Anemia

Anemia

1. Anemia definition and types Causes of anemia

2. Clinical presentation
3. Treatment options that can be used for anemia
management
 definition Anemia

• Definition:

• Anemia is a reduction in red cell mass. It is a decrease in the number of

red blood cells (RBC) per cubic millimeter(mm3) or as a decrease in the
hemoglobin concentration in blood to a level below the normal
physiologic requirement for adequate tissue oxygenation.

• It also defined as Hb less than 13g/dl in male and 12g/dl in female

 Classification Anemia

• Classification :

• Mild anemia (hemoglobin 9.0–10.9 g/dL)

• Moderate anemia (hemoglobin 7.0–8.9 g/dL)
• Severe anemia (hemoglobin less than 7.0 g/dL}
Anemia
pathophysiology
 Anemia
Causes
1. Decrease RBCs production
• Patients with specific comorbidities such as cancer and chronic kidney disease CKD).
It is usually caused by dysregulation of iron and erythropoietin (EPO) hemostasis

• A decrease in erythrocyte production can be multifactorial. Nutritional deficiencies

(iron, vitamin B12, and folic acid)

2. Patients with chronic immune-related diseases such as rheumatoid arthritis and

systemic lupus erythematosus are also at increased risk to develop anemia as
complication of their disease due to chronic inflammatory.

3. It also may be drug-induced.

4. Increased RBC destruction

5. Increased RBC loss.

 Types of anemia

•Microcytic anemia • Anemia of

• Iron deficiency inflammation
• Cells are smaller than normal • (AI)
• Causes
• inadequate dietary intake, • Anemia of chronic disease and
• inadequate gastrointestinal • Cells with normal size
(GI) • Causes
• absorption,
• Infectious or inflammatory
• increased iron demand
(eg, pregnancy), blood • processes
loss, • tissue injury
• chronic diseases: IBD
 Types of anemia

Macrocytic anemia
VitB12 or folate deficiency •
Cells are larger than normal •

deficiencyfolate VitB12
deficiency
Causes •
Causes •
• inadequate dietary intake,
• hyperutilization due to
pregnancy, • decreased absorption, and
• Hemolytic anemia, • inadequate utilization.
• myelofibrosis, malignancy,
• chronic inflammatory disorders,
• long-term dialysis, or
Anemia clinical presentations
 Anemia diagnosis

Test
• Complete blood count (CBC)
• Ferritin level
• Total iron binding capacity
• Vitamin B12 level
• Folic acid level
• RBCs morphology
 diagnosis of anemia based on laboratory data

fl/cell 100> fl/cell 80<

Normal 80-97fl/cell
diagnosis of anemia based on laboratory
..data
MCV
 Anemia diagnosis

• IDA
• Decreased serum ferritin (storage iron) with
decreased transferrin saturation(T.sat.)
• Increased total iron-binding capacity (TIBC).

• Vitamin B12 deficiency anemia .

• A vitamin B12 value less than 150 pg/mL with
symptoms

• Folate deficiency

• AI:
• Serum iron is usually decreased, serum ferritin is
normal or
Treatment of
anemia
Treatment of Iron deficiency anemia

• oral iron therapy that provides 150 to 200 mg of elemental iron daily. Many
different iron products and salt forms are available (ferrous sulfate,
gluconate, or fumarate)

• Ascorbic acid (vitamin C), given in doses up to 1 gram, is able to increase

iron absorption

• The preferred regimen for oral iron is 50 to 65 mg of elemental iron two to

three doses daily on an empty stomach (1 hour before or 2 hours after a
meal)
• if intolerable GIT disturbances occurred, then can be taken with food or start
with low dose as OD dosing then increased every 2-3 days until TDS dosing

• Reticulocytotic should occur in 7 to 10 days, hematological response in 2-

3 weeks ( Hb 1-2g/dl of 6% of Hct)

• Patients should be reassessed if Hgb does not increase by 2.0 g/dL in 3

Treatment of Iron deficiency anemia

• ferrous sulfate is 325 mg (one tablet) administered 3 times

daily
Treatment of Iron deficiency anemia

• ferric gluconate, iron dextran, iron sucrose, ferric carboxymaltose, and

ferumoxytol

• All parenteral iron products can be administered undiluted slowly as

an intravenous (IV) push, or diluted and administered by infusion and
Iron dextran is also the only product that may be given intramuscularly
(IM).

• Parenteral iron therapy is indicated when

1. patients cannot tolerate oral formulations
2. noncompliant
3. fail to respond to oral iron because of malabsorption syndromes.
4. Drug interaction eg. PPI
Treatment
of Iron deficiency anemia
Treatment of Vit B12 deficiency anemia

• Oral and parenteral vitamin B12 (cyanocobalamin) replacement therapies are

equally effective. But giving parenteral usually with neurological symptoms

• cyanocobalamin is commonly administered as an intramuscular or

subcutaneous injection of 1000 mcg/day for 1 week, followed by
1000 mcg/week for a month then monthly normalizing blood counts.

• oral maintenance (1000 to 2000 mcg/ day ) can be given

• Life-long maintenance therapy (1000 mcg/month) is required for patients

with pernicious anemia or surgical resection of the terminal ileum.

• Typically, resolution of neurologic symptoms, disappearance of

megaloblastic RBCs, and increased Hgb levels occur within a week of
therapy.
Treatment of folate deficiency anemia

• The effective dose of folic acid is 1 mg/day by mouth.

• patients with malabsorption syndromes may require doses up to 5 mg/day.

• RBC morphology should begin to revert back to normal within 24 to 48 hours

after therapy is initiated, Resolution of symptoms and reticulocytosis occurs
within days (2-10 days) of commencing therapy. Finally, the anemia should
be corrected in 1 to 2 months

• Once anemia is corrected, 100 mcg daily of folate as a nutritional

supplement
should be adequate for maintenance treatment
Treatment of anemia of inflammatory

1. Chemotherapy induced
• ESAs should only be used to prevent a transfusion and should not be initiated
unless the hemoglobin is less than 10.0 g/dL and chemotherapy is planned for a
minimum of two additional months.

• Management can be continued for 8 weeks after chemotherapy if there is

response

• Monitoring should be done each 4 weeks

• Goal of Hb is up to 10 g/dl

• An increase in Hb greater than 12 g/dL with treatment or a rise of greater than

1 g/dL every 2 weeks has been associated with increased mortality
and cardiovascular events.
Treatment of anemia of inflammatory
•Patients should be monitored every 4 weeks.
• If Hgb has not increased by 1.0 g/dL after 4 weeks and remains less than 10.0
• g/dL. Increase the dose by 25%

• If Hgb increases by more than 1.0 g/dL or is more than 10.0 g/dL the ESA
should
• be discontinued.

•Within 8 weeks if
• Hgb has increased by 1 g/dL but remains less than 10.0 g/dL, continue
Treatment of anemia of inflammatory

Chronic kidney disease .2

Patients with CKD typically develop normocytic, normochromic anemia as •

.a result of EPO deficiency

ESAs should be used with a target Hgb range in patients with CKD •
was lowered to 11.0 g/ in patients on hemodialysis and to 10.0 g/dL
.in CKD patients not on hemodialysis

Keep transferrin saturation is greater than 20% (0.20) and serum ferritin •
is greater than 100 ng/mL with iron supplementation
 Treatment of
anemia of inflammatory
Thank you