Anaemia

What is Anaemia?
- Haemaglobin concentration below the
normal range.
(Normal 13.5 -15 for male and
11.5 -13.5g/dl for Female)

Blood

Red cells
White cells
Plaletes

Produced from
Bone marrow

 Red cells are produced from Erythroblasts

- made up of Haemoglobin in cytoplasm
walled off by red cell membrane
RBC has no nucleus, Biconcave shape
- Haemoglobin is made up of Haem + Globin
- Globin gives the shape and functional
ability to haem for carriage of O2

Biconcave shape RBC provide large surface

uptake and release of O2 and co2

for

Anaemia could be
Mild
- Hb -- 9-11.5 g/dl
moderate - Hb -- 7-9.0 g/dl
severe
- Hb -- 4 - 7g/dl
very severe - Hb < 4g/dl
Hb does the main function of RBC that is carrying
O 2 and Co2

There are three main types of Hb depending

on the type of globin
1. HbA 97% of Hb 2 2 in adults
2. HbA2 - 1.32% of Hb 22 in adults
3. HbF(2,2) - < 1% of Hb 2,2 in adults
(Foetal life in higher amount)

How anaemia occurs?

Intake of adequate nutritionFe,B12, B6, folate,Cu & trace
eliments in meals

Normal digestion &

absorption in the GUT

Carried in blood

Bone marrow
-Enough Stem cells

Spleen

-Enough space

Carried
all over
the body
within
vessels

RBC
in
blood
for
120
days

-Enough influensing
hormornes
Normal Genetic
material for Hb & RBC
membrane production

If any problems in any of these sites leads to anaemia

Problem in intake of nutrition

Low Fe++ containing diet For Hb
Low B12 containing diet
Low B6 containing diet
Low Folate containing diet
Low trace eliments
All these leads to Anaemia as these are important
to produce Hb and red cell production.

Problems in the Gastro intestinal system

leading to
- poor digestion and or
- poor absorption of essential nutrients that
is important for Hb and RBC production.
Problems in carriage of these nutrition in
the blood
-Due to problems in the carrier proteins

Problems in the bone marrow

Pure marrow problems are
Poor number of Stem cells in the marrow
Reduced space in the marrow because of
replacement of the marrow by fibrous
tissue or cancer.
Other contributing factors are
Reduction of helping hormones Eg-:
Erythropoitin , Thyroxin

Bone marrow prob..

Genetically controlled problems of Hb and
red cell membrane production.
1. Hb abnormality Thalassaemia
-- Sickle cell disease
Abnormal Hb also changes the shape of
RBC and function of Hb.
2. RBC membrane abnormality
Spherocytosis,
Eliptocytosis
This also changes the shape of RBC
Abnormal RBC are ruptured in spleen in large
numbers because of rigidity of membrane.

Shorter lifespan of RBC

Occurs in abnormal Hb and abnormal cell
membrane of genetic conditions.
Abnormal antibody production against
RBC.
-Autoantibody formation.
-This also make the RBC more vulnerable for
destruction by spleen.

 Abnormally large spleen causing

destruction of large number of RBC.
-- Hypersplenism.
Abnormal leakage of Blood through the
blood vessels in the Gastrointestinal
system or uterus or form other sites
-vomiting of blood, Bleeding per rectum
Worm infestationAbnormal RBC are
ruptured in spleen in large number

1.
2.
3.
4.
5.
6.
7.
8.

If Mr Sundarm has anaemia, what are the

symptoms he will have?
A. Symptoms of anaemia
Poor tolerance with Exercise
Difficulty in breathing on exercise
Palpitation on exercise
Feeling of faintishness
Pounding in ears
Lethaginess
Poor mental concentration
Oedema may occur if the is cardiac failure due
to anaemia or associated hypoalbuminaemia

 B. Symtomes of the causes of anaemia

If due to Poor digestion and absorption
large bulky and offensive stools
Difficult to flush out the stool
Other symptoms of vitamin deficiency

 What physical examination you will look for?

Signs of anaemia itself
Pale looking skin, conjuntiva,palms & sole
Signs of complications of anaemia
Oedema of feet, elevated JVP, enlarged
congested liver.
Signs of underlying cause of anaemia
If anaemia is due to due to nutritional deficiency
ther will be evidence of other nutritional
deficiency- vit A, Protein

 If due to pure bone marrow failure due to

marrow infiltration there will be evidence of
problem related te platelet and white cell
reduction
Eg-:- Bleeding from Gum, red purpuric
patches over the body
-Infection of skin and oral cavity
- Spleen or lymph node enlargement.
If marrow failure is due to absence of stem cells
spleen will not enlarge.
If due to Short life span of RBC- Haemolysis
there will be yellow discolouration of sclera and
enlarged spleen

Fe deficiency
Symptoms
1. Symptoms anaemia
2. H/o poor intake of green leaves
meat & meat products
3. Symptoms of poor digestion
large bulky stools
4. Symptoms blood loss
burning abdominal pain, vomiting of
blood, passing blood stained stools
5. Symptoms of heavy period

O/E
Signs of anaemia
Signs of Fe deficiency
Smooth tongue glossitis
Ulceration of corner of lips- Angular stomatitis
Flat or spoon shaped nail
Feature of other deficiency
- Bitots spots- Vit A deficiency
Evidence of sites of bleeding
Pain over upper abdomen
Signs of underlying disease that causes
bleeding-through GIT- Mass in the abdomen
Per Rectal bleeding with Mass