fl
Normochromic normocytic – normal MCV
Macrocytic – Large MVC >96fl
Microcytes
Iron deficiency
Thalassaemia
Anaemia of chronic disease
Siderobalstic anaemia
Macrocytes
Two subtypes
Megaloblastic – Vit B12 deficiency
Normoblastic – Liver disease, alcohol, haemolysis.
Normocytes
Acute blood loss
Anaemia of chronic disease
Infection
Collagen diseases
Malignancy
Endocrine disease
Iron deficiency anaemia
Commonest cause of anaemia.
Limited absorption ability.
Increase loss due to haemorrhage.
Iron absorption
Duodenum & jejunum
Affect several factors.
Iron requirement
Iron store in reticuloendothelial cells, hepatocytes, skeletal muscles.
Ferritin is water soluble form – found in plasma.
Haemosiderin is iron/protein complex – found in bone marrow, liver, spleen.
Need
0.5-1mg/day due to loss faeces, urine, sweat.
Menstruating woman (40ml blood loss) 0.7mg/day.
Pregnancy – 1-2mg/day
Causes for iron deficiency anaemia
Blood loss – hookworm, menstrual loss.
Increase demand – pregnancy, growth.
Decreased absorption – postgastrectomy.
Poor intake.
Clinical feature
Common feature for anameas.
Koilonychia –spoon-shaped nails.
Angular stomatitis.
Treatment
Oral iron
IV iron
Treat the cause.
Anaemia of Chronic disease
A microcytic or normocytic.
Due to chronic disease
Tuberculosis
Osteomyelits
SLE, Rheumatoid arthritis,
Malignant disease
Anaemia of Chronic disease
It can be due to
Decrease release of iron from born marrow to developing erythroblasts.
Inadequate erythropoietin response to anaemia.
Decreased red cell survival.
Other Microcytic anamias
Siderobastic anaemia –
Inheritrd or acquired
Ring siderblasts in bone marrow
Lead poisoning
Lead inhibit some enzymes involved in haem synthesis.
Thalassaemia trait.
Normocytic anaemia
Can be seen in
Anaemia of chronic disease.
Some endocrine disorder – hypothyroidism, hypoadrenalism, hypopituitarism.
Aplastic anaemia
Macrocytic anaemia
Megaloblastic anaemia
Macrocytic but no megaloblasts.
Alcohol excess, Liver disease,
Pregnancy, New born.
Megaloblastic anaemia
Megaloblasts in bone marrow.
Delay in nuclear maturation.
Due to
Vit B12 deficiency
Folate deficiency
Vitamin B12 deficiency
Pernicious anaemia – intrinsic factors deficiency.
Malabsorbtion of vit B12 due different causes.
Low dietary intake.
Pernicious anaemia
Intrinsic factor secret from gastric mucosa.
Gastric mucosal atrophy.
Common in elderly.
Aplastic anaemia
Bone marrow failure.
Cause –
Congenital
Chemical, drugs, radiation.
Haemolytic anaemia
Increase RBC destruction.
Red cells are removed in reticuloendothelial system.
Different causes.
Haemolytic anaemia
Inherited haemolytic anaemias
Hereditary spherocytosis
Hereditary elliptocytosis
Haemoglobin abnormalities – Thalassaemia, Sickle cell anaemia
Acquired haemolytic anaemia
Autoimmune haemolytic anaemia