ANEMIA

 Anemia is a group of diseases charcterized by a decrease in either hemoglobin or volume of RBC, which
results in decreased oxygen carrying capacity of the blood.
 Anemia can result from inadequate RBC production, increased RBC destruction or blood loss.
 Anemia can be temporary or long term, and it can range from mild to severe.
 The most common symptom of all types of anemia is a feeling of fatigue and a lack of energy.
 Other common symptoms may include:

o paleness of skin

o fast or irregular heartbeat

o shortness of breath

o chest pain

o headache

o light-headedness

Causes
1) Anemia caused by blood loss

Causes of anemia due to blood loss include:

 gastrointestinal conditions, such as ulcers, hemorrhoids, cancer, or gastritis

 use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen

 menstrual bleeding

2) Anemia caused by decreased or faulty red blood cell production

Bone marrow is a soft, spongy tissue found in the center of bones. It is essential for the creation of red blood
cells. Bone marrow produces stem cells, which develop into red blood cells, white blood cells, and platelets.

A number of diseases can affect bone marrow, including leukemia, where too many abnormal white blood
cells are produced. This disrupts normal production of red blood cells.

Other anemias caused by decreased or faulty red blood cells include:

 Sickle cell anemia: Red blood cells are misshapen and break down abnormally quickly. The
crescent-shaped blood cells can also get stuck in smaller blood vessels, causing pain.

 Iron-deficiency anemia: Too few red blood cells are produced because not enough iron is
present in the body. This can be because of a poor diet, menstruation, frequent blood donation, endurance
training, certain digestive conditions, such as Crohn's disease, surgical removal of part of the gut, and some
foods.
  Bone marrow and stem cell problems: Aplastic anemia, for example, occurs when few or
no stem cells are present. Thalassemia occurs when red blood cells cannot grow and mature properly.

 Vitamin deficiency anemia: Vitamin B-12 and folate are both essential for the production of
red blood cells. If either is deficient, red blood cell production will be too low. Examples include
megaloblastic anemia and pernicious anemia.

3) Anemia caused by the destruction of red blood cells

Red blood cells typically have a life span of 120 days in the bloodstream, but they can be destroyed or
removed beforehand.

Excessive hemolysis (red blood cell breakdown) can occur for many reasons, including:

Infections, certain drugs, for example, some antibiotics, snake or spider venom, toxins produced
through advanced kidney or liver disease, an autoimmune attack, for instance, because of
hemolytic disease, severe hypertension, vascular grafts and prosthetic heart valves, clotting
disorders, enlargement of the spleen

MORPHOLOGICAL CLASSIFICATION
MATURATION AND DEVELOPMENT OF RBC

DIAGNOSIS
Tests might include:
 Complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of
red blood cells
 Blood iron level and your serum ferritin level, the best indicators of your body's total iron stores
 Levels of vitamin B12 and folate, vitamins necessary for red blood cell production
 Special blood tests to detect rare causes of anemia, such as an immune attack on your red blood cells, red
blood cell fragility, and defects of enzymes, hemoglobin, and clotting
 Reticulocyte count, bilirubin, and other blood and urine tests to determine how quickly your blood cells are
being made or if you have a hemolytic anemia, where your red blood cells have a shortened life span

IRON DEFICIENCY ANEMIA

 Iron deficiency anemia is a condition where there are too few red blood cells in the body due to a
shortage of iron.
IRON BALANCE

Iron balance in human beings is uniquely dependent on the body's ability to match the rate of iron
absorption from the proximal small intestine to iron requirements. During childhood, iron absorption
normally exceeds immediate requirements, ensuring a positive balance and the gradual establishment of an
iron store. In the adult, the level of absorption is approximately equal to a relatively fixed rate of loss that
is governed by factors unrelated to iron balance. When requirements are increased, e.g., during periods of
rapid growth and in pregnancy, absorption increases to replace the storage iron that is used up. 

Normal iron content of the body is about 3-4 g.

About 3mg of iron is bound to transferrin in plasma, and 1000mg of iron exists as storage iron in the form
of ferritin or hemosiderin. Rest of iron stored in the cytochromes.

Daily recommended dietary allowance for iron is 8mg in adult males and postmenopausal females and
18mg in menstruating females.

ETIOLOGY
 Inadequate iron intake
Eating too little iron over an extended amount of time can cause a shortage in your body. Foods such
as meat, eggs, and some green leafy vegetables are high in iron. Because iron is essential during times
of rapid growth and development, pregnant women and young children may need even more iron-rich
foods in their diet.
 Pregnancy or blood loss due to menstruation
Heavy menstrual bleeding and blood loss during childbirth are the most common causes of iron
deficiency anemia in women of childbearing age.
 Internal bleeding
Certain medical conditions can cause internal bleeding, which can lead to iron deficiency anemia.
Examples include an ulcer in your stomach, polyps in the colon or intestines, or colon cancer. Regular
use of pain relievers, such as aspirin, can also cause bleeding in the stomach.
 Inability to absorb iron
Certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs
iron. Even if you get enough iron in your diet, celiac disease or intestinal surgery such as gastric
bypass may limit the amount of iron your body can absorb.
 Endometriosis
If a woman has endometriosis she may have heavy blood loss that she can not see because it is hidden
in the abdominal or pelvic area.
PATHOPHYSIOLOGY OF IDA

SIG
NS AND SYMPTOMS
SYMPTOMS SIGNS
Decreased exercise tolerance Pale appearance
Fatigue Decreased mental acuity
Dizziness Increased intensity of some cardiac valvular
murmurs
Irritability
Weakness
Palpitation
Vertigo
Shortnesss of breath, chest pain
LABORATORY FINDINGS
o Low serum iron and ferritin levels
o High TIBC (total iron binding capacity)
o In the early stages, size of RBC is normal, hb, hct, and RBC indices remains normal. In the
later stages, hb and hct falls below normaland microcytic anemia develops.
o Low transferrin indicates IDA
TREATMENT
Dietary supplementation and oral iron preparations
o Iron is best absorbed from meat, fish, and poultry.
o Orange juice and other ascorbic acid rich foods can be included with meals to increase
absorption.
o Milk and tea reduce absorption and should be consumed in moderation.
o Ferrous sulfate, succinate, lactate, fumarate, glutamate, and gluconate are absorbed when
given orally.
Oral iron products

Adverse effects -:
o Dark discolouration of feces
o Constipation or diarhea
o Nausea/vomiting
Parenteral iron therapy
Indication for parenteral iron therapy include;
o Intolerance to oral, malabsorption, and nonadherence.
o Patients with significant blood loss who refuse transfusions and cannot take oral iron therapy.
o Patients with IBD and those with gastric bypass/ gastric resection due to poor oral absorption.
o Patients with CKD, especially those undergoing hemolysis and some cancer patients
receiving chemotherapy.
Preparations
o Iron dextran, sodium ferric gluconate, iron sucros, ferumoxytol, ferrous carboxymaltose.

Dose of iron (mg) = whole blood hemoglobin deficit (g/dl) * body weight (kg) * 0.22

o Sodium ferric gluconate is a complex of iron bound to one gluconate and 4 sucrose molecules.
o Adverse effects include- cramps, nausea, vomiting, flushing, hypotension
o Ferumoxytol 510mg IV is used to treat iron deficiency in adults with CKD who are of
dialysis.

TREATMENT ALGORITHM