DEFINING ANEMIA

Anemia is defined by a decrease in the number of red blood cells as measured by RBC count,
hemoglobin level, or hematocrit.1

Normal Hb levels are 12 to 18 g/dL of blood. There is a slight variation between genders for Hb levels with adult men
typically being in the range of 13 to 17 g/dL, whereas adult women have a slightly lower range of 12 to 16
g/dL.2 Classification of the severity of anemia is provided by the US Department of Health and Human Services and
is shown in the Common Terminolgy Criteria for Adverse Events (CTCAE) table below.

Anemia is the most common blood condition in the United States, affecting approximately 3.5 million
Americans.3 There are multiple types of anemia with multiple causes, and with the exception of those developing as a
result of acute or chronic hemorrhage, anemias can be categorized as hypoproliferative or hyperproliferative.4
Categories of anemia:
 •In hypoproliferative anemias, there is an inability to produce an adequate number of erythrocytes
in response to the appropriate stimulus.4
 •In hyperproliferative anemias, the bone marrow is consistently producing RBCs, but they are
destroyed in the periphery at a rate that is beyond the capacity of the bone marrow to replace.5
 •Loss of blood causes a consequent reduction in the oxygen carrying ability of the blood.4

Nugroho BS. dr. SpPD. FINASIM 1

SIGNS AND SYMPTOMS OF ANEMIA
Anemia may affect multiple biological systems.1,2
Note that some of these symptoms have only been reported in anemia due to specific causes

Neurological
•Fatigue
•Headaches, dizziness, vertigo
•Depression
•Difficulty Sleeping
•Sleep disturbances

Cardiorespiratory
•Tachycardia, palpitations
•Increased pulse pressure, systolic ejection murmur
•Orthostatic hypotension
•Dyspnea
•Cold intolerance

Immune system
•Impaired T-cell and macrophage function

GI system
•Anorexia
•Nausea

Vascular system
•Low skin temperature
•Pallor of skin, mucous membranes, and conjunctiva

Genital tract
•Loss of libido
•Menstrual problems

Many individuals with mild anemia will have no complaints and be

unaware that they are anemic. Others may complain of symptoms
such as shortness of breath or fatigue, especially with exercise.

Nugroho BS. dr. SpPD. FINASIM 2

 Patients with severe anemia are often symptomatic at rest. When signs and symptoms of anemia occur, the most
commonly observed include pallor of the skin and mucous membranes, soft systolic murmurs, palpitations of the
heart, dyspnea (shortness of breath), lethargy, and fatigability.3,4

How anemia can lead to symptoms1,5

 Decrease in RBC, Hb, or Hct level

 Diminished O2-carrying capacity
 Hypoxia and hypoxia-induced
effects on organ function
 Signs and symptoms of anemia

RBC = red blood cell

Hb = hemoglobin
Hct = hematocrit
O2 = oxygen

CAUSES OF ANEMIA

Classifications of anemia:
 •In hypoproliferative anemias, there is an inability to produce an adequate number of erythrocytes in
response to the appropriate stimulus.1
 •In hyperproliferative anemias, the bone marrow is consistently producing RBCs, but they are destroyed in
the periphery at a rate that is beyond the capacity of the bone marrow to replace.2
 •Loss of blood causes a consequent reduction in the oxygen carrying ability of the blood.1

Nugroho BS. dr. SpPD. FINASIM 3

Nugroho BS. dr. SpPD. FINASIM 4
Nugroho BS. dr. SpPD. FINASIM 5
Nugroho BS. dr. SpPD. FINASIM 6
Nugroho BS. dr. SpPD. FINASIM 7
Nugroho BS. dr. SpPD. FINASIM 8
Nugroho BS. dr. SpPD. FINASIM 9
Nugroho BS. dr. SpPD. FINASIM 10
Penatalaksanaan

 Keberhasilan pengobatan sangat tergantung pada kemampuan untuk

menegakkan diagnosis pada tingkat awal.
 Anemia pascaperdarahan diatasi dengan transfusi darah sebanyak 10 –
20ml/kgBB, atau plasma expander. Bila tak ada keduanya, cairan intravena lainnya
juga dapat digunakan.
 Dampak lambat dapat diatasi dengan transfusi packed red cell.
 Anemia defisiensi besi diatasi dengan makanan yang memadai, sulfas ferosus 10
mg/kgBB 3 x sehari atau Besi elementer 1mg/kgBB/hari.
 Anemia megaloblastik diobati spesifik, oleh karena itu harus dibedakan
penyebabnya, defisiensi vitamin B12 atau defisiensi asam folat.
 Dosis vitamin B12 100 mcg/hari im, selama 5 – 10 hari sebagai terapi awal diikuti
dengan terapi rumat 100-200 mcg/bulan sampai dicapai remisi.
 Dosis asam folat 0,5 – 1mg/hari secara oral selama 10 hari, dilanjutkan dengan
0,1 – 0,5 mg/hari.
 Penggunaan vitamin B12 oral tidak ada gunanya pada anemia pernisiosa. Selain
itu sediaan oral lebih mahal.
 Hemolisis autoimun diatasi dengan prednison 2 – 5 mg/kgBB/hari peroral dan
testosteron 1 – 2 mg/kgBB / hari i.v, untuk jangka panjang.
 Transfusi darah hanya diberikan bila diperlukan saja.

Nugroho BS. dr. SpPD. FINASIM 11