The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female.

• Anaemia may be due to

DECREASED MARROW PRODUCTION

lack of iron,vitB12,folate.Hypoplasia

invasion by malignant cells.

PERIPHERAL CAUSESblood loss

haemolysishypersplenism

MICROCYTIC iron deficiency

thalassemia sideroblastic anaemia of chronic disease

MACROCYTIC megaloblastic

normoblastic liver disease

hypothyroidism hyperlipidaemia

Alcoholpregnancy

cytotoxic drugsreticulocytosis(haemolysis)

MDS,marrow infiltration

NORMOCYTIC anaemia of chronic disease

acute blood loss hypothyroidism hemolytic

aplastic

HAEMOLYTICCONGENITAL

hereditary spherocytosis hereditary elliptocytosis

.thalassemia

.sickle-cellG-6-PD deficiencypyruvate kinase deficiency

ACQUIREDIMMUNEautoimmune, warm/cold

alloimmune (transfusion reaction, organ transplantation)

NON IMMUNEPNH mechanical(prosthetic heart valve,march & microangiopathichaemoglobinuria)Infection;falciparum malaria,sepsisChemicals,drugs(dapsone.sulphonamide)sec to other disease e.g renal or liver failure

Extra-vascular;sickle-cell,hereditary spherocytosis

intra-vascular;G6PD,acquired haemolytic anaemias

SYMPTOMSFatigue dyspnoea palpitationsheadachedizzinesangina

SIGNSmucous membrane pallortachypnoea postural hypotension high volume pulse

severe anaemia<8g/dltachycardia systolic flow murmurs raised JVP

ankle oedemaheart failure

IRON DEFICIENCYkoilonychiaatrophic glossitis rarely post-cricoid webs.

Thalassemic facies, bossing of skull, prominent malar eminence, skeletal deformities.

Hepatosplenomegalygrowth retardationintermittent feverhaemochromatosis resulting incirrhosis,cardiac failure,endocrinopathies.

MEGALOBLASTIC ANAEMIA

sore mouth smooth tongueangular cheilosisvitiligogrey hairweight losspyrexiaparesthesia

,dorsal column loss, subacute combined degeneration of cord

HAEMOLYTICmild jaundicehepatosplenomegaly (extravascular hemolysis)

haemosiderinuria (intravascular haemolysis)

ACUTE SYNDROMES.Precipitated by infection ,hypoxia,dehydration and acidosis.

Vaso-occlusive crises. acute severe bone pain. tachycardia, sweating, fever

sequestration crises sudden splenomegaly/hepatomegaly. aplastic crises. sudden lethargy,pallor

HEREDITARY SPHEROCYTOSIS

• mostly asymptomatic with chronic compensated haemolytic state

• there may be acute crisis. • Haemolytic crisis• Megaloblastic crisis• aplastic crisis• pigment gallstones in 50% causing

cholecystitis

Haemoglobinuria only at night.

Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have

thrombocytopenia,neutropenia

Acute drug induced haemolysis presenting with haemoglobinuria, withanalgesics.aspirin.phenacetinantimalarialsantibiotics,sulphonamide,ciprofloxacinmisc.vit K.quinidine.

Chronic compensated haemolysis. Infection or acute illness.

Low Hb

Low MCV<76fl Normal MCV High MCV>96fl

Low/norm MCV

Blood film & retic count Hh retic(haemolysis)

Norm/low retic

Low MCH

Low ferritin

Iron deficiency

Target cells,

Basophilic stippling

Hb electrophoresis

High HbA2 Norm HbA2

B-thalassemia Alpha-thalassemia

dimorphic

Bone marrow

sideroblastic

Ferritin norm/high

ACD

Bone marrow

Iron stores adequate?

Osmotic fragility test +v

Blood film

spherocytes No spherocytes fragmentation

DCT + DCT _

autoimmune Hereditary spherocytosis

haemolysis

malaria

Hereditary

enzymopathies

microangiopathic

traumatic

clostridium

A)iron deficiency anaemiaB)sideroblastic anaemiaC)anaemia of chronic diseaseD)thalassemia

Ans) sideroblastic anaemia

A)hypothyroidismB)pregnancyC)haemolysisD)anaemia of chronic disease

Ans) anaemia of chronic disease

A) thalassemia

B) Leukemia

C) Infective endocarditis

D) sickle cell anaemia

•Ans Sicle cell anaemiaAns Sicle cell anaemia