Anaemia

General introduction. classification, evaluation and laboratory diagnosis.

1. ANAEMIA By: Nityanand Upadhyay Associate Professor Department of MLT Integral University, Lucknow

2. 1. DEFINITION OF ANAEMIA 2. CRITERIA OF ANAEMIA 3. SEVERITY OF ANAEMIA 4. MANIFESTATION OF ANAEMIA 5. EVALUATION OF ANAEMIA 6. CLASSIFICATION OF ANAEMIA LEARNING POINTS

3. “ Anaemia refer to a decrease in the total number of circulating RBC,s with decrease in Haemoglobin concentration when compared with normal value for the age , group and sex.” DEFINITION

4. 1. In western population Hb <13.2gm/dl in adult males and Hb <11.7gm/dl in adult females is taken as Anaemia . 2. As per WHO criteria for Anaemia are- Adults male Hb <13.0gm/dl Adult Females Hb <12.0gm/dl Children upto 12 years Hb <11.0gm/dl Pregnant Women Hb <11.0gm/dl CRITERIA FOR ANAEMIA

5. 3. As per Council On Foods and Nutritions - Age Hb Hct ./PCV Adult Males <14.0gm/dl <42.5% Adult Females <12.0gm/dl <36.0% Children 4Yrs. to <11.5gm/dl <33.0% Puberty . 6 months to <11.0gm/dl <33.0% 4Yrs.

6. 1. Mild Anaemia : Hb 9.1-10.5gm/dl 2. Moderate Anaemia : Hb 6.0-9.0gm/dl 3. Severe Anaemia : Hb <6.0gm/dl SEVERITY OF ANAEMIA

7. Symptomatology of Anaemia depends upon- 1. Haemoglobin 2. Change in Blood Volume 3. Severity of the disease contributing to anaemia 4. The rate at which the above changes occurs MANIFESTATION OF ANAEMIA

8. The main symptoms of anemia are- 1. Dyspnoea : Difficulty in breathing. 2. Pallor(Pale appearance): Pallor is most evident features of anaemia and detected in Conjuctiva , Mucus membrane of Tongue/Lips and Nailbeds . 3. CNS Signs: Patient may complain of Headache, Vertigo, Tinnitus, Lack of concentration and Muscle pain.

9. 4. Glossitis : (Inflammation of Tongue/Difficulty in Eating)- In sever anaemia there is atrophy of the tongue papillae, Stomatitis (Inflammation of mucus membrane of Mouth). 5. Dysphagia :(difficulty in swallowing). 6. Cardiac Features: Systolic murmur heard in the pulmonary area. Hyperdynamic circulation, Pulse is fast and bounding.

10. To evaluate the case of Anaemia , the following steps are required: 1. History of Patient 2. Clinical Examination 3. Laboratory Investigations 4. Others Investigations EVALUATION OF ANAEMIA

11. Onset of symptoms : Acute or Insidious. History of drugs intake. Exposure to chemicals. Family history of same disease. Occupation of patient. Symptoms of glossitis , stomatitis . History of haematuria , tarry stool. 1. HISTORY OF PATIENT

12. In women, history to amount of blood loss during menstruation. Number of Pregnancy. Dietary history. Fever. History of Tuberculosis. History of Jaundice. Pain in legs. Colour of Urine- yellow or cola coloured .

13. Pallor- Conjunctiva, tongue and skin. Nails- for platynychia / koilonychia . Jaundice. Sign of infections Bleeding Lymphadenopathy 2.CLINICAL EXAMINATIONS

14. Splenomegaly Hepatomegaly Cardiac assessment. Chest Examination for Infections. Assessment of kidneys for chronic renal disease. Sign of various systemic disease.

15. A. HAEMATOLOGIC B. URINE C. STOOL D. BIOCHEMISTRY E. RADIOLOGIC 3. LABORATORY INVESTGATIONS

16. Hb PCV Red cells Indices- MCV,MCH,MCHC,RDW. Reticulocytes count A. HAEMATOLOGIC

17. Red cells Morphology(GBP) DLC Platelets count Platelets function test TLC ESR Bone marrow examination

18. Physical examination- Colour,pH , specific gravity. Biochemical examination- Protein, sugar, Blood, Urobilinogen , Ketones . Microscopic examination-Blood cells. B. URINE ANALYSIS

19. Physical Examination- Bulky, tarry color. Biochemical examination- Occult Blood. Microscopic examination- Ova of Parasites. C. STOOL

20. S. Iron S. Ferritin S. Transferritin Blood urea S. Creatinine BUN D. BIOCHEMISTRY

21. Bilirubin SGOT SGPT S. Alkaline phoshphatase Vit . B12 Folic acid Vit . C

22. X-ray chest USG abdomen- lump CT/MRI- suspected malignancies E. RADIOLOGIC

23. Anaemia are classified: 1. Morphologic Classification:- Based on morphology of RBC,RBC,s size and volume. 2. Etiological Classification: Based on Etiology. CLASSIFICATION

24. The Anaemia are classified on the basis of Morphology are- A. MICROCYTIC ANAEMIA B. NORMOCYTIC ANAEMIA C. MACROCYTIC ANAEMIA 1. MORPHOLOGIC CLASSIFICATION

25. When MCV < 80.0 fl and MCHC<32.0 A. MICROCYTIC ANAEMIA

26. When MCV : 81-98 fl B. NORMOCYTIC ANAEMIA

27. When MCV >100fl C. MACROCYTIC ANAEMIA

28. Etiological classification of Anaemia are: - A) Anaemias due to impaired red cell production. B) Haemolytic anaemia due to increased red cell destruction. 2.ETIOLOGICAL CLASSIFICATION

29. a) Deficiency of essential nutrients:- Iron deficiency anaemia B12, Folate deficiency Vit.C deficiency A) Anaemias due to impaired red cell production.

30. b) Defect in stem cell:- Aplastic anaemia Pure red cells aplasia c) Miscellaneous :- Anaemia of chronic disorders Marrow suppression due to drugs

31. 1) INTRACORPUSCULAR DEFECT:- These are- a) Enzyme deficiency: G-6-PD Deficiency PK ( Pyruvate Kinase ) deficiency P-5-N- deficiency B) Haemolytic anaemia due to increased red cell destruction.

32. b) Membrane defect: Hereditary Spherocytosis Hereditary Ovalocytosis Hereditary Eliptocytosis c) Haemoglobin abnormalties : Thalassemia syndromes Sickle cell syndromes Hb D, Hb E and other abnormal haemoglobin

33. Immune haemolytic anaemia Fragmentation syndromes Hypersplenism Drugs and Chemicals 2. EXTRACORPUSCULAR DEFECT

34. Thanks……