Nurliyana ramli

Anaemia
 Definition
• Defined as low hb concentration and may be
either due low red cell mass, or increased in
plasma volume (eg in pregnancy)
 Cause of anaemia
Decreased /ineffective Normal marrow prod. But
marrow production increased removal of
- Lack or iron, vit B12 / cells
folate -blood loss
- Malignancy -hemolysis
- Renal failure -hypersplenism
- Anemia of chronic -Tropic area , hookworm
disease
 Dx of anaemia
• Dietary habits
• Medications
• Possible exposure to chemicals/toxins
• Description and duration of symptoms
- tiredness
-headache and vertigo
- Difficult or labour breathing from exertion
- GI problem
- Overt sx of blood loss ( blood in urine, blackish stool)
 Dx of anaemia
Physical ex
• General findings
- Hepato or splenomegaly
- Heart abnormalities
- Skin pallor
• Spesifics findings
- Vit B12 def -> malnutrition sx and neurological changes
- Iron def -> severe pallor , smooth tongue
- Haemolytic anemia -> jaundice due to increase bilirubin from
RBC destruction
 Iron deficiency anaemia (IDA)

Clinical Manifestations
- Most common: pallor
- Second most common:
• inflammation of the tongue
(glossistis)
• Cheilitis=inflammation/fissure
s of lips
• Sensitivity to cold
• Weakness and fatigue
Diagnostic Studies
• FBC
• Iron studies Diagnostics:
Iron levels: Total iron-binding capacity
(TIBC), Serum
Ferritin.
• Endoscopy/Colonscopy
 Management
• Treat the cause
• Diet
• Drug th/
- T. Ferrous fumarate 200mg BD PO
(SE: nausea, abdominal discomfort, constipation, black stool)
* Cont until Hb normal or at least 3 months
- Parenteral iron
Almost never needed, indicated if oral route impossible or
ineffective eg: functional iron def in chronic renal failure
 MEGALOBLASTIC ANEMIAS
• Characterized by large RBCs
which are fragile and easily
destroyed
• Common forms of
megaloblastic anemia
1. Cobalamin deficiency
2. Folic acid deficiency
This picture shows large, dense,
oversized, red blood cells (RBCs)
that are seen in megaloblasticanemia
 COBALAMIN (VITAMIN B12)
DEFICIENCY

• formerly known as PERNICIOUS ANEMIA

• Vitamin B12 (cobalamin) is an important
watersoluble vitamin.
• Intrinsic factor (IF) is required for cobalamin
absorption
Causes of cobalamin deficiency
- Gastric mucosa not secreting IF – pernicious anemia
- GI surgery , loss of IF-secreting gastric mucosal cells
- Long-term use of H2-histamine receptor blockers cause
atrophy or loss of gastric mucosa.
- Nutritional deficiency (vegans)
- Hereditary defects of cobalamine utilization
 COBALAMIN (VITAMIN
B12) DEFICIENCY

• Clinical manifestations
General symptoms of anemia
Sore tongue
Anorexia
Weakness
Parathesias of the feet and hands
Altered thought processes
Confusion / dementia
 COBALAMIN DEFICIENCY
DIAGNOSTIC STUDIES
• RBCs appear large
• Abnormal shapes
• Schilling Test: a medical investigation used for
patients with vitamin B12 deficiency. The
purpose
of the test is to determine if the patient has
pernicious anemia.
 COBALAMIN (VITAMIN
B12) DEFICIENCY

Treatment
- Treat the cause
- Most cases need IM hydroxocobalamine (B12)
1mg , alternate day for 2 weeks (if with CNS
signs until improvement)
- Then maintainance every 3 months for life
- If causes is dietary -> Oral B12 given
 Thalassemia
Def : genetic disease of unbalanced Hb synthesis
, as if underproduction (or no pruduction of
globin chains ), unmatched globins
precipitated damaging RBC membraned 
haemolysis while still in the marrow
Thalasemia facies in b thalasemia
major (cooley’s anemia)
Due to extramedullary
erythropoiesis
- Frontal bossing
- Maxillary hypertrophy
- Depression of nasal
bridge
- Maloocclusion of teeth
@chipmunk face
Aplastic anemia