This document contains a report on anaemias submitted by five students to their lecturer. It defines anaemia, lists its parameters and causes. It describes different types of anaemias including hemorrhagic, aplastic, megaloblastic, pernicious, hemolytic, sickle cell and iron deficiency anaemia. It discusses the mechanisms, symptoms, classifications, treatment and other details of various anaemias in under 30 sections.

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Submitted by
Md.Fokhrul Islam Fahad
ID - 091893
25th
Batch
Shamima Akhter
ID - 091872
Md.Abid Hassan
ID – 091852
Sadia Afrin Aporna
ID – 091911
Md.Firoze Sultan
ID - 091844
Submitted to
Md.Shah Aziz
Lecturer of Phytochemistry -2
University of Development
Alternative (UODA)
Dhanmondi,Dhaka
CourseName: Phytochemistry- 2
CourseCode: PHARM1205
University of Development Alternative (UODA)
Dhanmondi ,Dhaka

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ANAEMIASANAEMIAS
ByBy
MD.FOKHRUL ISLAM FAHADMD.FOKHRUL ISLAM FAHAD

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Definition of Anaemia
 Anaemia may be defined as a reduction ofAnaemia may be defined as a reduction of
hemoglobin concentration per unit volume ofhemoglobin concentration per unit volume of
peripheral blood ,which is usually associated withperipheral blood ,which is usually associated with
the reduction of RBCthe reduction of RBC
 Parameters of AnaemiaParameters of Anaemia
 Hematocrit – Percentage of blood volume as RBCsHematocrit – Percentage of blood volume as RBCs
 Hemoglobin – Concentration of hemoglobin in bloodHemoglobin – Concentration of hemoglobin in blood
 Mean Corpuscular Volume (MCV) – Average size ofMean Corpuscular Volume (MCV) – Average size of
RBCRBC
 Mean Corpuscular Hemoglobin (MCH) – AverageMean Corpuscular Hemoglobin (MCH) – Average
hemoglobin content of RBChemoglobin content of RBC
 RDW – range of deviation around averageRDW – range of deviation around average

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Causes of AnaemiaCauses of Anaemia
 Excessive blood loss due to acute & chronicExcessive blood loss due to acute & chronic
hemorrhage.hemorrhage.
 Reduced production of RBC due to lack ofReduced production of RBC due to lack of
some factors which are necessary for RBCsome factors which are necessary for RBC
Production .Production .
 Certain disease & infections may produceCertain disease & infections may produce
anaemia.anaemia.
 Destruction of bone marrow.Destruction of bone marrow.
 Excessive blood cell destruction inExcessive blood cell destruction in
comparison to the production of blood .comparison to the production of blood .

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Mechanisms of AnaemiaMechanisms of Anaemia
 Marrow production defectsMarrow production defects
((hypoproliferationhypoproliferation))
 Low reticulocyte countLow reticulocyte count
 Little or no change in red cell morphology (aLittle or no change in red cell morphology (a
normocytic, normochromic anemianormocytic, normochromic anemia
 Red cell maturation defects (Red cell maturation defects (ineffectiveineffective
erythropoiesiserythropoiesis))
 Slight to moderately elevated reticulocyte countSlight to moderately elevated reticulocyte count
 Macrocytic or microcytic anemiaMacrocytic or microcytic anemia
 Decreased red cell survival (Decreased red cell survival (blood loss/blood loss/
hemolysishemolysis).).

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Symptom of AnaemiaSymptom of Anaemia

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CLASSIFICATION OF
ANAEMIAS
There are several types of anaemia:There are several types of anaemia:
1.1. HEMORRHAGIC ANAEMIAHEMORRHAGIC ANAEMIA
2.2. APLASTIC ANAEMIAAPLASTIC ANAEMIA
3.3. MEGALOBLASTIC ANAEMIAMEGALOBLASTIC ANAEMIA
4.4. PERNICIOUS ANAEMIAPERNICIOUS ANAEMIA
5.5. HEMOLYTIC ANAEMIAHEMOLYTIC ANAEMIA
6.6. SICKLE CELL ANAEMIASICKLE CELL ANAEMIA
7.7. IRON DEFICIENCY ANAEMIAIRON DEFICIENCY ANAEMIA
8.8. SECONDARY ANAEMIA (RENAL)SECONDARY ANAEMIA (RENAL)

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1. HEMORRHAGIC1. HEMORRHAGIC
ANAEMIA (BLOOD LOSS)ANAEMIA (BLOOD LOSS)
 ACUTEACUTE: Sudden loss of blood: Sudden loss of blood
 RBC Count decreased for 1 – 3RBC Count decreased for 1 – 3
daysdays
 RBCs are restored in 3 – 6 weeksRBCs are restored in 3 – 6 weeks
 CHRONIC BLOOD LOSSCHRONIC BLOOD LOSS ::
 They cannot absorb Fe enough toThey cannot absorb Fe enough to
form Hbform Hb
 Have Hypochromic, MicrocyticHave Hypochromic, Microcytic
Anaemia.Anaemia.

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2. APLASTIC2. APLASTIC
ANAEMIA:ANAEMIA:
 Aplastic Anaemia is characterizedAplastic Anaemia is characterized
by bone marrow aplasiaby bone marrow aplasia
 Aplastic anaemia occurs when theAplastic anaemia occurs when the
bone marrow produces too few ofbone marrow produces too few of
all three types of blood cellsall three types of blood cells
(RBC,WBC & platelets(RBC,WBC & platelets
 It is also characterized by theIt is also characterized by the
occurance of anaemia ,leucopeniaoccurance of anaemia ,leucopenia
& thrombocytopenia& thrombocytopenia

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CAUSES OF APLASTICCAUSES OF APLASTIC
ANAEMIA:ANAEMIA:
 Lack of functioning Red Bone Marrow, theLack of functioning Red Bone Marrow, the
hemopoietic tissue.hemopoietic tissue.
 History of specific infectious disease such asHistory of specific infectious disease such as
infectious hepatitisinfectious hepatitis
 By taking certain medications such as antibiotic &By taking certain medications such as antibiotic &
anticonvulsantsanticonvulsants
 By taking drugs which regularly cause bone marrowBy taking drugs which regularly cause bone marrow
depression, such as busulphan, vincristine, N-depression, such as busulphan, vincristine, N-
musterd etcmusterd etc
 Exposure to certain toxins, eg.heavy metalsExposure to certain toxins, eg.heavy metals
 Exposure to radiations , eg. X-ray, B-ray, Y-ray &Exposure to radiations , eg. X-ray, B-ray, Y-ray &
neutronsneutrons
 History of an autoimmune diseaseHistory of an autoimmune disease
 Inherited conditionInherited condition

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TREATMENT OFTREATMENT OF
APLASTIC ANAEMIA:APLASTIC ANAEMIA:
 The offending drug ,if any,should be stoppedThe offending drug ,if any,should be stopped
immediatelyimmediately
 Recurrent blood transfusion (whole blood) isRecurrent blood transfusion (whole blood) is
essentialessential
 Vigourous antibiotics (broad spectrum) shouldVigourous antibiotics (broad spectrum) should
be started immediately to prevent secondarybe started immediately to prevent secondary
infectioninfection
 Steroids e.g prednisolone 60mg/day may beSteroids e.g prednisolone 60mg/day may be
used for 6 weeks .Plus-bone marrowused for 6 weeks .Plus-bone marrow
stimulating agent –oxymetholone therapystimulating agent –oxymetholone therapy
-2.5mg/kg.body wt.may be given up 3-6 month-2.5mg/kg.body wt.may be given up 3-6 month
 Platelet transfusion for bleeding are requiredPlatelet transfusion for bleeding are required

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3. MEGALOBLASTIC3. MEGALOBLASTIC
ANAEMIA:ANAEMIA:
 Deficiency of Vit BDeficiency of Vit B1212 and or Folicand or Folic
Acid.Acid.
 Intrinsic Factor can also beIntrinsic Factor can also be
deficient.deficient.
 Production of Erythrocytes becomesProduction of Erythrocytes becomes
slow.slow.
 They remain large, hve odd shapesThey remain large, hve odd shapes
and are called ‘Megaloblasts’.and are called ‘Megaloblasts’.

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B12 metabolismB12 metabolism

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MEGALOBLASTIC ANAEMIA:MEGALOBLASTIC ANAEMIA:
 Intestinal Sprue or MalabsorptionIntestinal Sprue or Malabsorption
Syndrome can also cause this.Syndrome can also cause this.
 Megaloblasts are over sized,Megaloblasts are over sized,
anisocytic.anisocytic.
 They have fragile membranes andThey have fragile membranes and
rupture easily.rupture easily.

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CAUSES OF MEGALOBLASTICCAUSES OF MEGALOBLASTIC
ANAEMIA:ANAEMIA:
 Nutritional deficiency of vitamin B12 &Nutritional deficiency of vitamin B12 &
folic acid due to less intake.folic acid due to less intake.
 Lack of intrinsic factors in gastric secretionLack of intrinsic factors in gastric secretion
which is needed to absorb vitamin B12 fromwhich is needed to absorb vitamin B12 from
the gastrointestinal tract.the gastrointestinal tract.
 It is also associated with the type 1It is also associated with the type 1
diabetes ,thyroid disease.diabetes ,thyroid disease.
 This anaemia is caused due to increasedThis anaemia is caused due to increased
demand of nutrition duringdemand of nutrition during
pregnancy,malignancy,leukemia lymphomapregnancy,malignancy,leukemia lymphoma
& Inflammatory disorders etc.& Inflammatory disorders etc.

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Megaloblastic AnaemiaMegaloblastic Anaemia
 Macrocytic RBCMacrocytic RBC
 HypersegmentedHypersegmented
NeutrophilNeutrophil
 TREATMENT:TREATMENT:
Vitamin B12Vitamin B12
Folic Acid if it isFolic Acid if it is
nutritional.nutritional.

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4. HEMOLYTIC4. HEMOLYTIC
ANEMIASANEMIAS
 Mostly heriditary.Mostly heriditary.
 Cells are fragile, rupture easily asCells are fragile, rupture easily as
they move through the capillaries.they move through the capillaries.
 The life span of erythrocytes isThe life span of erythrocytes is
reduced.reduced.
HERIDITARY SPHEROCYTOSIS:HERIDITARY SPHEROCYTOSIS:
 Small spherical erythrocytes.Small spherical erythrocytes.
 Cannot be compressed even slightlyCannot be compressed even slightly
 Rupture and are lysed very easily.Rupture and are lysed very easily.

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5. Pernicious anemia5. Pernicious anemia
 The fundamental defect inThe fundamental defect in
pernicious anaemia is a failure ofpernicious anaemia is a failure of
secretion of intrinsic factor by thesecretion of intrinsic factor by the
stomach due to permanent atrophystomach due to permanent atrophy
of the gastric mucosa.of the gastric mucosa.
 Gastric atrophy is the end result ofGastric atrophy is the end result of
complex interaction betweencomplex interaction between
genetic & autoimmune Factors.genetic & autoimmune Factors.
 This type of Anaemia is occurredThis type of Anaemia is occurred
due to vitamin B12 deficiency.due to vitamin B12 deficiency.

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Pernicious anemiaPernicious anemia
 Diagnostic featuresDiagnostic features
 SerumSerum antibodiesantibodies to intrinsic factor/parietal cellsto intrinsic factor/parietal cells
are highly specific for pernicious anemia.are highly specific for pernicious anemia.
 ↑↑ serumserum homocysteine and methyl malonichomocysteine and methyl malonic
acidacid levels (levels (more sensitivemore sensitive than serum vitaminthan serum vitamin
B12 levels)B12 levels)
 Clinical CourseClinical Course
 atherosclerosis and thrombosisatherosclerosis and thrombosis
((↑↑homocysteine)homocysteine)
 ↑↑ incidence of gastric cancerincidence of gastric cancer

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6. SICKLE CELL6. SICKLE CELL
ANEMIAANEMIA
 Affects 0.3 to 1% of West African &Affects 0.3 to 1% of West African &
African blacks.African blacks.
 The Beta chains of Hemoglobin areThe Beta chains of Hemoglobin are
defective.defective.
 They have Hb SThey have Hb S
 Sickling occurs when Hb loses Oxygen.Sickling occurs when Hb loses Oxygen.
 A vicious circle of events occurs:A vicious circle of events occurs: 
Oxygen tensionOxygen tension  SicklingSickling  Rupture ofRupture of
ErythrocytesErythrocytes 
FurtherFurther  Oxygen tensionOxygen tension
 This is called a crisis in sickle cellThis is called a crisis in sickle cell
disease.disease.

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Sickle cellsSickle cells
 Molecular aggregationMolecular aggregation
of Hgb-Sof Hgb-S
 SS, SC, S-thalSS, SC, S-thal
 rarely S-traitrarely S-trait

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ERYTHROBLASTOSISERYTHROBLASTOSIS
FETALISFETALIS
 Rh Isoimmunisation causes thisRh Isoimmunisation causes this
diseasedisease
 Antigen antibody reaction causesAntigen antibody reaction causes
lysis of erythrocytes.lysis of erythrocytes.
 Seen in Neonates and is also calledSeen in Neonates and is also called
Icterus Gravis Neonatorum.Icterus Gravis Neonatorum.
 Excess Bilirubin enters the brain,Excess Bilirubin enters the brain,
causing ‘kernicterus’causing ‘kernicterus’
 Can become fatal.Can become fatal.

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IRON DEFICIENCYIRON DEFICIENCY
ANEMIAANEMIA
 The most common type of anemiaThe most common type of anemia ..
 Caused by nutritional deficiency of Iron.Caused by nutritional deficiency of Iron.
 Erythrocytes are smaller and have lessErythrocytes are smaller and have less
Hb.Hb.
 So they are called Microcytic &So they are called Microcytic &
Hypochromic.Hypochromic.
 Treated by taking Iron rich diets.Treated by taking Iron rich diets.
 Dark green leafy vegetables: espDark green leafy vegetables: esp
Drumstick leaves.Drumstick leaves.
 Meats like Liver & spleen.Meats like Liver & spleen.

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IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
 Facts and FiguresFacts and Figures
 Most common cause of anemiaMost common cause of anemia
 500 million cases worldwide500 million cases worldwide
 Prevalence is higher in less developed countriesPrevalence is higher in less developed countries
 Unique Physical Exam findingsUnique Physical Exam findings
 CheilosisCheilosis
 fissures at the corners of the mouthfissures at the corners of the mouth
 KoilonychiaKoilonychia

spooning of the fingernailsspooning of the fingernails

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Iron def. AnemiaIron def. Anemia
 Low Retic countLow Retic count
 High RDWHigh RDW
 Due to chronic bloodDue to chronic blood
lossloss
 Diet deficiencyDiet deficiency

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 Increased demand for ironIncreased demand for iron
and/or hematopoiesisand/or hematopoiesis
 Rapid growth in infancyRapid growth in infancy
or adolescenceor adolescence
 PregnancyPregnancy
 Erythropoietin therapyErythropoietin therapy
 Increased iron lossIncreased iron loss
 Chronic blood lossChronic blood loss
 MensesMenses
 Acute blood lossAcute blood loss
 Blood donationBlood donation
 Phlebotomy as treatmentPhlebotomy as treatment
for polycythemia verafor polycythemia vera
 Decreased iron intake orDecreased iron intake or
absorptionabsorption
 Inadequate dietInadequate diet
 Malabsorption fromMalabsorption from
disease (sprue, Crohn'sdisease (sprue, Crohn's
disease)disease)
 Malabsorption fromMalabsorption from
surgery (post-surgery (post-
gastrectomy)gastrectomy)
 Acute or chronicAcute or chronic
inflammationinflammation
Causes of Iron DeficiencyCauses of Iron Deficiency

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IRON RICH DIETSIRON RICH DIETS

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SECONDARYSECONDARY
ANEMIA(RENAL)ANEMIA(RENAL)
 Renal Diseases can causeRenal Diseases can cause
decreaseddecreased ErythropoietinErythropoietin ..
 Erythropoietin is essential forErythropoietin is essential for
proper production of erythrocytesproper production of erythrocytes
(Erythropoiesis)(Erythropoiesis)
 Renal disease thus causes Anemia.Renal disease thus causes Anemia.

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ANEMIA: EFFECTS ONANEMIA: EFFECTS ON
CVSCVS
 Decreased Blood ViscosityDecreased Blood Viscosity
 Decreased Peripheral Resistance.Decreased Peripheral Resistance.
 Increased blood flow to tissuesIncreased blood flow to tissues
 Increased Venous Return.Increased Venous Return.

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 So increased Cardiac Output.So increased Cardiac Output.
 Hypoxia causes peripheralHypoxia causes peripheral
vasodilatation which furthervasodilatation which further
increases blood flowincreases blood flow
 Higher work load on the heartHigher work load on the heart
 Cardiac Reserve decreases.Cardiac Reserve decreases.
ANEMIA: EFFECTS ONANEMIA: EFFECTS ON
CVSCVS

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 Anemia is a decrease in either Hb or RBCs.Anemia is a decrease in either Hb or RBCs.
 Types of Anemia:Types of Anemia:
 HemorrhagicHemorrhagic
 AplasticAplastic
 MegaloblasticMegaloblastic
 PerniciousPernicious
 HemolyticHemolytic
 Sickle CellSickle Cell
 Iron deficiencyIron deficiency
 Secondary (Renal)Secondary (Renal)
REVIEWREVIEW

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Questions?

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