ANEMIA

 Anemia is defined as a hemoglobin concentration in blood

below the lower limit of the normal range for the age and sex
of the individual.
 CLASSIFICATION
OF ANEMIA
ANEMIA

PATHOPHYSIOLOGIC
MORPHOLOGIC
OR ETIOLOGIC
ANEMIA
ANEMIA
I. PATHOPHYSIOLOGIC OR
ETIOLOGIC ANEMIA
I. HEMORRRHAGIC ANEMIA
II. HEMOLYTIC ANEMIA
III. NUTRIONAL DEFICIENCY ANEMIA
IV. APLASTIC ANEMIA
V. ANEMIA OF CHRONIC DISEASES
II. MORPHOLOGIC ANEMIA

Morphological classification depends upon MCV, MCH and

MCHC.

a. MCV - Mean corpuscular volume (MCV) is the average

volume of an RBC.
b. MCH - The mean corpuscular hemoglobin (MCH) is
the average weight of hemoglobin content in an RBC.
c. MCHC - The mean corpuscular hemoglobin
concentration (MCHC) is the average hemoglobin
concentration per unit volume of packed red cells.
 HEMPRRHAGE –
EXCESSIVE BLOOD LOSS

HEMORRHAGI 1) ACUTE HEMORRHAGE

C ANEMIA

2)CHRONIC
HEMORRHAGE 
 Acute hemorrhage

Acute hemorrhage refers to sudden loss of a

large quantity of blood as in the case of
accident. 
Decreased RBC count causes hypoxia, which
stimulates the bone marrow to produce
more number of RBCs.
Condition corrected within 4-6 weeks.
 Chronic hemorrhage

• It refers to loss of blood by internal or external bleeding, over a long

period of time. 
• occurs in conditions like peptic ulcer, purpura, hemophilia and
menorrhagia.
• Due to continuous loss of blood, lot of iron is lost from the body
causing iron deficiency.
• This affects the synthesis of hemoglobin resulting in less hemoglobin
content in the cells. The cells also become small.
HEMOLYTI
C ANEMIA
• DESTRUCTION OF RBC .
• 1) EXTRINSIC HEMOLYTIC ANEMIA
• 2) INTRINSIC HEMOLYTIC ANEMIA
A. Extrinsic hemolytic anemia

• The type of anemia caused by destruction of RBCs by external factors.

• Healthy RBCs are hemolyzed by factors outside the blood cells such as
antibodies, chemicals and drugs.
Common causes of extrinsic hemolytic
anemia 
• Liver failure.
• Renal disorder
• Hypersplenism 
• Burns
• Infection like hepatitis, malaria etc
• Poisoning by chemical substances like lead, coal and tar
•  Autoimmune diseases such as rheumatoid arthritis and ulcerative
colitis. 
 Intrinsic hemolytic anemia

This type of anemia is caused by destruction of RBCs because of the

defective RBCs.
There is production of unhealthy RBCs, which are short lived and are
destroyed soon.
Intrinsic hemolytic anemia is often inherited and it includes sickle cell
anemia and thalassemia.
 SICKLE CELL ANEMIA

• Sickle cell anemia is an inherited

blood disorder, characterized by
sickle-shaped red blood cells. 
• It is also called hemoglobin SS
disease 
• Sickle cell anemia is due to the abnormal hemoglobin called hemoglobin S
(sickle cell hemoglobin).
• In this, a-chains are normal and B-chains are abnormal. 
• Sickle cell anemia occurs when a person inherits two abnormal genes (one from
each parent).
• In children, hemolyzed sickle cells aggregate and block the blood vessels,
leading to stop page of blood supply
•  The infarction is common in small bones The infarcted small bones in hand and
foot results in varying length in the digits.
• This condition is known as hand and foot syndrome.
• Jaundice also occurs in these children.
 Thalassemia

• Thalassemia is an inherited
disorder, characterized by
abnormal hemoglobin.
 a-thalassemia

The a-thalassemia occurs in fetal life or infancy.

In this, a-chains are less, absent or abnormal.
In adults, B-chains are in excess and in children, y-chains are in excess.
 This leads to defective erythropoiesis and hemolysis.
The infants may be stillborn or may die immediately after birth.
 B-thalassemia

• In B-thalassemia, B-chains are less

in number, absent or abnormal
with an excess of a-chains. 
• The a-chains precipitate causing
defective erythropoiesis and
hemolysis,
3. Nutrition Deficiency Anemia

• Anemia that occurs due to deficiency of a nutritive sub stance

necessary for erythropoiesis is called nutrition deficiency anemia.
• The substances which are necessary for erythropoiesis are iron,
proteins and vitamins like C, B, and folic acid. 
 Iron deficiency anemia

• Iron deficiency anemia is the most

common type of anemia. It develops due
to inadequate availability of iron for
hemoglobin synthesis
• Causes of iron deficiency anemia:
• i. Loss of blood.
• ii. Decreased intake of iron.
• iii. Poor absorption of iron from
intestine.
• Increased demand for iron in conditions
like pregnancy 
Pernicious anemia
• Pernicious anemia- Pernicious anemia is the anemia due to deficiency
of vitamin B-12. 
• also called Addison’s anemia. 
• It is due to atrophy of the gastric mucosa because of autoimmune
destruction of parietal cells.
• Gastric atrophy - decreased production of intrinsic factors and poor
absorption of vitamin B12.
Megaloblastic anemia
• Due to deficiency of RBC maturation factor folic acid.
• Rbc are not matured – DNA synthesis also defective – so nucleus
remaining immature.
Aplastic anemia
• Due to the disorders of red bone marrow.
• Red bone marrow is reduced and replaced by fatty tissues.
• Bone marrow disorders occurs in following conditions :-
• 1) repeated exposure to X-ray or radiations.
• 2) presence of bacterial toxins
• 3) Tuberculosis
• 4) viral infections like HIV infections.
ANEMIA OF chronic disorders
• Common cause of anemia of chronic disorders are :-
• 1) rheumatoid arthritis.
• 2)chronic infections like tuberculosis.
• 3)chronic renal failure.
• Etc..
Morphological classification
The morphological classification is based on the size or volume of the
red blood cell and may also be classified by the hemoglobin content
of the red blood cell.
 A red blood cell of a normal size or volume - normocytic.
Abnormally large cell -macrocytic.
Abnormally small cell - microcytic
Normal hb content – normochromic
Low hb content – hypochromic
More hb content – hyperchromic.
Types :-
• 1) Normocytic normochromic anemia
• 2) Macrocytic normochromic anemia
• 3)Macrocytic Hypochromic anemia
• 4) Microcytic hypochromic anemia.
 CLINICAL FEATURES OF
ANEMIA
SIGNS
1. Pallor- Pallor is the most common and characteristic sign
which may be seen in the mucous membranes,
conjunctivae and skin.
2. Tachycardia
3. Collapsing pulse
4. Dyspnea on exertion
5. Giddiness
Sympto
ms
1. Tiredness
2. Easy fatiguability
3. Generalized muscular weakness
4. Headache
5. Anorexia (Loss of appetite)
6. Numbness and tingling sensations of the hands and feet
7. Attacks of faintness
8. Weight loss