RBC-ANAEMIA

ANAEMIA
ANAEMIA
Definition
• Clinical condition characterised by reduction in
• RBC Count
• Or Hemoglobin content
• Or both
• Below the lower limit of the normal range for that age and
gender
Classification of Anaemia
• Morphological
• Depends upon the size and colour of RBC
• Etiological
• Depends upon the cause

Morphological Classification
1
Microcytic hypochromic
2
Normocytic normochromic
3
Macrocytic
Etiological classification
1
Increased blood loss
2
Impaired RBC production
3
Increased RBC destruction
Morphological Classification
TYPE OF MCV MCH MCHC EXAMPLES

ANEMIA
Microcytic Iron deficiency anemia,
hypochromic    Thalassemia
Normocytic Acute hemorrhage,
normochromic N N N Hemolytic anemia
Megaloblastic anemia,
Macrocytic ↑ ↑ N
Pernicious anemia
Increased Blood Loss
1. Acute Blood loss

• Accident ,Childbirth
• Normocytic normochromic anaemia
2. Chronic Blood loss

• Hookworm infestation
• Bleeding peptic ulcer
Impaired RBC Production
1. Cytoplasmic maturation defects
• Deficient Heme synthesis – Iron def. anemia
• Deficient Globin synthesis – Thalassemia
2. Nuclear maturation defect

• Vit.B12 / Folic acid deficiency - Megaloblastic anemia
3. Defect in stem cell proliferation & maturation

• Aplastic anemia
• Pure red cell aplasia
4. Bone marrow infiltration

• Leukemia
• Lymphoma
• Multiple myeloma
5. Anemia of chronic disorders

• Infections
• Renal disease
• Liver disease
5. Congenital anemia
• Sideroblastic anemia
Increased RBC Destruction
• Extracorpuscular
• Intracorpuscular

Extracorpuscular
• Antibody mediated
• Immune Hemolytic anemia
• Direct Toxic effects
• Malaria, Bacterial infection,Drugs
• Hypersplenism
Intracorpuscular
• Defects in Membrane
• Hereditary Spherocytosis
• Defects in Red cell Enzymes
• G6PD deficiency
• Defects in Hemoglobin
• Abnormal Hbs : Hemoglobinopathies
• ↓ globin chain synthesis : Thalassemias
CLINICAL CASE 1
A 12 years old girl child complains of lethargy and fatigability for

the last three months. Physical examination revealed pallor.
Routine blood investigation showed Hb -7.4 gm% and peripheral
smear revealed microcytic hypochromic RBCs.
Investigations
1. Hb estimation
2. PCV / Hematocrit
3. Total RBC count
4. Blood indices
5. Peripheral blood smear examination
6. Serum Fe & TIBC
7. Reticulocyte count
8. WBC & platelet count
9. ESR
10. Bone marrow examination
What is the diagnosis???
Iron Deficiency Anaemia

Anemia-Bone marrow examination
• Adult : Sternum
• Children : Tibia or Pelvic bone
• Punctured using needle

• Red bone marrow is aspirated
• Myeloid : Erythroid = 3: 1
(Myeloid→Granulocytes & its precursors)
Iron deficiency anemia
• Most common type of anemia
• Common in women of reproductive age group
• Causes
• Decreased intake
• Defective absorption
• Increased requirement : Children , Pregnancy
• Loss through hemorrhage
Symptoms of Iron deficiency anemia
• Dyspnea
• Palpitation
• Fatigue : Muscle hypoxia
• Drowsiness : Cerebral hypoxia
• Pica
Signs of Iron deficiency anemia
Koilonychia Angular stomatitis
Glossitis
Plummer Vinson syndrome
Signs of Iron deficiency anemia
• Pallor
• Glossitis (atrophy of papilla in tongue)
• Koilonychia ( Spoon shaped nails)
• Angular stomatitis
• Dysphagia : Difficulty in swallowing (Plummer Vinson syndrome)
Investigations- Iron deficiency anemia
• Hemoglobin & RBC Count : Decreased
• Peripheral smear : Microcytic hypochromic

: Anisocytosis & Poikilocytosis
Investigations- Iron deficiency anemia
• MCV, MCH & MCHC : Decreased
• Sr.Iron : Decreased
• TIBC : Increased
• Bone marrow : Hypercellular with Erythroid hyperplasia

Treatment of Iron deficiency anemia
• Iron supplementation
• Oral : Ferrous sulphate tablets
• Parenteral : Iron dextran complex (i.m)

(given when patient has intolerance to
oral iron or in case of severe anemia
Megaloblastic anemia
• Deficiency of Vit B12 and/or Folic acid
• Impaired DNA synthesis
• Affect hemopoietic precursors in bone marrow
• Maturation delayed
• Abnormality : MACROCYTES
Causes of Megaloblastic anemia
Vit B12 deficiency Folate deficiency :
• Decreased intake • Inadequate intake

• Defective absorption • Malabsorption
• Increased demand
• Drugs
Clinical Features-Megaloblastic anemia
• Pallor • Neurological manifestations
➢Numbness
➢Ataxia
➢Diminished reflexes
• Glossitis
Investigations-Megaloblastic anemia
• Hemoglobin : Decreased
• ↑ MCV, ↑ MCH , normal MCHC
• Peripheral smear – Macrocytes , Anisocytosis, Poikilocytosis
• Bone marrow– Hyper cellular , Megaloblasts

Bone marrow picture showing megaloblastic changes
Treatment of Megaloblastic anemia
• Inj.Hydroxycobalamin IM 1000µg for 3 weeks
• Physiotherapy
Pernicious anemia
• Autoimmune disease
• Antibodies against Intrinsic Factor of Castle or Parietal cells
• Production of Intrinsic Factor in Parietal cells defective

Pernicious anemia
Lack of Intrinsic Factor
Defective absorption of Vit.B12
Megaloblastic anemia
Investigations – Pernicious anemia
• Hb ↓
• RBCs – Macrocytic
• ↑MCV,↑MCH ,normal MCHC
• Bone Marrow
➢Hyper cellular
➢Megaloblastic with abnormal mitosis
Treatment- pernicious anemia
• Hydroxycobalamin IM inj
• Physiotherapy
Hemolytic anemia
• RBC are destroyed rapidly
• Types :
i. Acquired
ii. Hereditary
• Extravascular-RBC lysed in RES
• Intravascular-RBC lysed in blood vessel

Clinical Features of Hemolytic anemia
• Symptoms & signs of anemia

• Jaundice (Unconjugated Hyperbilirubinemia)
• Splenomegaly
• Gall stones
Investigations of hemolytic anemia
Tests for checking increased RBC breakdown
1. Unconjugated Bilirubin ↑
2. Urinary Urobilinogen ↑
Tests to determine integrity of red cells
1.Peripheral smear – Abnormal morphology

• Microspherocytes
• Fragmented RBCs
2.Osmotic fragility ↑
3.Electrophoresis : Abnormal Hb
Tests for increased RBC production
1. Reticulocyte count ↑
2. Bone marrow – Erythroid hyperplasia

Treatment of hemolytic anemia
• According to cause
Aplastic anaemia
• Lack of functioning bone marrow
• Pancytopenia : All cells reduced in number
• Clinical features
➢Anaemia
➢Bleeding disorder
➢Infection
Investigations of Aplastic anemia
• Pancytopenia
• Reticulocyte count ↓
• Bone marrow :Dry tap

Treatment of Aplastic anemia
• Blood transfusions
• Bone marrow transplantation

POLYCYTHEMIA
• Increased RBC count OR Hemoglobin
1.True
• Primary – Polycythemia vera
• Secondary
2.Relative
• Contracted plasma volume → ↑ Hb concentration
Polycythemia vera
• Malignant condition of bone marrow
• RBC Count : 7-8 million/mm³
• Hematocrit : 60-70%
• ↑ RBC ,WBC & platelets
• No rise in Erythropoietin level

Secondary Polycythemia
• Secondary to pathological conditions producing

Chronic Hypoxia → ↑ erythropoietin secretion
➢ High altitude.
➢ Chronic lung diseases
➢ Cyanotic heart diseases
➢ Carbon monoxide poisoning
Effects of polycythemia :
• Flow of blood will be sluggish
• Venous or arterial thrombosis
• ↑ in viscosity → ↑ in peripheral resistance → ↑ in arterial pressure

Important questions
Physiological Basis
1. Anemia following partial gastrectomy
2. Anemia following ileal resection
3. Anemia in renal disease
4. Polycythemia in High altitude, Smokers, CO poisoning ,Heart disease
5. Increased RBC count in males
6. Decreased RBC count in females
7. Oral Vit. B12 cannot cure pernicious anemia
Essay
1. Erythropoiesis
i. Sites
ii. Stages
iii. Factors influencing
iv. Role of erythropoietin
v. Maturation factors
Essay
• Sickle cell anemia
• Iron deficiency anemia
• Thalassemia
i. What is that ?
ii. Cause?
iii. Clinical features : symptoms & signs
iv. Any special features
v. Investigations
vi. Treatment
vii. Draw picture wherever necessary
Short notes
1. Catabolism/ Fate of hemoglobin
2. Fetal hemoglobin
3. Classification of anemia
4. Investigations in anemia
5. Reticulocytosis
6. Draw & Label
i. Erythropoiesis
ii. Catabolism of hemoglobin

RBC-ANAEMIA

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ANAEMIA

• Clinical condition characterised by reduction in

• Depends upon the size and colour of RBC

• Depends upon the cause

TYPE OF MCV MCH MCHC EXAMPLES

1. Acute Blood loss

2. Chronic Blood loss

2. Nuclear maturation defect

3. Defect in stem cell proliferation & maturation

4. Bone marrow infiltration

5. Anemia of chronic disorders

Increased RBC Destruction

Increased RBC Destruction

A 12 years old girl child complains of lethargy and fatigability for

Iron Deficiency Anaemia

• Punctured using needle

• Hemoglobin & RBC Count : Decreased

• Peripheral smear : Microcytic hypochromic

• MCV, MCH & MCHC : Decreased

• Bone marrow : Hypercellular with Erythroid hyperplasia

• Oral : Ferrous sulphate tablets

• Parenteral : Iron dextran complex (i.m)

• Deficiency of Vit B12 and/or Folic acid

• Impaired DNA synthesis

• Affect hemopoietic precursors in bone marrow

Vit B12 deficiency Folate deficiency :

• Decreased intake • Inadequate intake

• ↑ MCV, ↑ MCH , normal MCHC

• Peripheral smear – Macrocytes , Anisocytosis, Poikilocytosis

• Bone marrow– Hyper cellular , Megaloblasts

• Inj.Hydroxycobalamin IM 1000µg for 3 weeks

• Antibodies against Intrinsic Factor of Castle or Parietal cells

• Production of Intrinsic Factor in Parietal cells defective

Defective absorption of Vit.B12

• Intravascular-RBC lysed in blood vessel

• Symptoms & signs of anemia

1.Peripheral smear – Abnormal morphology

2. Bone marrow – Erythroid hyperplasia

• Lack of functioning bone marrow

• Pancytopenia : All cells reduced in number

• Bone marrow :Dry tap

• Bone marrow transplantation

• Malignant condition of bone marrow

• RBC Count : 7-8 million/mm³

• ↑ RBC ,WBC & platelets

• No rise in Erythropoietin level

• Secondary to pathological conditions producing

• Flow of blood will be sluggish

• Venous or arterial thrombosis

• ↑ in viscosity → ↑ in peripheral resistance → ↑ in arterial pressure

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