Vitamin B12 deficiency Folic acid Fluid overload Blood Loss Iron deficiency

-Inadequate Intake deficiency -Excessive fluid/ Na -Inadequate intake Genetic Defect reflecting abnormal
-Internal/ External
-Mal absorption -Inadequate intake -Mal absorption
-Absence/ inadequate /Trauma
intake -Increased Physiologic demand
intrinsic factor production -Surgery or Dx
-Mal during pregnancy
Na and fluid retention procedures Substitution of amino acid
absorption
α-globin β-globin Denaturation of valine instead of glutamic
mutation in a excesse α- acid in β-chains of
mutation in a
Atrophic Gastritis, Movement of fluid into the Acute Bleeding Chronic Bleeding normal chain chains hemoglobin molecules
autoimmune vascular compartment Iron level insufficiency in the
(Rapid Blood (Due to chronic
destruction of gastric
conditions)
Cobalami parietal cells Loss) α-Thalassemia β- Formation of Formation of HbS
precipitate (Heinz
n RDA not Hemodilution
Impaired/insufficient Bodies) in bone
Impaired Loss of erythrocytes Prolonged/ Over
satisfied secretion of and other activation of Hemoglobin synthesis in marrows

intrinsic factor components response to initiate the red bone marrow Continuous chain Deoxygenation / low O2
Decrease Haemoglobin Erythropoiesis synthesization,
Impairment of DNA
synthesis blood tension causes HbS
Low Inability to and Hematocrit accumulation in the
Decrease in RBC aggregation and
cobalamin absorb vit b12 concentrations Iron store depletion RBCs, interfering
count polymerization
level in the normal maturation
Damage to cell
Red Cell release Abnormal Heme membrane
Inactivation Absence of folic acid insufficiency Synthesis Formation of semi solid gel
of folate function: affected O2 transport insufficiency occurring in casing sickle shape and
formation of heme RBC short altered cell flexibility
coenzyme circulation
portion of Hgb, inability Formation of Abnorma lifespan
to support cell division Tissue Hypoxia
Iron deficiency Hypochromic, small, l globin
and maturation anemia non functional RBCs synthesis Red cell
Short Cell Life span Rigid and abnormal
Production of miss Impaired Dx Test: Prematur due to abnormal characteristics unable to
Impaired response/ failure or decrease in the release of
shape macrocytic, Erythropoiesis Ferretin levels e characteristics carry O2
erythropoietin in kidneys
non functional, Hemolysi
immature and
are low Microcytic
Insufficient RBC
large RBCs Anemia
release Reduction or absence of stimulation to the Haemolytic
Megaloblast red bone marrows Dx Test: anemia Sickle cell
ic Anemia Pernicious MVC is below
Anemia 80 fl Disease
Decrease or impairment of erythrocyte
production during Erythropoiesis Dx test: Hgb
Dx Test: electrophoresis
MVC is above
100 fl Blood Loss Anemia Aplastic Anemia

Deficiency in the repair

capacity of
ANEMIA Pancytopenia hematopoietic tissue .

Depression or cessation of
Suppress Reduction in
Erythropoietin Ineffective Chronic Disease Diagnostic Tests: activity of all blood producing
Inhibit Erythroid Anemia elements bone marrow
Response erythropoie
precursors Reduced iron progenitors
sis Hgb: below 120-160g/L
transport Affects RBC life Depletion and damage of
(male)
and survival hematopoietic stem cells
110-150g/L female
Mutation in
The lymphocytes release cytokines (interlukin-1 and Retention of Hct: below 40-50% Targets own marrow stem genes
interferon) Inadequate uremic toxins cells responsible
erythropoietin and nitrogen in RBC: below (4.0~5.5) ×1012 /L
release the blood for telomere
Presence of inflammatory state in response (male)
Activation of cytotoxic T cells
Below (3.5~5.0) ×1012 /L(female) repair
to cell injury
Acquisition of Chronic Inflammatory Conditions Chronic Renal failure
including AIDS, tuberculosis, osteomyelitis, RA,
Idiopathic;
SLE, Cancer, Hodgkin’s Disease, etc
autoimmunity
 RISK FACTORS

Predisposing Factors: Precipitating Factors

Age Genetic Endowment of Defective Genes
Lifestyle Malnutrition (Iron, Folic acid and Vitamin B12
deficiency)
Diet Chronic Kidney, Autoimmune diseases, Gastrointestinal
Diseases
Familial History Blood Loss through Internal/ External haemorrhage
Clinical manifestations:
Race Enzyme deficiencies (Glucose-6-phospate
dehydrogenase)
Bone Marrow Damage and Injury
Faulty Blood Transfusions and Drug Induced or Chemical
Exposure

Vitamin B12 deficiency Folic acid Fluid overload Blood Loss Iron deficiency Genetic Defect reflecting Idiopathic; Chronic
-Inadequate Intake deficiency -Excessive fluid/ Na -Internal/ External -Inadequate intake abnormal haemoglobin
-Mal absorption /Trauma ANEMIA -Mal absorption inflammatio
-Inadequate intake chain autoimmuni
-Absence/ inadequate
intake -Surgery or Dx -Increased Physiologic n; Chronic
intrinsic factor production procedures demand during pregnancy ty Kidney
-Mal absorption
-Gynecologic failure