Eti0logical Classification Of Anemia

OBJECTIVES
Definition
General Presentation Classification

What is Anemia?
Anemia refers to a state in which the

level of hemoglobin in the blood is below the normal range appropriate for that age and sex.
WHO Definition
Male less than 13 g/dl Female less than 12 g/dl Pregnant less than 11 g/dl

Factors responsible for Anemic State

Volume loss Reduced red cell mass Reduced hemoglobin Red cell / Hemoglobin defect Impaired red cell / hemoglobin production

Ultimately, the oxygen-carrying capacity of blood is reduced.

PALLOR
Sites to look for:
Palpebral conjunctiva
Skin Creases of palms and hands Nails Mucous membranes

Presentation
Usually non-specific symptoms:

Tiredness Lightheadedness Breathlessness Lassitude

Non-specific signs:

Pallor Tachypnoea Raised jugular venous pressure Postural hypotension Tachycardia Flow murmurs

Etiological Classification Of Anemia

3 major categories
1) Marrow production defects (Hypoproliferation) 2) Red cell maturation defects (Ineffective erythropoiesis)
3) Decreased red cell survival (Blood loss/Hemolysis)

Hypoproliferative Anemias

Marrow damage: Infiltration (leukemia,lymphoma) / fibrosis Aplasia Drugs (anti-retrovirals)

Fe def.

 Disturbance of proliferation and differentiation of stem

cells:

Pure red cell aplasia Anemia of renal failure Anemia of endocrine disorders (hypoTH, DM)

 Unknown / multiple mechanisms

Anemia of chronic inflammations 1. Chr. Microbial infections (OM, bac endocarditis, lung abscess)

2. Chr. Immune disorders (RA, regional enteritis)

3. Neoplasms (HL, ca lung/breast)

Myelophthisic anemias

Maturation Disorders

Cytoplasmic defects: Defecient heme synthesis Defective globin synthesis Myelodysplastic syndromes

fe def. thalassemia sideroblastic anemia

 Nuclear defects: Folate def. Vit. B12 def. Drug toxicity (mtx, alkylating agents)

Refractory anemia (myelodysplasia)

Blood loss
Blood loss: Acute Chronic

trauma lesions of g.i.t. gynaecologic disturbance

Hemolytic Anemia
Intrinsic abnormalities of red cells

1. Hereditary
a) Red cell membrane disorders

Disorders of membrane cytoskeleton: Spherocytosis Elliptocytosis Disorders of lipid synthesis: selective increase in membrane lecithin

b) Red cell enzyme deficiencies

Glycolytic enzymes: PK def. Hexokinase def. Enzymes of HMP shunt: G6PD Glutathione synthetase

c) Disorders of hemoglobin synthesis

Deficient globin synthesis: Thalassemia syndromes Hemoglobinopathies (str. abnormality): Sickle cell anemia Unstable hb

2. Acquired

a) Membrane defect:

PNH

 Extrinsic abnosmalities of red cells

1. Antibody mediated

Isohemagglutinins: Transfusion reactions Erythroblastosis fetalis

 Autoantibodies:

Idiopathic (primary) Drug-associated SLE Malignant neoplasms Mycoplasmal infection

2. Mechanical trauma to red cells

Microangiopathic Hemolytic Anemias (MAHA) TTP DIC Cardiac traumatic hemolytic anemia

3. Infections: Malaria

Hookworm
4. Chemical injury: Lead poisoning 5. Sequestration in Mononuclear Phagocyte

System:

Hypersplenism