Anaemia
Anaemia
Anaemia
Submitted By
• Dr. NAVDEEP GILL
B.D.S
INTRODUCTION
• It is defined as a Hb. Concentration in
blood below the lower limit of the normal
range for the age & sex of the individual
• Normal count:-
• In adults:For males-13.0 g/dl
For females-11.5 g/dl
In infants:15 mg/dl(lower limit)
CLASSIFICATION
• Pathophysiologic
• Morphologic
Pathophysiologic Classification
1.Anaemia due to increased blood loss
a)Acute post-haemorrhagic Anaemia
b)Chronic blood loss
2.Anaemia due to impaired red cell
production
a)Cytoplasmic maturation defects
Deficient haem synthesis:Iron deficiency
anaemia
Pathophysiologic Classification
• Deficient globin synthesis:Thalassaemia
b)Nuclear maturation defectsVit. B12 &/or
folic acid deficiency:Megaloblastic
anaemia
c)Defect in stem cell proliferation &
differentiation- Aplastic anaemia
Pure red cell aplasia
Pathophysiologic Classification
d) Anaemia of chronic disorders
e) Congenital anaemia
3. Anaemia due to increased red cell
destruction (haemolytic anaemia)
d) Extrinsic(extracorpuscular) red cell
abnormalities
e) Intrinsic(intracorpuscular) red cell
abnormalities
Morphologic Classification
A) Microcytic, Hypochromic
B) Normocytic, Normochromic
C) Macrocytic, Macrochromic
Sideroblastic Anaemia
• Comprise a group of disorders of diverse
etiology in the bone marrow, show
characterstic“ring sideroblasts”.
• Classification:
1. Hereditary (Congenital) sideroblastic anaemia
2. Acquired sideroblastic anaemia
E. Primary acquired sideroblastic anaemia
F. Secondary acquired sideroblastic anaemia
B. Secondary acquired sideroblastic anaemia
ii) Drugs and chemicals and toxins
e.g. isoniazide, cycloserine, chloramphenicol,
alcohol & lead.
iv) Haematological disorders
e.g. Myelofibrosis, polycythaemia vera, acute
leukaemia, myeloma & lymphoma.
vi) Misc.
e.g. Carcinoma, myxoedema & SLE.
Lab Investigation
Im m u n e N o n Im m u n e
A u to im m u n e A llo im m u n e D r u g in d u c e d
Id io p a th ic S e c o n d a ry
Lab Findings Of AIHA
• Warm antibody AIHA
- Mild to moderate chronic anaemia
- Reticulocytosis
- Prominent spherocytosis in the PBF
- Positive direct Coombs’ (antiglobulin)
test for presence of warm antibodies on
the red cell, best detected at 37 C.
Lab Findings Of AIHA
• Cold antibody AIHA
- Chronic anaemia
- Low reticulocyte count since young red
cells are affected more.
- Spherocytosis is less marked
- Positive direct Coombs’ test
- Donath-Landsteiner test : Cold Ab. Titre is
very high at 4 C & very low at 37 C.
Lab Findings Of Hereditary
Haemolytic Anaemia
A) Hereditary abnormalities of red cell membrane –
- Anaemia : mild to moderate degree
- Reticulocytosis : usually 5-20 %
- Blood film : abnormality of RBCs in the form of
microspherocytes
- MCV : normal or decreased
MCHC : increased
- Osmotic fragility test : in testing the spheroidal
nature of RBCs ( lysing more readily in sol. of low
salt conc. ) i.e. osmotic fragility decreased.
- Autohaemolyses test negative
- Direct COOMB’s test negative
Lab Findings Of Hereditary
Haemolytic Anaemia
B) Hereditary disorders of red cell interior –
2. During period of acute haemolysis :
- Rapid fall in haematocrit by 25-30 %.
- Features of intravascular haemolysis :
rise in plasma Hb.
haemglobinuria
rise in unconjugated bilirubin
fall in plasma haptoglobin
Lab Findings Of Hereditary
Haemolytic Anaemia
- Formation of Heinz bodies called Heinz
body haemolytic anaemia .They aren’t
seen for first 2 days as they are removed
by spleen leading to formation of BITE
CELLS .
2. Between the crises –
- Affected patient has no anaemia
- Red cell survival shortened
Thalassaemia
• Thalassaemias are a group of hereditary
disorders in which there is reduced rate of
synthesis of one or more of the globin
polypeptide chains .
Classification
• α-Thalassaemias :-
2. Hydrops foetalis
3. Hb-H disease
4. α-Thalassaemia trait
• β-Thalassaemia :-
1. β-Thalassaemia major
7. β-Thalassaemia intermedia
8. β-Thalassaemia minor
Lab Investigations
• α-Thalassaemias :-
- Moderate anaemia ( Hb = 8-9 g/dl )
- Blood film :
Severe microcytosis
Hypochromia
Basophillic stippling
Target cells
Normoblasts
Lab Investigation
• β-Thalassaemia :-
- Anaemia severe
- Blood Film:
- Severe Microcytic hypochromic RBCs morphology
- Marked an isopoikilocytosis
- Basophilic stippling
- Presence of many target cells
- Tear drop cells
- Serum bilirubin (Unconjugated) raised
Lab Investigations
- Mild reticulocytosis
- HbH inclusions as Heinz bodies
- Hb electrophoresis –
2-4 % HbH
Remainder : HbA , HbA2 & HbF
• α-Thalassaemia trait :-
- Hb normal or reduced
- Blood film :
hypochromic red cell morphology
No evidence of haemolysis or anaemia
- MCV, MCH & MCHC INCREASED
- Hb ELECTROPHORESIS: Small amount of Hb-Bart’s in
neonatal period.
Lab Investigations
- Reticulocytosis present
- MCV, MCH & MCHC reduced
- WBC count raised
- Platelet Count normal or reduced in
patients with spleenomegaly
- Osmotic fragility decreased
- Hb electrophoresis: HbA2 increased , HbA
absent.
Lab Investigations
- Bone marrow examination :
Normoblastic erythroid hyperplasia with
predominance of intermediate & late
normoblasts
• β-Thalassaemia minor :-
- Mild anaemia
- Blood film shows anisopoikilocytosis ,
microcytes & hypochromia,basophilic
stippling with occasional target cells.
- Serum bilirubin normal or raised
Lab Investigations
- Mild reticulocytosis present
- MCV,MCH,MCHC reduced
- Osmotic fragility decreased
- Hb electrophoresis shows about two fold
increase in HbA2 & slight elevation in HbF
The Thalassaemias
• Management
– Regular transfusion
– Iron chelation
– Splenectomy
– Immunisation
– Bone marrow transplantation
• WCC differential –N
• Blood Film
Some causes of microcytic
anaemia…..
• Acquired
– Iron deficiency
– Anaemia of chronic disease
– Myelodysplastic syndromes
– Lead poisoning
More causes of microcytic
anaemia…..
• Inherited
– Beta Thalassaemia trait
– Beta Thalassaemia major
– Alpha Thalassaemia trait
– Sickle cell trait
– Congenital sideroblastic anaemia
Hypochromic Anaemia
Ferritin
Iron Sideroblastic
deficiency Haemoglobinopathy
Anaemia
Anaemia of
Chronic disorders Other causes of high
ferritin
What further details are
important in the clinical history?
• Dietary intake of iron
• Symptoms of malabsorption / weight loss
• Overt GI blood loss
• Menorrhagia
• Pregnancy
• Oral iron therapy
• Bleeding history/ family history of
bleeding disorder
Iron Requirements
• Rectum • Haemorrhoids
• Ulceration
• Carcinoma
Iron loss in pregnancy
• Obligatory iron loss 150-200
mg
• Fetal iron 200-370 mg
• Iron in placenta and cord 30-170
mg
• Iron in blood lost at delivery 90-310 mg