Anemias

Leture 9+10

Course code: Zool-01704

Course Name: Haematology
Department: Zoology
Presented By: Mr. Nabeel Tahir
 ANEMIA:
 It is a group of diseases characterized by a decrease in either hemoglobin
(Hb) or the volume of red blood cells (RBCs), which results in decreased
oxygen- carrying capacity of the blood.
 Anemia is defined by the World Health Organization (WHO) as Hb
less than 13 g/dL (less than 130 g/L; less than 8.07 mmol/L) in men
and less than 12 g/dL (less than 120 g/L; less than 7.45 mmol/L) in women.
 Children of both sexes below 14 years of age have lower levels, the cut-off
for anemia being 11 g/dL in those aged 6 months to 6 years and 12 g/dL in the
6–14 age group.
 Anemia is not one disease, but a condition that results from a number
of different pathologies.
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 o A hematocrit test measures the proportion of red blood cells in your
blood.
Male = <42%.
Female = <37%.

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 CLASSIFICATION OF ANEMIA
 Anemia can be classified on the basis
of
 Morphology of the RBCs
 Etiology
 Pathophysiology
 Physiology.

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 PHYSIOLOGIC CLASSIFICATION OF
ANEMIA

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 ETIOLOGY

The low hemoglobin level that defines anemia results from two
different mechanisms:
• Increased hemoglobin loss due to either: – hemorrhage (red cell loss) or
–
hemolysis (red cell destruction).
• Reduced hemoglobin synthesis due to either: – lack of nutrient or –
bone
marrow failure.
• Host of systemic disorders such as infection, chronic renal diseases
or malignancy.

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 Use of erythrocyte morphology in differential diagnosis of
anemia

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 MICROCYTIC
ANEMIA

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Microcytic-Hypochromic Anemias
• Characterized by red cells that are abnormally small and contain
reduced amounts of hemoglobin.
• Related to:
• Disorders of iron metabolism
• Disorders of porphyrin and heme synthesis
• Disorders of globin synthesis

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 IRON DEFICIENCY ANEMIA (IDA)
 Iron deficiency is a state of negative iron balance in which the daily iron
intake and stores are unable to meet the RBC and other body tissue needs.
 The body contains approximately 3.5 g of iron, of which 2.5 g are found in Hgb.
 A significant amount of iron is stored as ferritin or aggregated
ferritin (hemosiderin) in the reticulo-endothelial cells of the liver, spleen,
and bone marrow and by hepatocytes.
 Decreased level of ferritin and serum iron, as well as decreased
transferrin saturation.
 Hb and Hematocrit decrease later.
 Daily requirement of Iron 0.9mg in males, 2mg females, in pregnancy it is
3-
5mg and in infant it is 0.5mg.

12  postmenopausal femalesdietary
The daily recommended and 18allowance
mg in menstruating
for iron is 8 mg in adult males
females.
and
 EPIDEMIOLOGY
 Iron deficiency anemia is the commonest form of anemia worldwide and
may be present in up to 20% of the world's population.
 A diet deficient in iron, parasitic infestations, for example, hookworm
(causing
blood loss), and multiple pregnancies contribute to its high
prevalence in underdeveloped countries.
 Even in Western societies, it has been reported that as many as
20% of menstruating females show a rise in hemoglobin levels on iron
therapy

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  Causes of Iron Deficiency
Anemia
 Blood Loss
• Menstruation
• Gastrointestinal (e.g., Peptic
ulcer)
• Trauma
 Decreased Absorption
• Medications
• Gastrectomy
• Regional enteritis
 Increased requirement
• Infancy
• Pregnant/lactating women
 Hereditary
14  Impaired Iron use
 PATHOPHYSIOLOGY OF
IDA
 Diminished total body iron content, developing in stages over a period
of negative iron balance.
Iron depletion – Stage One
Iron deficient erythropoiesis – Stage
Two Iron deficiency anemia – Stage
Three
 Stage One
Iron storage is exhausted - indicated by decrease in serum ferritin levels,
no anemia – RBC morphology is normal.
 Stage Two
Insufficient iron to insert into protoporphyrin ring to form heme –
Protoporphyrin
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accumulates in cell and complexes with zinc to form ZPP, no anemia,
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  Stage Three
All laboratory tests for iron status become abnormal, most significant finding
is microcytic, hypochromic anemia and there is hyperplasia of erythroids.
 Erythroid hyperplasia is a condition of excessive count of erythroid
precursor cells (in layman words, immature red blood cells) in the bone
marrow.

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 Iron deficiency develops insidiously

Iron stocks deplete

Decline in serum ferritin and absence of stainable iron in bone

marrow

Decrease in serum iron and decrease in serum transferrin

Decrease synthesis of hemoglobin, myoglobin and other iron

containing
proteins

ANEMIA
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 SIGNS
 Pale skin and mucous membranes
OF IDA
 Painless glossitis (Inflammation of the tongue)
 Angular stomatitis (Red, swollen patches in the both corners of
mouth)
 Koilonychia (spoon shaped nails)
 Dysphagia (difficulty in
Chronic Iron
swallowing)
deficiency
 Pica (unusual cravings)
 Atrophic gastritis
 Poikilocytes

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 MANAGEMENT OF IDA

Treatment Goals

 To Decrease Signs And

Symptoms

 Correct The Underlying Etiology

 Prevent Recurrence Of Anemia.

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 A. NON- PHARMACOLOGICAL MANAGEMENT OF
IDA
 Iron rich diet
 Blood
Transfusion

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 B. PHARMACOLOGICAL
MANAGEMENT OF IDA
IRON

PARENTERA
ORAL IRON L IRON

Ferrous sulphate
Iron-dextran
Ferrous gluconate
Iron-sorbitol-citric acid
Ferrous fumarate
Ferrous sucrose
Ferrous succinate
Ferric carboxymaltose
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Thank you