ANEMIA

Anemia decreases oxygen-carrying capacity

of blood, it is usually expressed in terms of
hemoglobin concentration of blood, and the
clinical features of anemia are primarily due
to tissue hypoxia and hypoxia-induced
compensatory mechanisms.
Anemia is defined as decreased red cell count
or hemoglobin content of blood.
1. Detection of anemia is usually performed
by estimating hemoglobin content of blood.
2. It can also be done by performing either
total RBC count of blood or by estimating
packed cell volume (hematocrit).
3. Clinically, anemia is detected by assessing
the degree of paleness usually by looking at
the lower palpebral conjunctiva or nail beds.
4. Detection of morphological type of anemia
depends on various blood indices.
Anemias can be classified either
morphologically or etiologically.
Common causes of anemia are:
1. Inadequate supply of nutrients resulting in
deficiency anemias (deficiency of iron,
vitamins and proteins).
2. Aplasia of bone marrow.
3. Anemia associated with chronic diseases.
4. Anemia associated with renal failure
5. Anemia due to inherited diseases (e.g.
thalassemia)
6. Anemia due to blood loss.
MORPHOLOGICAL CLASSIFICATION
Morphologically, anemia are classified into
hypochromic microcytic,
normochromic,
microcytic and macrocytic normochromic
types
 Hypochromic Microcytic Anemia: MCV,
MCH, and MCHC are below normal.
Such subnormal red cell indices correspond
to microcytosis and hypochromia of red
cells in the blood film.
Micronormoblasts are seen in bone marrow
examination.
This occurs due to the result of a defect in
red cell formation in which hemoglobin
synthesis is impaired to a great extent.
The common examples are:
i. Iron-deficiency anemia in which there is
inadequate iron for the formation of the heme
component of the hemoglobin, and
ii. Thalassemia in which the formation of the
globin component of hemoglobin is defective.
 Normochromic Normocytic Anemia:
MCV, MCH, and MCHC are within the normal
range.
Size and hemoglobin concentration of the red
cells are normal in the blood film.
It usually occurs in following conditions:
i. Substantial blood loss(blood loss anemia),
ii. Hemolysis (hemolytic anemia) and
iii. Impairment of red cell production by bone
marrow failure or chronic renal failure (aplastic
anemia).
 Macrocytic Normochromic Anemia:
The MCV is above the upper limit of the normal.
It corresponds to macrocytosis of red cells in the
blood film.
The red cells are usually normochromic, though
they are macrocytic.
Megaloblasts are seen in bone marrow
examination.
The typical example of this type of anemia is
megaloblastic anemia that occurs due to
deficiency of vitamin B12 or folic acid.
ETIOLOGICAL CLASSIFICATION
1)Blood Loss Anemia: Anemia due to blood
loss mainly occurs due to acute hemorrhage or
chronic hemorrhage.
Acute hemorrhage: Anemia due to acute
hemorrhage depends on the extent of blood
loss and the time that has lapsed since
bleeding.
1. In acute blood loss, usually there is a
reduction in the total blood volume. Therefore,
hemoglobin in the residual blood is normal.
2. However, when the compensatory
mechanisms set in to expand the blood
volume, hemodilution decreases hemoglobin
content.
3. Therefore, estimation of hemoglobin after
few hours of acute blood loss does not assess
the actual degree of anemia.
Chronic hemorrhage: Chronic hemorrhage
occurs mainly in gastrointestinal,
genitourinary and respiratory tract diseases.
1. Gastrointestinal blood loss: Peptic ulcer,
hemorrhoids, hiatus hernia, carcinoma of the
stomach and colon, esophageal varices,
chronic aspirin ingestion, ulcerative colitis,
hookworm infestation, etc.
2. Respiratory diseases: Respiratory diseases
that produce epistaxis, hemoptysis as occurs
in pulmonary tuberculosis or bronchogenic
carcinoma produce anemia.
3. Genitourinary diseases: Diseases that
cause hematuria and hemoglobinuria produce
anemia.
4. Diseases of genital tract: In females, loss of
blood from genital tract like menstrual
disorders (menorrhagia,metrorrhagia) and
uterine pathologies produce anemia.
 2)Aplastic Anemia
Aplastic anemia is the anemia due to
impaired red cell production.
Marrow examination shows a near absence of
hematopoietic precursor cells.
 3)Hemolytic Anemia
Hemolytic anemia results from increase in
the rate of red cell destruction.
Defects causing premature red cell
destruction may be divided into two broad
categories:
intracorpuscular, and extracorpuscular
COMMON ANEMIAS
Iron-deficiency Anemia (IDA)
This is the commonest form of anemia in the
developing countries.
 It usually occurs due to deficiency of iron in
the diet. There are three major factors in the
pathogenesis of IDA.
1. Increased physiological demand for iron as
occurs in pregnancy, lactation, growing
children. Therefore, in these groups, extra iron
should be available in the diet; otherwise IDA
occurs.
2. Inadequate iron intake, as occurs due to
deficiency in the diet.
3. Pathological blood loss like bleeding peptic
ulcer, piles, worm infestations, epistaxis,
hemoptysis etc.
Anemia of IDA is microcytic hypochromic type.
Laboratory findings are decreased all blood
indices (MCV, MCH and MCHC), microcytic
hypochromic cells in blood smear and
micronormoblasts in bone marrow, and
decreased marrow iron store.
 Hereditary Spherocytosis:
This is a hemolytic anemia in which the
fundamental abnormality is the increased
defect of red cell membrane (due to decreased
quantity of spectrin) that results in spherocytic
shape of the cell.
Spherocytes have a decreased surface area to
volume ratio and the cells are more rigid (less
deformable).
Therefore, when cells pass through the splenic
pulp, they are destroyed.
1. This is an autosomal dominant disorder which
affects males and females equally.
2. The usual features are anemia, jaundice,
enlarged spleen, and may present with gall stone.
3. The blood picture typically shows anemia with
spherocytosis, increased osmotic fragility,
hyperbilirubinemia, and reticulocytosis.
4. Usually, anemia is normocytic and
normochromic.
5. Splenectomy helps in improving the condition.
 Sickle-cell Anemia
This is a hereditary disorder in which red cells
contain an abnormal hemoglobin called Hb S.
Hb S is the hemoglobin in which glutamic acid is
replaced by valine at the 6th position of beta chain.
In the deoxygenated state, conformational changes
induced by Hb S makes the cell more rigid and
deformed to take the shape of a sickle.
Therefore, cells undergo intravascular hemolysis.
 Thalassemia
Thalassemia is a genetically determined
heterogenous group of commonest monogenic
disorder in which the rate of synthesis of one or
more types of hemoglobin polypeptide chain is
decreased.
Thus, there are two major classes of thalassemia:
α thalassemia and β thalassemia, in which α and
β globin genes are involved respectively.
This causes decrease in the respective
polypeptide chain of hemoglobin.
 β thalassemia:
In β thalassemia (failure to synthesize β chain),
which is more common, there is excess α chain
production that damages red cell precursor
and red cells.
1. There are many homozygous and
heterozygous, and major and minor forms of
the disease.
2. In β thalassemia major, anemia develops in
first few months of life and becomes
progressively severe.
3. Splenomegaly, hepatomegaly and skeletal
deformities are common.
4. Though anemia is usually microcytic and
hypochromic, all forms and combinations are
not uncommon.
 α-thalassemia
Anemia of α-thalassemia (failure to
synthesize α chain) is more hemolytic than
dyserythropoietic.