Anemia Its quantitative or qualitative reduction in RBC

Anemia Its quantitative or qualitative reduction in RBC count, leading to decreased oxygen carrying capacity It is characterised by: Reduction in the number of RBC (less than 4 millions/cu mm) and/or Decreased concentration of hemoglobin (less than 12 gm%)

Features: seen in anemic patients § Tiredness, easy fatiguability & generalized muscular weakness § Pallor-nail beds, conjuctiva, mucous membrane & skin are paler § Dysnoea on exertion with palpitations § Haemic murmers (due to increased velocity of blood flow) § High output failure § Angina inolder patients § Intermittent claudication § Amenorrhea may develop in women § Anerexia in some persons

Anemia Morphological Etiological § Normocytic normochomic -Due to production of RBC § Macrocytic normochomic -Due to excess loss of blood § Macrocytic hypochromic -Due to destruction of RBC § Microcytic hypochromic

I. Anemia's due to decreased production of erythrocytes: 1. Nutritional deficiancy anemia - megaloblastic anemia - iron deficiency anemia 2. Hypoplastic anemia 3. Chronic renal failure/chronic inflammatory disease 4. Aplastic anemia

II. Anaemia due to blood loss 1. Acute hemorrhage 2. Chronic hemorrhage

III. Anaemia due to destruction of RBC ( hemolytic anaemia) Corpuscular defect -Sperocytosis -- sickle cell anemia --thallassamia -Glucose-6 -phosphate deficiency -- methaemoglobinemia -Methaemoglobin -10 -25% --cyanosis -35%-- dysnoea -70% lethal Extra corpuscular defect - transfusion of mismatched blood - Reaction to drugs, malaria, snake venom etc - hypersplenism

Megaloblastic anemia • Due to deficiency of Vit. B 12, folic acid, intrinsic factor. • Pernicious anemia atrophy of gastric mucosa. • Vit. B 12 deficiency affects both the nervous system & hemopoietic system

Features: • RBC, WBC & platelets • Megaloblast accumulate in the bone marrow • MCV & MCH are , MCHC is normal • Sub acute combined degeneration of spinal cord in which both afferent & efferent tracts are involved • Glossitis (inflammation of the tongue) • Peripheral neuropathy • Relative leucopenia, thrombocytopenia Folic acid is due to absorption or due to demand Symptoms same as vit. B 12 except for neurological symptoms

• Treatment: • Vit. B 12 therapy restores both hematological & neurological functions • Administration of folic acid restores hematological functions but not neurological

Iron deficiency anemia (microcytic & hypo chromic) • • Erythrocytes are smaller & paler Iron required for haem synthesis Cause: inadequate suppy when demand is more Usually seen in: growing children , menstruating women, lactating & pregnant women. In adult males it is mainly due to blood loss • Features: • RBC, Hb • MCV, MCHC & MCH • Nails dry, spoon shaped, develop long striations Treatment: Administration of ferrous iron either orally or intramuscularly

Failure of bone marrow function( Aplasia) • Primary failure of bone marrow • Enormous exposure to X- rays or gama rays • Cancer in the bone • Poisoning of aromatic organic chemicals or some toxins • Substitution of normal marrow with fibrous tissue

• Normal, RBC's. They have a zone of central pallor about 1/3 the size of the RBC. ). A few small fuzzy blue platelets are seen. In the center of the field are a band neutrophil on the left and a segmented neutrophil on the right.

The RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).

Macrocytic anemia Note the hypersegmented neurotrophil and also that the RBC are almost as large as the lymphocyte. Finally, note that there are fewer RBCs.

Blood indices 1. Mean corpuscular volume(MCV): Is the average volume of single RBC Normal: (80 -94 cu µ) 90 fl or µm 3 volume of PCV in ml/liter of blood MCV= RBC count in million/cu mm 90 fl = 45/5 x 10 MCV microcytosis MCV macrocytosis

2. Mean corpuscular haemoglobin (MCH): Is average Hb content in a single RBC Normal: 25 -33 picograms Hb in gm/liter of blood MCH= = 15 x 10 / 5= 30 pg RBC count in million/cumm MCH microcytic iron deficiency MCH macrocytic megaloblastic

3. Mean corpuscular hemoglobin concentration (MCHC): Average concentration of Hb as a percentage of the volume of one RBC HB gm/100 ml of blood MCHC = x 100 PCV in 100 ml of blood 33. 3% = 15/45 x 100 Normal: 32 -36 %

MCV MCHC MCH RBC Hypochromic microcytic (iron deficiency) Normochromic macrocytic (megaloblastic) Normochromic Normocytic (hemorrhage) Importance of blood indices got diagnostic value in determining the type of anemis PCV