Anemia Introduction

INTRODUCTION TO
ANAEMIAS
ENAAM HUSSEIN, PHD

16.10.1016
DEFINITION:
Anaemia is a condition in which the Hb

concentration of the red blood cells or
the packed cell volume (haematocrit) of
red cells is below the lower limit of the
normal range for the individual’s age,
gender, and geographical location.
HAEMOGLOBIN (HB)
Cord blood: have high concentration 
16.5 – 19.5 g/dl or up to 21/g/dl.
Children: same in males and females

“ 6 months up to 6 years” 11-14 g/dl.
Adult male  12.5 – 16.5 g/dl.

Adult female  11.5 – 15.5 g/dl.
ANAEMIA CAN ALSO BE
DEFINED AS: -
A reduction of RBCs mass below the
normal lower limit.
Physiological definition:
It is a condition in which the
circulating blood lack the ability to
adequately oxygenate the body
tissues.
CLASSIFICATION:
Anaemia can be classified depending on

either:
1)Morphology (on Red cell indices)
2) Etiology (its causes).

A) MORPHOLOGICAL
CLASSIFICATION:
2. It bases on the RBCs morphology
or red cell indices (MCV, MCH,
MCHC))
There are three types of anaemia:-
• Normocytic
• Microcytic
• Macrocytic
CONTI.
Reference values of red cell indices:-
MCV  76 – 96 fl.
MCH  27 – 32 pg  (Hb) in one RBC.
MCHC  32 – 36 g/dl  in 100 ml of
blood.
1. NORMOCHROMIC, NORMOCYTIC
ANEMIA
(normal MCHC, normal MCV)
it indicates reduction in the RBCs number
Anemias of chronic diseases
Hemolytic anemias
Acute blood loss, e.g., accident.
A plastic anemias
 Haematological malignancies, e.g.,
leukaemia  in which the tissue of
haemopoiesis is replaced by leukaemia
cells.
2. MICROCYTIC
HYPOCHROMIC ANEMIA
(low MCHC, low MCV),

e.g:
 Iron deficiency anemia
 Thalassaemias
 Anemia of chronic disease
 Sideroblastic anaemia
3.NORMOCHROMIC,
MACROCYTIC ANEMIA
(normal MCHC, high MCV):
 Megaloblastic anaemia:
 Vitamin B12 deficiency
 Folate deficiency
 Pernicious anaemia
B) ETIOLOGICAL CLASSIFICATION
(KINETIC)
It is related to a causative agent.
ETIOLOGICAL
CLASSIFICATION):
CAUSES OF ANAEMIAS
1. BLOOD LOSS:
Acute blood loss:

In which a large amount of blood is lost
for a short period of time, it is
associated with normocytic
normochromic anaemia.
CONTI.
Chronic “Persistent” Blood Loss:
in which a small amount of blood is lost
for a long period of time as seen in ulcer,
uterus problems and schistosomasis,
-It is associated with microcytic
hypochromic anaemia.
2.IMPAIRED RBCS FORMATION:
It is caused by:
-Deficiency of essential haemostatic
substance
e.g. iron, folic acid, vitamin B12, minerals
and protein.
folic acid are essential  for DNA
synthesis.
Minerals, iron and protein are essential  for
Hb synthesis.
-Anemia due to chronic infection: e.g.
Tuberculosis (TB).
CHRONIC DISEASES
- Renal diseases:
chronic renal failure “CRF” can be
associated with anemia.
In Renal Failure the reduction of
erythropoietin hormone and folic acid
deficiency can lead to anaemia.
CON.
-Liver diseases:
-Liver is responsible for the protein and
coagulation factors formation
- 40% of thrombopoiotin hormone is
found in liver and its loss leads to
problems in the platelets.
- In liver disease there is a reduction of
the stored folic acid and iron.
CON.
-Hypothyroidism:
it leads to  of thyroxin which aids
in the cell formation and maturation.
CON.
-Malignancies:
Any cancerous cell needs folic acid (for
DNA) , iron, vitamin B12 and oxygen to
divide and this leads to anaemia.
Bone marrow (B.M)
infiltration
In which abnormal cells replace the
normal cells of B.M.
The B.M is composed of normal
haemopoitieic cells, fats and matrixes,
but it can be replaced by lymphoma,
myeloma or leukaemias which are
known as haematological malignancies.
3. INCREASED RBCS
BREAKING DOWN:
Normal life span is 100 – 120 days, in
the pathologic cases, the life span can
be 30-50 days.
CON.
There are 2 types of RBCs breaking
down:
•Inherited or congenital haemolytic
anaemia:
- Sickle cell anaemia.
- Thalassaemia.
•Acquired haemolytic anaemia:
- Malaria “ common in Sudan”.
- Autoimmune haemolytic anaemia.
-*Alloimmune haemolytic anaemia is seen in
case of :
 blood transfusion
 haemolytic diseases of newborn “HDN”
*Alloimmune haemolytic anaemia caused
by a foreign Antigen from the same spp e.g.,
human  human.
Physiological adaptation of
anaemia
PHYSIOLOGICAL ADAPTATION:
DEPENDS ON
1)Onset of anaemia: if anaemia develops
gradually, body can adapt that, but rapid
development of anaemia is dangerous.
2)Age of patients: Young people can
adapt with anaemia better than old age
patients. This in part is due to their
normal cardiovascular system
Anaemia is associated with hypoxia:
Hypoxia is the the main problem of
anemia.
Hypoxia is the reduction of oxygen
supplement to tissue.
ADAPTATION TO
ANAEMIA IS VIA :
(1) Decreased hemoglobin- oxygen affinity:
-increase release of oxygen from RBCs to
tissues. Brain, kidney and muscles.
-The increase release of oxygen lead to
increased concentration of deoxyhemoglobin
in the RBCs, which stimulates the production
of 2,3-diphosphoglycerate (2,3-DPG)
CON.
Then the  globin chain separate from
each other and oxygen is released from
haem molecules.
2,3 DPG  is produced from the
glucose destruction by the RBCs
CON.
2) Increase of blood flow to the tissues
which leads to palpitation.
3) Maintains the blood volume by
shifting of the extravasclar fluids into
the vessels to prevent hypovolumia.
CON.
4) Redistribution of blood flow for the vital
organs on the expense of skin which make
the patient look pale .
CLINICAL
PRESENTATION
Headache
pallor
Faintness
Heart palpitations
Slight fever
Other signs that are associated with a
specific type of anaemia
LABORATORY
DIAGNOSIS
1)Quantitative tests:
Hb
PCV
RBCs count
Red cell indices: MCV, MCH and
MCHC.
Red cell distribution width (RDW)
CONT.
 Hb estimation:
 Red cell indices (MCV, MCH,
MCHC): Calculated from the Hb,
PCV, RBCs count.
 White Blood Cells and platelets
count: Help in distinguish pure
anemia from pancytopenia.
 Reticulocytes count: Reflect the
production of RBCs.
2) SEMI-QUANTITATIVE
TESTS:
Examination of Peripheral blood
film:
 Observation of erythrocyte
abnormalities
Semi-quantitative grading of
erythrocyte morphology:
Descriptive: mild, moderate, severe
Numerical: 0, +1, +2, +3, +4.
CONTI.
 examine the WBCs morphology and
differential count.
 examine the Platelet number and
morphology.
Bone marrow examination:
It is not essential to examine the bone marrow
in all cases of anemia.
a) Bone marrow examination performed by
aspiration or trephine biopsy.
b) Aspiration: provide a smear in which:
- Developing cells can be examined.
- Myeloid: Erythroid ratio assessed.
- Cellularity of marrow examined.
- Presence of foreign cells.
- Iron status.
3)SUPPLEMENTARY
(SPECIAL TESTS):
Haematological tests
-Hb electrophoresis.
-Sickling test.
Non-haematological:
- Serum iron.
- Serum bilirubin.

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INTRODUCTION TO

ENAAM HUSSEIN, PHD

Anaemia is a condition in which the Hb

Children: same in males and females

Adult male  12.5 – 16.5 g/dl.

Anaemia can be classified depending on

1)Morphology (on Red cell indices)

2) Etiology (its causes).

(low MCHC, low MCV),

Acute blood loss:

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