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ANEMIA
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Definition
According to Cawson Scully, Anemia is
not a disease in itself and may be a
feature of many diseases but the
different type of anemia have many
clinical features in common
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CLASSIFICATION
(Based on the pathogenesis)
Blood loss anemia Iron deficiency anemia; Plummer Vinsonsyndrome
Hemolytic anemia Glucose 6 Phosphate Dehydrogenase; druginduced; immune mediated
Hemoglobinopathies or disorders of hemoglobin Sickle cellanemia; Thalassemia; Cooleys anemia
Hypoproliferative anemia Vitamin B12 deficiency;
Pernicious anemia; Folic acid deficiency; Aplastic anemia
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Causes ofanemia Blood loss Menorrhagia, Any gastrointestinal lesion (e.g. ulcer
or carcinoma), lesion of the urinary tract, trauma
Impaired absorption of hematinics
Increased demands for hematinics especially pregnancy
Poor intake of Hematinics Aplastic anemia and Leukemia
Hemolytic anemias
Miscellaneous mechanisms, including drugs and chronic disease
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Clinical features of anemia
Sometimes none
General lassitude
Cardiorespiratory
DyspnoeaCongestive cardiac
failure
Murmurs
Angina pectoris
Cutaneous
Pallor
Brittle nails
Koilonychia (irondeficiency)
Oral
Sore mouth
Oral ulceration
Angular stomatitis
Glosstitis
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In general anesthetic
The main danger is when a general anesthetic is
given, as it a vital to ensure full oxygenation
Myocardium may be unable to respond to the
demands of anesthesia Whenever possible therefore the cause of the
anemia should be corrected preoperatively, but at
least the hemoglobin level must be raised, if
necessary by transfusion.
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In general anesthetic
Elective operations under general anesthesia
should not usually be carried out when the
hemoglobin is less than 10 g/dl
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In general anesthetic
In an emergency, anemia can be corrected
by whole blood transfusion, but this should
only be given to a young and otherwise fit
patient
Transfusion risks include fluid overload, and
viral infections such as hepatitis and HIV
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In general anesthetic
Packed red cells avoid the risk of fluid
overload and can be given in emergency to
the elderly patient or those with incipient
congestive cardiac failure. A diuretic given at
the same time further reduces the risk of
congestive cardiac failure.
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In general anesthetic
The patient should be stabilized at least 24
hours preoperatively and it should be noted
that hemoglobin estimation are unreliable for
12 hours post-transfusion. Nitrous oxide is
possibly contraindicated in vitamin B12,
deficiency
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Iron Deficiency Anemia
Women of child bearing age and older are
therefore mainly affected
Excessive menstrual losses or
gastrointestinal blood loss are the main
causes. Very many children are mildly iron
deficient because of the high demands for
growth, especially during adolescence.
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Iron Deficiency Anemia
By contrast, iron deficiency in an adult male
almost invariably indicates blood loss, usually
from the gastrointestinal or genitourinary
tracts. The same holds true for post-
menopausal women
Symptoms ascribed to iron deficiency do not
always respond to iron replacement
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IRONDEFICIENCY ANEMIA
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Laboratory findings during the development of iron deficiency anemia
MCVHb MCHC Serum
ferriti
n
Transferrinsaturation*
Marrow ironstores
Normal N N N N 33% N
Mild iron deficiency anaemiaq
N orq
Nq
>16%
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Treatmentofiron deficiency
The best treatment of iron deficiency is an
iron salt by mouth but the cause of the
deficiency should be found and eliminated
Ferrous gluconate 250 mg/day can be given
if ferrous sulphate is not tolerated
FeSO4200mg 3 times/ day
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Treatmentofiron deficiency
Oral iron may need to be given for 3 months
or more to replenish marrow iron stores
Parenteral iron has no advantages except,
for example, when inflammatory bowel
disease is aggravated by oral iron
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PLUMMERVINSONSYNDROME
Dysphagia; Xerostomia
Depapillated tongue
Koilonychia
Angular stomatitis
Pallor and fatigue dyspnea
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Vitamin B12 Deficiency
Pernicious (Addisonian) anemia is the most
common type of macrocytic anemia and
typically affects women in the middle age or
over particularly of Northern Europeandescent
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Pernicious anemia
It is caused by a specific defect of absorption of
Vitamin B12 not by malnutrition
Autoantibodies against gastric parietal cells and / or
intrinsic factor or both are found and the disease issometimes seen with other autoimmune diseases,
especially hypothyroidism, or less often, diabetes,
mellitus, vitiligo, Addisons disease or
hypothyroidism
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Causes of vitamin B12 deficiency
Poor intake
Poverty
Strict vegetarians
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Causes of vitamin B12 deficiency
Malabsorption
Defect in intrinsic factor production Congenital
Autoimmune (pernicious anemia)
Gastrectomy
Illeal diseaseCoeliaa disease
Tropical sprue
Crohns disease
Blind loop syndrome
Resections
Fish tapeworm
Transcobalamin II deficiency
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Causes of vitamin B12 deficiency
DrugsColchicine
Neomycin
Nitrous oxide
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Causes of folate deficiency
Poor intake
Poverty
Old age Alcoholism
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Causes of folate deficiency
Malabsorption
Coeliac disease
Crohns disease Other malabsorption states
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Causes of folate deficiency
Increased demandsInfancyPregnancyChronic
hemolysisMalignant diseaseExfoliative skin
lesionsChronic dialysis
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Causes of folate deficiency
Increased demands
Infancy
Pregnancy Chronic hemolysis
Malignant disease
Exfoliative skin lesions
Chronic dialysis
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Oral aspects of the deficiency anemias
sore or burning, but otherwise normal tongue
Atrophic glossitis
Moellers glossitis and other colour changes
Candidosis
Angular stomatitis (cheilitis)
Aphthous stomatitis
PatersonK
elly syndrome (Plummer
Vinson)
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Anemia associated with systemic disease
Chronic inflammation (infections or
connective tissue disease).
Neoplasms including leukaemia. Acute
leukaemia is an important cause of
anaemia and should always be considered
when anaemia is seen in a child.
Liver disease.
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Anemia associated with systemic disease
very rarely : Hypothyroidism
Hypopituitarism Hypoadrenocorticis
Uraemia
HIV infection
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Aplastic Anemia
Bone-marrow aplasia is a rare disease
causing refractory normochromic, normocytic
anemia, leucopenia and thrombocytopenia
Drugs are an important cause but many
cases are idiopathic, though probably viral or
immunologically mediated
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Aplastic Anemia
The prognosis is poor and 50
per cent of patients die within 6
months usually fromhemorrhage or infection
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Causes of aplastic anaemia
Idiopathic
Genetic
Fanconis anaemia
Dyskeratosis congenita
Drugs
Phenylbutazone
Chloramphenicol
Sulphonamides
Gold Penicillamine
Anticonvulsants
Cytotoxic agents
Chemicals
Benzene
Toluene
Heavy metals
Glue-sniffing Viruses
Hepatitis
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Principles ofmanagement
Removal of the cause. Even when this isdecoverable, as in the case of drugs, such aschloramphenicol, marrow damage may still beirreversible
Isolation and antibiotics to control infection Androgenic steroids. (Corticosteroids are of
questionable
