Anemia

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ANEMIA

DEFINITION
A condition in which the number of red blood cells or
their oxygen-carrying capacity is insufficient to
meet physiologic needs, which vary by age, sex, altitude,
smoking, and pregnancy status.
(WHO)
PREVALENCE
Anemia is a major killer

WHO estimates that 42% of children less than 5 years of age and
40% of pregnant women worldwide are anemic

40– 60% of maternal deaths in developing countries due to anemia

Affects both adults and children of both sexes.

Pregnant women and adolescent girls are more susceptible and


more affected by anemia.
RISK FACTORS OF ANEMIA
Poor socio-economic class

Age

Teenage pregnancy

Menstrual problems

Multiparity

Kidney disease etc…


ERYTHROPOIESIS
PATHOPHYSIOLOGY

↓ in RBCs, Diminished Hypoxia and Signs and


Hb or HCT oxygen hypoxia- symptoms of
level carrying induced anemia
capacity effects on
the organ
function
ETIOLOGY
SYMPTOMS (COMMON)

GENERAL
Fatigue
Unusual rapid heart beat ,
particularly with exercise
Exertional dyspnea
Headache
Dizziness
Pale skin
Leg cramps
Insomnia
Lack of concentration
SYMPTOMS (SPECIFIC)

ANEMIA DUE TO VITAMIN


IRON DEFICIENCY ANEMIA B12
Pica “Pins and needles” sensation
koilonychias at hands and feet
(Paraesthesia)
Soreness of mouth with cracks Lost sense of touch
at corners
A wobbly gait and difficulty
walking
Clumsiness and stiffness of
legs and arms
Dementia
Hallucinations
Paranoia
SIGNS
General
Brittle nails
Koilonychias
Atrophy of papillae of the tongue aka
glossitis
Brittle hair
Dysphagia
Plummer-Vinson syndrome
CLASSIFICATION
Blood loss

Based on etiology Impaired production


(Hypoproliferative)

Increased destruction
(Hemolytic)

Normocytic

Based on Microcytic
morphology

Ane Macrocytic
mia
Anemia (based on
morphology)
Normochromic- Normochromic-
normocytic anemia macrocytic anemia
Normal MCV and normal MCHC High MCV and normal MCHC

Includes anemia of chronic Includes folate deficiency,


diseases, hemolytic anemias, vitamin B12 deficiency anemias
anemia of acute hemorrhage,
aplastic anemias

Hypochromic-microcytic
anemia
Low MCV and low MCHC
Includes (iron deficiency anemia,
thalassemia's, anemia of chronic
diseases)
BASED ON CLINICAL PICTURE
Iron deficiency anemia

Megaloblastic anemia

Pernicious anemia

Hemorrhagic anemia

Hemolytic anemia

Thalassemia anemia

Sickle cell anemia

Aplastic anemia
Ane
Iron deficiency anemia
Excessive loss of iron, women are at risk (menstrual blood and fetus growth)
Megaloblastic anemia
Less intake of vitamin B12 and folic acid, Bone marrow produce abnormal
RBCs e.g. cancer drugs
Pernicious anemia
Inability to absorb vitamin B12
Hemorrhagic anemia
Excessive loss of RBCs through bleeding, stomach ulcers, menstruation
Hemolytic anemia
RBCs plasma ruptures due to parasites, toxins, antibodies
Thalassemia anemia
Less synthesis of hemoglobin (population of Mediterranean sea)
Sickle cell anemia
Hereditary blood disorders
Aplastic anemia
Destruction of red bone marrow; cause by gamma radiation, toxins
LAB INVESTIGATIONS
Red cells population is defined by;
Qualitative parameters
MCV
MCH
MCHC
Quantitative parameters
HCT
Hb
Red cell concentration per unit volume
Normal hemoglobin values
The increased amounts of iron required by pregnant or lactating women are
difficult to obtain through diet alone; thus, oral iron supplementation
generally is necessary
Desired outcomes
The ultimate goals of treatment in the anemic
patient are
To alleviate signs and symptoms
Correct the underlying etiology
Prevent recurrence of anemia
PREVENTIVE MEASURES
Coffee and tea
Inhibit iron absorption when consumed with a meal or shortly after meal
Conti…
Vitamin C
Powerful enhancer of iron absorption from nonmeat meal when
consumed with a meal
Conti…
Iron rich foods
Spinach, dried fruits, kidney
beans, egg, red meat,
chocolate etc…

Germination and fermentation


of cereals and legumes
improve the bioavailability of
iron by decreasing the content
of phylate
Conti…
Promote and support breastfeeding
exclusively for 6 months followed by breastfeeding with complementary
foods, including iron-rich through the 2nd year of the life
MANAGEMENT
Disease-
specific
Aim of manageme
treatment nt
depending
Normalize upon
Hb and red underlying
cell indices; etiology
Lifestyle replenish
management iron sources
Patients with
iron deficiency
should receive
dietary advice
Investigation
of serious
underlying
cause (e.g.
Determine cancer)
Care the etiology
objectives
PHARMACOLOGICAL
TREATMENT
Treatment
of anemia

Oral iron Parenteral Blood


supplements transfusions

Injectable Human
iron recombinant
erythropoietin
Treatmentimp
Iron deficiency anemia
Oral iron therapy with soluble ferrous iron salts, which are
not enteric coated and not slow- or sustained-release, is
recommended at a daily dosage of 200 mg elemental iron in
two or three divided doses

Diet plays a significant role because iron is poorly absorbed


from vegetables, grain products, dairy products, and eggs

Iron is best absorbed from meat, fish, and poultry.

Administration of iron therapy with a meal decreases


absorption by more than 50% but may be needed to
improve tolerability

Rise in Hb – 0.8 gm/dl/week


Side effects: nausea, vomiting, constipation, abdominal
pain, dark stools..
Oral iron products
Parenteral iron may be required for patients
with iron malabsorption, intolerance of oral
iron therapy, or noncompliance.
Available parenteral iron preparations have
similar efficacy but different
pharmacologic, pharmacokinetic, and
safety profiles.
Sodium ferric gluconate (62.5 mg iron/5ml)
and iron sucrose (20mg iron/ml), appear to
be better tolerated than iron dextran (50
mg iron/ml)
Vit B12 deficiency anemia
Oral vitamin B12 supplementation are as effective as
parenteral

Oral cobalamin is initiated at 1-2 mg daily for 1 to 2


weeks, followed by 1 mg daily

Parenteral therapy is more rapid acting than oral


therapy and should be used if neurologic symptoms
are present.

A popular regimen is cyanocobalamin 100 mcg daily


for 1 week, then weekly for 1 month, and then monthly

When symptoms resolve, daily oral administration can


be initiated
Folate deficiency
Oral folate 1 mg daily for 4 months is
usually sufficient

If malabsorption is present, the daily


dose should be increased to 5 mg
Anemia of chronic diseases
Treatment of anemia of chronic disease →
less specific than that of other anemias and
should focus on correcting reversible causes

Erythropoietin stabilizing agents → epoeitin


alfa and darbepoitin alfa

RBC transfusions are effective but should be


limited to episodes of inadequate oxygen
transport and severe reduction in Hb
ACCORDING TO WHO, “Transfusions should
be prescribed ONLY for conditions for which
there is NO OTHER TREATMENT”

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