Anemia

Anurag B Patidar
Lecturer , CON,DMCH
 INTRODUCTION
• Anemia occurs when blood does not have
enough red blood cells or when the blood
does not have enough hemoglobin.
• Hemoglobin is the oxygen-carrying pigment
found in red blood cells. Anemia can be life-
threatening.
 Intro….
• Red blood cells are produced through a series
of complex and specific steps.
• They are made in the bone marrow, and when
all the proper steps in their maturation are
complete, they are released into the blood
stream.
• The hemoglobin molecule is the functional
unit of the red blood cells and is the protein
structure that is inside the red blood cells.
Definition:

Anemia is operationally defined as a reduction in one or more of the

major RBC measurements:

hemoglobin concentration, hematocrit, or RBC count .

 WHO's Hemoglobin thresholds used to define anemia
(1 g/dL = 0.6206 mmol/L)
Age or gender group Hb threshold (g/dl) Hb threshold (mmol/l)

Children (0.5–5.0 yrs) 11.0 6.8

Children (5–12 yrs) 11.5 7.1

Children (12–15 yrs) 12.0 7.4

Women, non-pregnant
12.0 7.4
(>15yrs)
Women, pregnant 11.0 6.8

Men (>15yrs) 13.0 8.1

 Incidence
• In the United States, 2%-10% of people have
anemia.
• Other countries have even higher rates of
anemia.
• Young women are twice as likely to have
anemia than young men because of regular
menstrual bleeding.
 Types of anemia
• In general, there are three major types of
anemia, classified according to the size of the
red blood cells.
 Types A/C size
•If the red blood cells are smaller than normal, this is
called microcytic anemia. The major causes of this
type are iron deficiency anemia and thalassemia.

•If the red blood cells size are normal in size (but low
in number), this is called normocytic anemia, such as
anemia that accompanies chronic disease or anemia
related to kidney disease.
•If red blood cells are larger than normal, then it is
called macrocytic anemia. Major causes of this type
are pernicious anemia and anemia related to
alcoholism.
 Other types
• Iron deficiency anemia
• Vitamin B 12 deficiency anemia
• Folic acid anemia
 Causes
• Iron deficiency anemia:
• 1. Loss of iron at a greater rate than normal (blood
loss): gastritis, peptic ulcers, ulcerative colitis, IBD
polyps, gastrointestinal tumors (such as stomach or
colon cancer), heavy menstrual periods, kidney
tumors, bladder tumors, cystitis, prostatitis, and
hemorrhoids.
• Additionally, the frequent use of aspirin, ibuprofen or
other non-steroid anti-inflammatory drugs, can also
cause iron deficiency anemia.
 CAUSES
• 2. Poor absorption of iron from the diet.
• Poor absorption of iron from the diet is usually as a
result of surgical removal of part or all of the stomach
or celiac sprue (a condition in which the lining of the
small intestine is damaged by a protein found in
wheat or rye called gluten).
• 3. Eating a diet low in iron. This anemia can happen
from not eating enough iron-rich foods, such as fruit,
whole-grain bread, beans, lean meat and green
vegetables.
 CAUSES…
• Vitamin B12 anemia
• Vitamin B12 anemia is the result of an impaired ability of the digestive
tract to absorb the B12 that is a normal part of the diet. B12 is essential
for the production of red blood cells, as well as the maintenance of the
nervous system.
• Failure of the stomach lining to produce intrinsic factor, the production of
intrinsic factor is blocked.
• Rremoval of small intestine where vitamin B12 is absorbed
• Crohn’s disease- a chronic inflammatory disease that affects any part of
the gastrointestinal tract
• Eating a vegan diet which excludes eggs, diary products, meat and fish.
 Causes…
• Folic acid deficiency
• Folic acid deficiency is usually caused by an
inadequate intake of folic acid, a vitamin mainly
supplied by the fresh green leafy vegetables,
mushrooms, lima beans and kidney beans.
• This disorder is most common in the poor and
elderly (due to poor eating habits), in heavy
alcohol drinkers, and in persons afflicted with
intestinal disorders such as Crohn’s disease.
 CAUSES
•Anemia related to pregnancy: Water weight gain during
pregnancy dilutes the blood, which may be reflected as
anemia.
 CAUSES
• Sickle cell anemia: In some individuals, the problem
may be related to production of abnormal hemoglobin
molecules. Abnormal hemoglobin molecules may cause
problems in the integrity of the red blood cell structure
and they may become crescent-shaped (sickle cells).
• There are different types of sickle call anemia with
different severity levels. This is typically hereditary and is
more common in those of African, Middle Eastern, and
Mediterranean ancestry.
 CAUSES
•Anemia related to kidney disease:
•The kidneys release a hormone called the
erythropoietin that helps the bone marrow
make red blood cells. In people with chronic
kidney disease, the production of this
hormone is diminished, and this in turn
diminishes the production of red blood cells,
causing anemia.
 CAUSES
•Hemolytic anemia: Hemolytic anemia is a type of anemia
in which the red blood cells rupture (known as hemolysis)
and become dysfunctional.
•This could happen due to a variety of reasons. Some
forms of hemolytic anemia can be hereditary with constant
destruction and rapid reproduction of red blood cells.
•This destruction may also happen to normal red blood
cells in certain conditions, for example, with abnormal heart
valves damaging the blood cells.
 Symptoms
• Paleness of conjunctiva
• Weakness
• Tiredness
• Chest pains (in severe cases)
• Shortness of breath (in severe cases)
• Heart palpitations (in severe cases)
• An increased heart rate especially during exertion (in severe
cases)
• Rapid breathing , Low blood pressure
• Abdominal pain
• Weight loss
Lab tests for anemia may include the following:

Complete blood count: Hb level

Stool hemoglobin test: Tests for blood in stool which may

detect bleeding from the stomach or the intestines.

Ferritin: Evaluates at the total iron available in the body.

Transferrin level: Evaluates a protein that carries iron

around the body.
 Lab tests
•Vitamin B12: A vitamin needed to produce red blood cells, low in
people with poor eating habits or in pernicious anemia.
•Bilirubin: Useful to determine if the red blood cells are being
destroyed within the body which may be a sign of hemolytic anemia.
•Hemoglobin electrophoresis: Sometimes used when a person has a
family history of anemia; this test provides information on sickle cell
anemia or thalassemia.
•Liver function tests: A common test to determine how the liver is
working, which may give a clue to other underlying diseases causing
anemia.
•Bone marrow biopsy: Evaluates production of red blood cells and
may be done when a bone marrow problem is suspected.
 Treatment of Anemia
• Iron-deficiency anemia Treatment will depend upon whether
an individual is not getting enough iron in the diet; not
absorbing iron (surgery for celiac sprue, etc.); or losing small
amounts over time due to anything from alcoholic gastritis to
medication abuse to tumors.
• The doctor will often recommend iron-rich foods (such as
liver, seafood, dried fruits, beans, whole grains, green leafy
vegetables and blackstrap molasses) or iron folic acid tablets.
• In the more severe cases of iron deficiency anemia caused by
blood loss, surgery, blood transfusions may be recommended.
 Iron therapy
• Generally, iron supplementation therapy is an
oral therapy, and parenteral iron therapy
(intravenously or intramuscular) is only given
when
• oral therapy has failed or oral absorption is
seriously compromised (by illnesses,
• or when the patient cannot swallow) and
benefit from oral therapy cannot be expected.
epoetin alfa (Procrit or Epogen) injection can be used to
increase red blood cell production in people with kidney
problems.
The production of erythropoietin is reduced in people with
advanced kidney disease, as described earlier.
 Treatments
• Vitamin B12 deficiency
• Current treatment of vitamin B12 deficiency consists of a life-
long regimen of monthly B-12 injections.
• Folic acid deficiency
• Treatment is frequently a dietary correction.
• Main sources of folic acid include meat, poultry, cheese, milk,
eggs, liver, green leafy vegetables, raw fruits, lima and kidney
beans, and yeast.
• Folic acid tablets cure the anemia quickly. In rare instances,
injections of folic acid are necessary.
Surgery

•There are no specific surgical interventions for the

treatment of anemia.
•However, depending on the causes of the anemia,
surgery may be a treatment option.
•For example, if colon cancer or uterine cancer that
slowly bleeds is the cause of anemia, then surgical
removal of the
cancer would potentially treat the anemia.
 Prevention of Anemia
• Consumption of a healthy diet including iron-
containing foods and those with B-complex
vitamins is essential to developing and
maintaining a satisfactory blood count.
• Thank you