Anaemia and their types, causes, signs and symptoms, and treatments.

ANAEMIA is when there is a reduction in the number/quantity of haemoglobin in the blood

below the reference level according to the age and sex of the individual.

Various types of anaemia are classified by MCV. The three major types are:
1) Hypochromic microcytic with a low MCV
2) Normochromic normocytic with a normal MCV
3) Hyperchromic macrocytic with a high MCV

Patients with anaemia may be asymptomatic. A slowly falling level of Hb allows for
haemodynamic compensation and enhancement of the oxygen-carrying capacity of the
blood.

Symptoms are non-specific. It includes
- Fatigue, headache and faintness are all very common in the general population
- Breathlessness
- Angina
- Intermittent claudication
- Palpitations

A good way to assess the effects of anaemia is to ask about breathlessness in relation to
different levels of exercise (e.g. walking on the flat or climbing one flight of stairs)

Signs include:
- Pallor (an unhealthy pale appearance)
-Tachycardia (Increase of the heart rate above normal)
- Systolic flow murmur
- Cardiac failure

- Koilonychia (spoon-shaped nails seen in iron deficiency anaemia)
- Jaundice (found in haemolytic anaemia)
- Bone deformities (found in thalassaemia major)
- Leg ulcers (occur in association with sickle cell anaemia).

MICROCYTIC ANAEMIA

a) Iron deficiency anaemia
-Develops when there is inadequate iron for haemoglobin synthesis. Latent iron
deficiency is said to be present during this period:
- Blood loss
- Increased demands, such as growth and pregnancy
- Decreased absorption (e.g. postgastrectomy)
- Poor Intake
-Most is due to blood loss, usually from the uterus or GIT. Premenopausal women are
in a state of precarious iron balance owing to menstruation.
-The most common cause of iron deficiency worldwide is blood loss from the GIT (due
to hookworm infestation).
-Poor quality of diet, predominantly containing vegetables, also one of the causes in
developing countries.
-Infants also have iron deficiency in developed countries, especially premature babies,
due to the high demands of growth.
-Specific symptoms include:
- Brittle, spoon-shaped nails
- Atrophy of the papillae of the tongue
- Angular stomatitis
- Brittle hair
- A syndrome of dysphagia and glossitis

-Treatment:
-Iron deficiency is not a diagnosis. The correct management of iron deficiency is
to find the cause, and to give iron therapy, by monitoring using the reticulocyte
count and Hb level, with an expected rise in haemoglobin of 1 g/dL per week.
- Oral iron is required in most cases. Ferrous sulphate (200 mg three times daily,
a total of 180 mg ferrous iron), which is absorbed best when fasting. If the
patient has side effects such as nausea, diarrhoea or constipation, taking tablets
with food or reducing the dose using, for instance, ferrous gluconate (300 mg
twice daily, only 70 mg ferrous iron). This can take 6 months.
- Vitamin C acts as a reducing agent, it increases the absorption of Iron and
converts Fe
3+
(Ferric) to Fe
2+
(Ferrous)

b) Anaemia of chronic disease
- This is common to patients with chronic infections such as tuberculosis or chronic
inflammatory disease such as Crohns disease, rheumatoid arthritis, systemic lupus
erythematosus (SLE), polymyalgia rheumatica and malignant disease.
- There is a decreased release of iron from the bone marrow to developing
erythoblasts, and inadequate erythropoietin response to the anaemia, and
decreased red cell survival.
- Treatment:
- Patients do not respond to iron therapy, and the treatment is that of the
underlying disorder. Recombinant erythropoietin therapy is used in the anaemia
of renal disease and occasionally in inflammatory disease.

c) Sideroblastic anaemia
- Inherited or acquired disorders characterized by a refractory anaemia, a variable
number of hypochromic cells in the peripheral blood, and excess iron and ring
sideroblasts in the bone marrow.
- There is accumulation of iron in the mitochondria of erythroblasts owing to
disordered haem synthesis forming a iron granules around the nucleus that can be
seen with Perls reaction. Thus, there is an ineffective haem synthesis.
- Treatment:
- Some respond when drugs or alcohol are withdrawn, if these are the causative
agents. Treatment with folic acid may be required to treat accompanying folate
deficiency.

NORMOCYTIC ANAEMIA
- Seen in anaemia of chronic disease, in some endocrine disorders (e.g.
hypopituitarism, hypothyroidism and hypoadrenalism) and in some haemotological
disorders (e.g. aplastic anaemia and some haemolytic anaemias). In addition, this type
of anaemia is seen acutely following blood loss.

MACROCYTIC ANAEMIA

a) Megaloblastic anaemia
- Presence in the bone marrow of erythroblasts with delayed nuclear maturation
because of defective DNA synthesis (megaloblasts large and have large immature
nuclei). Giant metamyelocytes are frequently seen in megaloblastic anaemia (twice
the size of normal cells and often have twisted nuclei).
- May occur in:
- Vitamin B
12
deficiency or abnormal vitamin B
12
metabolism
- Folic acid deficiency or abnormal folate metabolism
- Other defects of DNA synthesis, or resulting from therapy with drugs
interfering with DNA synthesis
- Myelodysplasia due to dyserythropoiesis.
- Treatment:
- Depends on the type of deficiency. Blood transfusion is not indicated in chronic
anaemia; it is dangerous to transfuse elderly patients, heart failure may happen.
- Folic acid may produce a haemotological response in vitamin B12 deficiency
but may aggravate the neuropathy. Large doses of folic acid alone should not be
used to treat megaloblastic anaemia unless the serum vitamin B12 level is
known to be normal. In severely ill patients, it may be necessary to treat with
both folic acid and vitamin B12 while awaiting serum levels.

b) Non-megaloblastic anaemia
- Raised MCV with macrocytosis on the peripheral blood film can occur with a
normoblastic rather than a megaloblastic bone marrow.
- Physiological cause: Pregnancy. Macrocytosis may also occur in newborn.
- Pathological cause:
- Alcohol excess
- Liver disease
- Reticulocytosis
- Hypothyroidism
- Some haematological disease (e.g. aplastic anaemia, sideroblastic anaemia,
pure red cell aplasia)
- Drugs (e.g. cytotoxics azathioprine)
- Spurious (agglutinated red cells measured on red cell counters)
- Cold agglutinins due to autoagglutination of red cells (the MCV descreases to
normal with warming of the sample to 37 degress c.)
- Normal serum levels of vitamin B12 and folate will be found. There is an
increased lipid deposition in the red cell membrane.
- An increased number of reticulocytes lead to a raised MCV because they are
large cells.

APLASTIC ANAEMIA
- This is due to bone marrow failure leads to few RBC, few WBC, few platelets.
- Causes fatigue, weakness, paleness and sudden death.
- Treatment: blood transfusion, stem cell transplant, exposure to atoxin.

AUTOIMMUNE HAEMOLYTIC ANAEMIA
- The autoimmune system attack RBCs, thus, reducing the number of RBC.

SICKLE CELL ANAEMIA
- Crescent shaped RBCs, hereditary disorder, the cells cannot pass through the
capillary
-Breakdown of RBC anaemia & physical weakness
- Clumping of cells and clogging of small blood vessels
-Heart failure, pain and fever, brain damage, damage to other organs
-causing impaired mental function & paralysis.
-causing rheumatism, pneumonia & kidney failure
-accumulation sickled cells in spleen spleen damaged