ANAEMIA

♦ A term used to describe red cell

deficiencies that result in hypoxia
♦ It is manifested by decreased red cell
count, haematocrit and decreased OR
dysfunctional haemoglobin or both.
♦ General clinical signs and symptoms of

anaemia are:
1) Weakness and loss of breath,
especially after physical exercise
2) Dizziness or fainting
3) Gastrointestinal disturbances, loss of
appetite and indigestion
4) Confusion, insomnia or hallucinations
5) Headaches
6) Lethargy
7) Cardiomegaly
8) Pallor

♦ Specific clinical signs and symptoms of

anaemia are:
1) Koilonychia (spoon shaped nails)
2) Jaundice
3) Leg ulcers
4) Bone deformities
5) Mental retardation

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♦ The severity of the clinical signs varies
from none to life-threatening depending
on:
a) The severity of red cell deficiency
b) Rate of onset of anaemia
c) Age of patient
d) The general health of the patient

♦ It is important to note that anaemia is

always not a primary disease, but a
secondary manifestation of another
disorder.
♦ The underlying disorder must be
investigated clinically and in the
laboratory.
♦ The ideal way to resolve anaemia is by
identification and correction of the
underlying condition.
♦ The appearance of red cells on a blood
film sometimes gives evidence of the
cause of anaemia.
Classification of Anaemia
♦ Anaemias are classified on the basis of
morphological characteristics, aetiology
and pathological manifestations.
♦ The first two are the mostly widely used

methods.

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1. Morphological classification
• Based on the descriptive and
quantitative criteria to classify red cells
by maturation stage, shape, size and
haemoglobin content.
• Size is derived from determination of

mean corpuscular volume (MCV);

haemoglobin content is derived from
mean corpuscular haemoglobin
concentration (MCHC) and mean
corpuscular haemoglobin (MCH). These
calculations are referred to as red cell
indices.
• Normal reference ranges for the above
are:
a) MCV = 80 - 97 Fl
b) MCHC = 31% - 36%
c) MCH = 27 - 31 pg
• An MCV between 80 and 97 fL is

normocytic, above 97 fl is macrocytic

and below 80 fl is microcytic.
• An MCHC between 31 and 34% is

normochromic, above 36% is

hyperchromic and below 31%, it is
hypochromic.

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• Anaemias can be classified
morphologically as normocytic
normochromic, microcytic
hypochromic, normocytic
hypochromic, or macrocytic
normochromic depending on the
values of the red cell indices of interest
2. Aetiological Classification of Anaemias
• Based on the mechanisms by which
haemoglobin or red cell count are
decreased.
• Three possibilities of causes of anaemia
are:
a) Impairment of marrow
production resulting in fewer or
defective cells
b) Normal production but
circulating cells are being
destroyed or lost
c) Red cell survival is normal,
but plasma volume dilutes the
red cell count and haemoglobin
concentration.
• Identification of cause of anaemia is

done after investigation of

morphological patterns of the red cell.
Eg, iron deficiency anaemia is always

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 suspected if the red cells show a
microcytic hypochromic picture.

Laboratory findings in anaemia

• Initial findings in anaemia are:
1. Decreased haemoglobin levels;
<11.5 g/dl in females, < 12.5 g/dl in
male and 8.5 g/dl in children:
2. Decreased haematocrit value; <
36% in females, < 40% in males and
<30% in children.
3. Decreased or normal red cell
count.

Treatment
1. In severe forms of anaemia there is
need to quickly restore the body's
capacity to transport O2 to the tissues
by restoring Hb through red cell
transfusion.
2. If known, treatment of underlying
disease is important.