Anaemia:

   It is a state when the amount of haemoglobin in the peripheral blood is less than normal for the age and sex of the individual.

   Defined as the reduction in the amount of hemoglobin in the peripheral blood per unit volume of blood for the age and sex of the individual.

   This reduction in the amount of hemoglobin may or may not be associated with the reduction in the red blood cells count.

Classification:

Anaemia is classified on etiology and morphologic basis.

Etiological classification:

Dyshaemopoietic anaemias

Haemorrhagic anaemias

Haemolytic anaemia:

Dyshaemopoietic anaemias

Deficiency type-

Due to deficiency of the essentials required for the formation of Hb.

Deficiency of Iron.

Deficiency of Folic acid, Vit B12, Pyridoxin(vitB6), VitC.

Deficiency of proteins (Kwashiorkar)

Deficiency of trace elements like copper cobalt, manganese.

B) Due to marrow depression/ Suppression :

Infiltration of bone marrow by

-Leukaemia

-Lymphoma

-Myeloma

-Myelodysplastic disorders.

Aplastic anaemia

Anaemia with renal failure

Anaemia with chronic disorders

-Infections and

- connective tissue disorders.

Aplastic anaemia

Anaemia with renal failure

Anaemia with chronic disorders

-Infections and

- connective tissue disorders.

Anaemia due to drugs:

-Anticancer drugs

-Antibacterial drugs (chloramphenicol, sulphonamide)

-Antirheumatic drugs (oxyphenbutazone, gold salts)

-Anticonvulsant drugs (Methyl-hydantion)

-Tranquillizers

Haemolytic anaemia:

Anaemia results from increased breakdown of RBCs than production.

It may be due to defect in red blood cell (Intrinsic defect) or may be due to defect in plasma (extrinsic defect)

Haemorrhagic anaemias:

Anaemias caused by blood loss.

Acute blood loss:

   Significant amount of blood (1-2litre) when lost in a short time (1/2-2hrs)

   Anaemia becomes evident at the end of 3-4 days.

   e.g Accidental bleeding

Chronic blood loss:

When small amount of blood (5-10ml daily)

 is lost over periods (months), iron deficiency results.

e.G , Haemorrhoids.

Morphological classification:

Based on the morphology of Red blood cells. Best done on MCV,MCH & MCHC, usually done on blood film.

Normocytic normochromic anaemia:

Haemorrhagic anaemia

Aplastic anaemia

Anaemia due to renal failure

Anaemia due to chronic diseases.

Microcytic hypochromic anaemia:

Iron deficiency anaemia

Thalassaemia

Sederoblastic anaemia

Anaemia of chronic diseases.

Macrocytic anaemia:

Megaloblastic anaemia

Pernicious anaemia

Folate deficiency anaemia

Macrocytic hyperchromic anaemia doesn’t occur as RBC can’t have more haemoglobin per unit volume than normally they have. (Normally red cells are saturated with Hb)

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Clinical presentation:

Weakness,

Pallor,

palpitations,

feverish,

breathlessness on exertion.

Others such as diarrhoea,poor appetite,anorexia may be present.

In case of children-

Loss of attention,

Irritability

Apathy.

Investigations of anaemia:

Haemoglobin estimation:

   Hb value less than normal level is the laboratory confirmation of anaemia.

Diagnosis of morphological type of anaemia:

Examination of blood film

Determination of Red cell absolute value:

    Packed cell volume, Hb estimation and red cell count are required to calculate the absolute values of MCV and MCHC which decides morphological type of anaemia.

Diagnosis of aetiological type of anaemia

Detemination of efficacy of treatment:

    Estimation of Hb (Hb starts rising by the end of a week, usually 1gm/dl per week; the rise is more marked in the early phase; In the severely anaemic patients the rise in the Hb conc. May be 1-2 gram per week. In adequate treatment normal Hb conc is reached in 8-10 weeks time.

Reticulocytes count:

   Normally the reticulocytes constitute 1-3% in the peripheral blood. In the iron deficiency anaemia the reticulocyte count is normal or low; with the administration of haematinics the reticulocytes count start rising from 7-10 days, about 4-6% at the end of 3-4 weeks; Then falls gradually reaching 1-3% in about 8 weeks-12 weeks. 

IRON DEFICIENCY ANAEMIA: http://ofhumanbeing.blogspot.com/

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