1. ANAEMI
A
Presenter:-
ROBIN GULATI

2. CONTENTS
Definition
Symptoms
Causes
Classification
Diagnosis
Treatment

3. Definition
 Reduced
concentration
of
haemoglobin
in the blood.
 The number
of red blood
cells in the
blood is low.

4. Normal haemoglobin levels
 Adult males: 130 to 180 grams per litre
 Adult females: 120 to 160 grams per litre
 Levels for children vary with age but are
generally 1 to 2 grams lower than adult
female values.

7. Causes of Anaemia
1. Anaemia from active bleeding:
 Heavy menstrual bleeding
 Wounds
 Gastrointestinal ulcers
 Cancers such as cancer of the colon

8. 2. Iron deficiency anaemia:
 Limited or inadequate iron due to
poor dietary intake
 Stomach ulcers or other sources of
slow, chronic bleeding (colon
cancer, uterine cancer, intestinal
polyps, haemorrhoids, etc.)- all lead
to slow loss of iron.

9. 3. Anaemia related to kidney
disease:
 Release of a hormone called the
erythropoietin (EPO) from kidney for
making red blood cells.
 Diminished production of erythropoietin
in kidneys.
 This is called anaemia related to chronic
kidney disease.

10. 4. Anaemia related to pregnancy:
 Water weight gain
during pregnancy dilutes the blood,
which may be reflected as anaemia.

11. 5. Anaemia related to poor nutrition:
 Vitamin B12 and folic acid are required for
the proper production of haemoglobin.
 Deficiency: inadequate production of red
blood cells.
 Poor dietary intake
 Strict vegetarians who do not take
sufficient vitamins are at risk to develop
vitamin B12 deficiency.

12. 6. Pernicious Anaemia: Poor absorption
of vitamin B12.
7. Sickle cell anaemia:
 Production of abnormal haemoglobin
molecules
 Crescent-shaped (sickle cells).
 There are different types of sickle cell
anaemia with different severity levels.

13. 8. Thalassemia:
 Cause quantitative haemoglobin
abnormalities
 An insufficient amount of the correct
haemoglobin type molecules is made.

14. 9. Alcoholism:
 Poor nutrition and deficiencies of
vitamins and minerals are associated
with alcoholism.
 Alcohol toxic to the bone marrow and
may slow down the red blood cell
production.

15. 10.Bone marrow-related anaemia:
 Anaemia may be related to diseases
involving the bone marrow.
 Some blood cancers such as leukaemia
or lymphomas can alter the production of
red blood cells and result in anaemia.

16. 11.Aplastic anaemia:
 Some viral infections may severely affect
the bone marrow and significantly
diminish production of all blood cells.
 Chemotherapy (cancer medications) and
some other medications may pose the
same problems.

17. 12.Haemolytic anaemia:
 Red blood cells rupture (known as
haemolysis) and become dysfunctional.
 Some forms of haemolytic anaemia can
be hereditary with constant destruction
and rapid reproduction of red blood cells.
 This type of destruction may also happen
to normal red blood cells in certain
conditions, for example, with abnormal
heart valves damaging the blood cells or
certain medications that disrupt the red
blood cell structure.

18. 13.Anaemia related to medications:
 Side effect in some individuals.
 The mechanisms are numerous
(haemolysis, bone marrow toxicity) and
are specific to the medication.
 Chemotherapy drugs used to treat
cancers.
 Seizure medications, transplant
medications, HIV medications, some
malaria medications, some antibiotics
(penicillin, chloramphenicol), antifungal
medications, and antihistamines.

19. Classification of Anaemia
Depending on the size of RBCs and
haemoglobin content:-
1. Hypochromic, microcytic anaemia
 Small red cells with low Hb
 Caused by iron deficiency
2. Macrocytic anaemia
 Large red cells
 Few in number

20. 3. Normochromic normocytic
anaemia
 Fewer normal sized red cells,
each with a normal haemoglobin
content

21. Based on concentrations of ferritin,
iron, vitamin B12 and folic acid in
serum:-
1. Deficiency of nutrients
necessary for haemopoiesis:-
 Iron
 Folic acid and vitamin B12
 Pyridoxine, vitamin C

22. 2. Depression of bone marrow
caused by:-
 Toxins (e.g. drugs in chemotherapy)
 Radiation therapy
 Diseases of the bone marrow
 Reduced production of, or
responsiveness to, erythropoietin (e.g.
chronic renal failure, rheumatoid
arthritis, AIDS

23. 3. Excessive destruction of RBCs
(haemolytic anaemia)
Causes include:
 Haemoglobinopathies (e.g. sickle
cell anaemia)
 Adverse reactions to drugs
 Inappropriate immune reactions

24. The Haematinic Agents
Erythropoieti
n
Iron
Vitamin B12
& Folic acid

25. Erythropoietin (EPO)
 Growth factor responsible for
erythropoiesis.
 Regulator of the proliferation of
committed progenitors (BFU- Burst
forming units, CFU- Colony forming
units)
 Absence of EPO: Severe anaemia

26. Deficienc Increased
Sensed release of
y of EPO from
by kidney
oxygen kidney
Activates Binds to
transcription surface
receptors of Bone
factors to committed marrow
regulate gene erythroid
expression progenitors
Stimulates
Proliferatio
expansion of
n and
erythroid
maturation
progenitors

28. Iron and Iron Salts
Daily requirements:-
 Adult male: 0.5-1 mg (13µg/kg)
 Adult female (menstruating): 1-2 mg
(21µg/kg)
 Infants: 60 µg/kg
 Children: 25 µg/kg
 Pregnancy (last 2 trimester): 3-5 mg (80
µg/kg)

29.  Important for the synthesis of
haemoblobin, myoglobin, cytochromes
and other enzymes.
 Major part of dietary iron is in ferric
form.
 Converted to ferrous form before
absorption.
 Two iron transporters present:-
 Divalent metal transporter 1 (DMT1):
Carries ferrous iron from intestinal
lumen to the mucosal cell.

30.  Mucosal block: excess iron from
mucosal cells oxidized to ferric form and
complexed with apoferritin to form
ferritin.
 Ferritin stored in mucosal cells and is
lost when they are shed (life span 2-
4days).
 Iron in plasma bound to transferrin and
used for erythropoiesis.

31. Vitamin B12 and Folic
Acid
 Necessary for DNA synthesis and
consequently cell proliferation.
 Dihydrofolate (FH2) and tetrahydro folate (FH4
) act as carriers and donors of methyl
group in metabolic pathways.
 FH4 acts as a cofactor and is essential
for synthesis of purines and
pyrimidines.
 Active FH4 form maintained by
dihydrofolate reductase (enzyme which
reduces dietary folic acid to FH4 and

32. Diagnosis
 Family history
 Previous personal history of anaemia or
other chronic conditions
 Medications
 Colour of stool and urine
 Bleeding problems
 Occupation and social habits (such as
alcohol intake)

33.  General appearance (signs of fatigue,
paleness), jaundice (yellow skin and eyes),
paleness of the nail beds, enlarged
spleen(splenomegaly) or liver
(hepatomegaly), heart sounds, and lymph
nodes.

34. Lab tests for anemia
1. Complete blood count (CBC):
 Determines the severity and type of
anaemia (microcytic anaemia or small
sized red blood cells, normocytic
anaemia or normal sized red blood
cells, or macrocytic anaemia or large
sized red blood cells) and is typically
the first test ordered.
 Information about other blood cells
(white cells and platelets) are also
included in the CBC report

35. 2. Stool haemoglobin test: Tests for blood
in stool which may detect bleeding from
the stomach or the intestines (stool
Guaiac test or stool occult blood test).
3. Peripheral blood smear: Looks at the
red blood cells under a microscope to
determine the size, shape, number, and
colour as well as evaluate other cells in
the blood.

36. 4. Iron level: An iron level may tell the
doctor whether anaemia may be related
to iron deficiency or not. This test is
usually accompanied by other tests that
measure the body's iron storage capacity,
such as transferrin level and ferritin level.
5. Transferrin level: Evaluates a protein
that carries iron around the body.
6. Ferritin: Evaluates at the total iron
available in the body.
7. Folate: A vitamin needed to produce red
blood cells, which is low in people with

37. 8. Vitamin B12: A vitamin needed to
produce red blood cells, low in people
with poor eating habits or in pernicious
anaemia.
9. Bilirubin: Useful to determine if the red
blood cells are being destroyed within the
body which may be a sign of haemolytic
anaemia.
10. Lead level: Lead toxicity used to be one
of the more common causes of anaemia
in children.
11. Haemoglobin
electrophoresis: Sometimes used when

38. 12. Reticulocyte count: A measure of new
red blood cells produced by the bone
marrow
13. Liver function tests: A common test to
determine how the liver is working, which
may give a clue to other underlying
disease causing anaemia.
14. Kidney function test: A test that is very
routine and can help determine whether
any kidney dysfunction exists.
15. Bone marrow biopsy: Evaluates
production of red blood cells and may be
done when a bone marrow problem is

40. Treatment
 Varies widely and depends on the cause
and the severity of anaemia.
 If anaemia is mild and is found to be
related to low iron levels, then iron
supplements may be given while further
investigation to determine the cause of the
iron deficiency is carried out.
 If anaemia is related to sudden blood loss
from an injury or a rapidly bleeding
stomach ulcer, then hospitalization and
transfusion of red blood cells may be
required to relieve the symptoms and

41.  Iron may be taken during pregnancy
and when iron levels are low.
 Oral iron: Fe sulfate, Fe gluconate, Fe
fumerate, Fe succinate, Fe ammonium
citrate, etc.
 Parenteral iron: Iron dextran (elemental
iron), Iron-sorbitol-citric acid complex.

42.  Parenteral iron is given in the following
conditions:-
 Oral iron is not tolerated: bowel upset
is too much.
 Failure to absorb oral iron:
malabsorption, inflammatory bowel
disease, rheumatoid arthritis.
 Non-compliance to oral iron.
 Severe deficiency with chronic
bleeding
 Rapid eryhthropoiesis

43.  Vitamin supplements in vit B12 and folic
acid deficiency.
 Pernicious anaemia: Monthly injections of
vitamin B12 are commonly used to replete
the vitamin B 12 levels.
 Drugs: Cyanocobalamin,
Hydroxycobalamin, Methylcobalamin.
 Duration of medication: initially 30-100
µg/day for 10days followed by 100 µg
weekly and then monthly for maintenance-
indefinitely or life long.

44.  Folic acid deficiency: oral therapy of folic
acid
 Therapeutic dose: 2-5 mg/day
 Prophylactic dose: 0.5 mg/day
 Erythropoietin deficiency/low levels
(chronic renal failure): Epoetin α,β
(recombinant human erythropoietin)
 I.V. or S.C. inj.
 25-100 U/kg s.c. or i.v.
 3 times a week (max. 600 U/kg/week)

45.  If alcohol is the cause of anaemia, then
in addition to taking vitamins and
maintaining adequate nutrition, alcohol
consumption needs to be stopped.