3. Definition. Anaemia is present when the haemoglobin level in
the blood is below the lower extreme of the normal range for the
age and sex of the individual. Classification of Anaemia. 1.
Morphological 2. Etiological (causes)
4. Based on morphology of red cell on stained blood films and
red cell size. 1. Macrocytic 2. Microcytic 3. Normocytic
5. a)Macrocytic (Megaloblastic Anaemia) Vit B12 deficiency
Folic acid deficiency Drug induced disorder of DNA synthesis
6. Microcytic Iron deficiency anaemia Deficiency of globin
synthesis
8. Based on etiological classification. I. Anaemia due to
impaired red cell production. II. Based on increased destruction of
RBCs
9. a) Deficiency of essential nutrients. 1) Fe 2) Vit B12 3)
Folic acid 4) Vit C I. Anaemia due to impaired red cell
production.
10. b) Defect in stem cell / erythroid precursor. 1) Aplastic
anaemia 2) Red cell aplasia c) Infiltration of bone marrow. 1)
Leukemia 2) Multiple myeloma 3) Carcinoma
12. II. Based on increased destruction of RBCs. A) Intra
corpuscular disease. B) Extra corpuscular disease. Intra
corpuscular disease 1) Hereditary. a) Enzyme deficiency # G6PD
deficiency. # Pyruvate kinase.
13. b) Membrane defect. # Hereditary spherocytosis. #
Hereditary ovalocytosis. c) Hb abnormalities. #
Haemoglobinopathies. # Sickle syndrome. # Thalassemia.
15. PATHOPHYSIOLOGY. Loss of blood. Excessive mature red cell
destruction. Impaired red cell production.
16. Clinical features Depending upon the Hb level the signs and
symptoms of anaemia is of 4 main factors; The speed of onset of
anaemia: Rapidly progressive anaemia causes more symptoms than
anaemia of slow- onset as there is less time for physiologic
adaptation. The severity of anaemia: Mild anaemia produces no
symptoms or signs but a rapidly developing severe anaemia (Hb below
6.0 g/dl ) may produce significant clinical features. The age of
the patient: The young patients due to good cardiovascular
compensation tolerate anaemia quite well as compared to the
elderly, due to associated cardio vascular disease.
17. The Hb dissociation : In anaemia the affinity of Hb for O2
is depressed. As a result, oxyhaemoglobin is dissociated more
readily to release free O2 for cellular use. SYMPTOMS: Tiredness,
easy fatigability, generalised muscular weakness, lethargy and
headache. In older patients: Cardiac failure, angina pectoris,
confusion and visual disturbances.
18. Signs 1. Pallor: Pallor is the most common and
characteristic sign which may be seen in the mucous membranes,
conjunctiva, nail & skin. 2. Cardiovascular system: A hyper
dynamic circulation may be present with tachycardia, collapsing
pulse, cardiomegaly, dyspnoea on exertion and in the case of
elderly congestive heart failure. 3. Central nervous system: The
older patients may develop symptoms referable to the CNS such as
attacks of faintness, giddiness, headache, drowsiness, numbness and
tingling sensations of the hands and feet.
19. 4) Ocular manifestations: Retinal haemorrhages may occur if
there is associated vascular disease or bleeding diathesis. 5)
Reproductive system: Menstrual disturbances such as amenorrhea and
menorrhagia 6) Renal system: Mild proteinuria and impaired
concentrating capacity of the kidney may occur in severe anaemia 7)
Gastrointestinal system: Anorexia, flatulence, nausea, constipation
and weight loss may occur.
20. Investigations Full medical history, signs and symptoms is
examined for evidence of anaemia. Colour of skin, conjunctivae,
scleral and nails. Changes in retina. Atrophy of the papillae of
tongue, rectal examination for evidence of bleeding. Presence of
hepatomegaly, splenomegaly, lymphadenopathy and bony tenderness are
looked for.
21. A. Hb estimation: Hb value below the lower limit of the
normal range for particular age and sex the patient is said to be
anaemic. In pregnancy, there is haemodilution and the lower limit
in normal pregnant women is less ( 10.5 g/dl ) than in the non
pregnant state. B. Peripheral blood film examination: Romanowsky
dyes. The blood smear is examined for
22. 1) Variation in size (Anisocytosis ) Normal 6.7 7.7 m (
mean value 7.2 m ) Increased variation in size of red cell
anisocytosis. Macrocytosis cells larger than normal. Microcytosis
cells smaller than normal. Dimorphic both microcytosis and
macrocytosis.
23. 2. Variation in shape (Poikilocytosis) - Increased
variation in shape of the red cells. - Abnormal shape determines
the cause of anaemia. 3. Inadequate haemoglobin
formation.(Hypochromasia) - Normally the intensity of pink staining
of Hb in a Romanowsky stained blood smear gradually decreases from
the periphery to the centre of the cell.
24. Increased central pallor - Hypochromasia. - lowered Hb
content. [ Eg: IDA, Chronic infections] - due to thinness of red
cells. [ Eg: Thalassemia ] Deep pink staining of red cells due to
increased Hb concentration. - Hyperchromasia. - Eg: Megaloblastic
anaemia. Spherocytosis.
25. 4. Compensatory erythropoiesis : Changes are associated
with compensatory increase in erythropoietic activity. a)
Polychromasia - Red cells having more than one type of colour.
Polychromatic red cells are slightly larger, stained bluish- grey.
b) Erythroblastaemia Presence of nucleated red cells in the
peripheral blood film. This appears in various types of severe
anaemias except in aplastic anaemia.
26. c) Basophilic stippling. Is diffuse and uniform basophilic
granularity in the cells. Classical punctate basophilia is seen in
: - Aplastic Anaemia. - Thalassemia. - Myelodysplasia. - Infections
& Lead poisoning. d) Howell Jolly bodies. Purple nuclear
remnants usually found singly and are larger than basophilic
stippling. Eg: Megaloblastic Anaemia.
27. 5) Miscellaneous changes. a) Spherocytosis : Presence of
spheroidal rather than biconcave disc-shaped red cells. Seen in -
Hereditary spherocytosis. Autoimmune Haemolytic anaemia. ABO
Haemolytic disease of newborn. b) Schistocytosis : Fragments of
erythrocytes. Seen in - Thalassemia. Megaloblastic anaemia. Iron
deficiency anaemia. Haemolytic anaemia.
28. c) Irregularily contracted red cells. - Found in drug and
chemical induced haemolytic anaemia. d) Leptocytosis. - Presence of
unusually thin red cells. Eg: Iron deficiency anaemia,Thalassemia.
Target cell : Form of leptocyte. - There will be a central round
stained area & a peripheral rim of Hb. Eg: Iron deficiency
anaemia. Thalassemia.
29. e) Sickle cells / Drepanocytes. Sickle - shaped red cells
found in sickle cell disease. f) Crenated red cells. Erythrocytes
which develop numerous projections from the surface. g)
Acanthocytosis. Presence of coarsely crenated red cells. Eg:
Splenectomised subject. Chronic liver disease. h) Burr cells. Cell
fragments having one/ more spines.
31. i) Stomatocyctosis. Central area having slit-like or mouth
like appearance. - Chronic alcoholism. - Hereditary stomatocytosis.
j) Ovalocytosis or elliptocytosis: Oval or elliptical shape of red
cells. - Megaloblastic anaemia - Hypochromic anaemia.
32. C) Red cell indices. Iron deficiency & Thalassemia -
MCV, MCH, & MCHC are reduced. In anaemia due to acute blood
loss & haemolytic anaemia - MCV, MCH & MCHC are all within
normal range. In megaloblastic anaemias - MCV is raised above the
normal range.
33. D) Leucocytes and platelet count. This helps to distinguish
pure anaemia from pancytopenia in which red cells, granulocytes and
platelets are all reduced. In anaemia due to haemolysis or
haemorrhage - neutrophil , platelet counts are elevated. In
infection and leukemias leukocytes are high and immature leukocytes
appears in the blood.
34. E) Reticulocyte count. Normal : 0.5 2.5 % It is done to
assess the marrow erythropoietic activity. In acute haemorrhage
& haemolysis the reticulocyte response is indicative of
impaired marrow function. F) Bone marrow examination.
35. G) Erythrocyte sedimentation rate. ESR is a non specific
test. Screening test for anaemia. Anaemia cause rise in ESR
level.