Anemia

INTRODUCTION
 Anemia is a major killer in India.
 Statistics reveal that every second Indian
woman is anemic
 One in every five maternal deaths is directly
due to anemia.
 Anemia affects both adults and children of
both sexes, although pregnant women and
adolescent girls are most susceptible and
most affected by this disease.

OBJECTIVES
 Definition of anemia
 Classification of anemia
 Anemia Cause
 Anemia Symptoms
 Lab Investigation of Anemia
 Treatment
 Prevention

DEFINITION
 Anemia (An-without,emia-blood)is a
decrease in the RBC count, hemoglobin
and/or Hematocrit values resulting in a
lower ability for the blood to carry oxygen to
body tissues .

NORMAL VALUES
 Category Reference Values
 Men >13 g/dl
 Women >12 g/dl
 Pregnant women >11g/dl
 Infants from 2 to 6 months >9.5 g/dl
 Children from 6 months
to 24 months >10.5 g/dl
 2yrs to 11 yrs >11.5 g/dl
 Children from 12 years >12 g/dl
Category Values Reference
Men >13 g/dl
Women >12 g/dl
Pregnant women >11g/dl
Infants from 2 to 6 months >9.5 g/dl
Children from 6 months to 24
months
>10.5 g/dl
2yrs to 11 yrs >11.5 g/dl
Children from 12 years >12 g/dl

TYPES OF ANEMIA
Based on clinical picture-
 Iron deficiency anemia.
 Megaloblastic anemia.
 Pernicious anemia.
 Hemorrhagic anemia.
 Hemolytic anemia.
-Thalassemia anemia
-Sickle cell anemia
 Aplastic anemia

TYPES OF ANEMIA
 Iron deficiency anemia
♣ excessive loss of iron .
♣ Women are at risk. ---- For menstrual blood and
growing fetus.
 Megaloblastic anemia
♣ Less intake of vitamin B 12 and folic acid.
♣ Red bone marrow produces abnormal RBC.
e.g cancer drugs
 Pernicious anemia
♣ Inability of stomach to absorb vitamin B 12 in small
intestine.

TYPES OF ANEMIA
 Hemorrhagic anemia
♣ Excessive loss of RBC through bleeding,stomach
ulcers,menstruation
 Hemolytic anemia
♣ RBC plasma membrane ruptures.
♣ may be due to parasites,toxins,antibodies.
 Thalassemmia
♣ Less synthesis of hemoglobin .Found in population of
Mediterranean sea.
 Sickle cell anemia
♣ Hereditary blood disorder, characterized by red blood
cells that assume an abnormal, rigid, sickle shape.
 Aplastic anemia
♣ destruction of red bone marrow .
♣ caused by toxins,gamma radiation.

 Normochromic, normocytic anemia (normal MCHC,
normal MCV).These include:
 anemias of chronic disease
 hemolytic anemias (those characterized by accelerated
destruction of rbc's)
 anemia of acute hemorrhage
 aplastic anemias (those characterized by disappearance of
rbc precursors from the marrow)
 Hypochromic, microcytic anemia (low MCHC, low
MCV).These include:
 iron deficiency anemia
 thalassemias
 anemia of chronic diseases
 Normochromic, macrocytic anemia (normal MCHC,
high MCV).These include:
 vitamin B12 deficiency
 folate deficiency
TYPES OF ANEMIA

RISK FACTORS
 Poor socio economic class
 Multiparity
 Teenage pregnancy
 Menstural problem

SYMPTOMS
Common symptoms of anemia
 Easy fatigue and loss of energy
 Unusually rapid heart beat, particularly with
exercise
 Shortness of breath and headache, particularly with
exercise
 Difficulty concentrating
 Dizziness
 Pale skin
 Leg cramps
 Insomnia

Anemia Caused by Iron Deficiency
People with an iron deficiency may experience these
symptoms:
 A hunger for strange substances such as paper, ice, or
dirt (a condition called pica)
 Upward curvature of the nails, referred to as
koilonychias
 Soreness of the mouth with cracks at the corners
Anemia Caused by Vitamin B12 Deficiency
People whose anemia is caused by a deficiency of Vitamin
B12 may have these symptoms:
 A tingling, "pins and needles" sensation in the hands or
feet
 Lost sense of touch
 A wobbly gait and difficulty walking
 Clumsiness and stiffness of the arms and legs
 Dementia
 Hallucinations, paranoia, and schizophrenia

SIGNS OF ANAEMIA
 Brittle nails
 Koilonychia (spoon shaped nails)
 Atrophy of the papillae of the tongue
 Angular stomatitis
 Brittle hair
 Dysphagia and Glossitis
 Plummer vinson/kelly patterson

The red cell population is defined by
1.Quantitative parameters:
 Volume of packed cells i.e. the hematocrit
 Hemoglobin concentration
 Red cell concentration per unit volume.
2.Qualitative parameters:
 Mean corpuscular volume
 Mean corpuscular hemoglobin
 Mean corpuscular hemoglobin concentration.
INVESTIGATIONS

 Hematocrit ( Packed cell volume): It is the proportion of
the volume of blood sample that is occupied by RBCs.
 Men -42-52%
 Women -36-48%
 Cell Volume Hemoglobin Concentration: It is the amount
of hemoglobin per unit volume of blood.(Gms/Dl)
 Women - 12-16gms/dl
 Men - 14-17 gms/dl
 Red Cell Count: Total number of Red Cells per unit
volume of blood sample. [ No.of RBC/ cu.mm ]
 Men - 4.2-5.4*106//mm3
 Women- 3.6-5.0* 106/mm3
INVESTIGATIONS

 Mean Corpuscular Volume: It is the average volume
a RBC. [ fL ]
 Normal 82-98mm3or 82-98fL
 Mean Corpuscular Hemoglobin: It is the average
hemoglobin content per RBC.
 Normal value is 27 to 31 pL
 Mean Corpuscular Hemoglobin Concentration: It is
the average concentration of hemoglobin in a given
Red Cell Volume. [Gms/ dL ]
 Normal 32-36 g/Dl
INVESTIGATIONS

MANAGEMENT
Care Objectives
 Determine the Cause of Iron Deficiency
 The etiology is often multifactorial; even when there is
an obvious cause, investigation of serious underlying
causes (e.g.cancer in adults) is recommended.
 Aim of Treatment
 Normalize hemoglobin levels and red cell indices;
replenish iron stores.
 Individualize disease-specific management depending
on underlying cause.
 Lifestyle Management
It is recommended that patients with iron deficiency
receive dietary advice .

NON PHARMOCOLOGICAL MANAGEMENT:
 Tea and coffee inhibit iron absorption when consumed
with a meal or shortly after a meal.
 Vitamin C (ascorbic acid) is also a powerful enhancer of
iron absorption from nonmeat foods when consumed
with a meal. The size of the vitamin C effect on iron
absorption increases with the quantity of vitamin C in the
meal.
 Germination and fermentation of cereals and legumes
improve the bioavailability of iron by reducing the
content of phytate, a substance in food that inhibits iron
absorption.
 Promote and support exclusive breastfeeding for about
6 months followed by breastfeeding with appropriate
complementary foods, including iron-rich through the
second year of life.

RECOMMENDED DIETARY
ALLOWANCE
Mg/DAY
Men Adult 8 mg
Women Adult (age 50 on) 8 mg
Adult (ages 19 to 50) 18 mg
Pregnant 27 mg
Lactating 9 mg to 10 mg
Adolescents (ages 9 to 18)
Girls
Boys
8 mg to 15 mg
8 mg to 11 mg
Children (birth to age 8) Ages 4 to 8 10 mg
Infants (7 months to 1 year)
Infants (birth to 6 months)
11 mg
0.27 mg

MANAGEMENT
Complimentary parasite control measures
 Anti-helminthic therapy with 400 mg of single dose
of albendazole is given to eliminate hook worms
before the initiation of iron and folic acid therapy.
 Child -
<2yrs-200mg/day single dose
 Pregnancy-
Albendazole is contraindicated in first trimester,
can be administered in second or third trimester.

TREATMENT FOR 6-24 MONTHS
Dosage Birth-weight category Duration
12.5 mg iron + 50 ug
folic acid daily
Normal
Low birth weight (<2500
g)
6-24 months of age
2-24 months of age

GROUP DOSAGE/day
Children 2-5 years 20-30 mg iron
Children 6-11 years 30-60 mg iron
Adolescents and adults 60 mg iron
TREATMENT OF MILD &MODERATE
 Anemia will correct within 2 to 4 months if
appropriate iron dosages are administered and
underlying cause of iron deficiency is corrected.
 Continue iron therapy an additional 4 to 6 months
(adults) after the hemoglobin normalizes to
replenish the iron stores.

TREATMENT OF SEVERE ANEMIA
 After completing 3 months of therapeutic
supplementation, pregnant women and infants
should continue preventive supplementation program
AGE GROUP DOSE DURATION
<2 years 25 mg iron + 100-400 ug
folic acid daily
3 months
2-12 years 60 mg iron + 400 ug folic
acid daily
3 months
Adolescents and adults,
including pregnant
women
120 mg iron + 400 ug
folic acid daily
3 months

Prevalence of anemia in
pregnancy
Dose Duration
>40 % in population 60 mg iron + 400 ug folic
acid daily
6 months in pregnancy,
and continuing to 3
months postpartum
TREATMENT OF PREGNANT WOMEN

 Iron absorption may be decreased by antacids or
supplements containing aluminum, maganesium,
calcium, zinc, proton pump inhibitors.
 Space administration apart by at least 2 hours.
 Oral iron preparations may cause nausea, vomiting,
dyspepsia, constipation, diarrhea or dark stools.
 Strategies to minimize these effects include: start at
a lower dose and increase gradually over 4 to 5
days; giving divided doses or the lowest effective
dose, or taking supplements with meals
 Although sustained release iron preparations tend
towards less gastrointestinal side effects, they may
not be as effective as standard film coated products
due to reduced/poor iron absorption.15

BENEFITS OF THERAPY
POPULATION GROUP BENEFITS
Children Improved behaviour and cognitive
development
Where anaemia is common, improved child
survival
Adolescents Improved cognitive development
In girls, better iron stores for later pregnancies
Pregnant women and their infants Decreased low birth weight
Where severe anaemia is common, decreased
maternal mortality and obstetrical
complications
All individuals Improved fitness and work capacity
Improved cognition

Anemia

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Anemia