![ 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)
•Men - 14-17 gms/dl
•Women - 12-16gms/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](https://image.slidesharecdn.com/anemia-240104095017-2b77af54/85/Anemia-types-of-anemia-and-causes-of-anemia-20-320.jpg)
![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](https://image.slidesharecdn.com/anemia-240104095017-2b77af54/85/Anemia-types-of-anemia-and-causes-of-anemia-21-320.jpg)
Anemia types of anemia and causes of anemia
- 1. An emia Presented by:- Dr Suman B
- 2. CONTENTS o INTRODUCTION oDEFINITION oPHYSIOLOGY oPATHOPHYSIOLOGY oNORMAL VALUES oCLASSIFICATION oTYPES OF ANEMIA oRISK FACTORS oCAUSES oSIGNS&SYMPTOMS oINVESTIGATIONS oMANAGEMENT oNON PHARMOCOLOGICAL MANAGEMENT oRECOMMENDED DIETARY ALLOWANCE oTREATMENT
- 3. INTRODUCTION oAnemia is a major killer in India. o Statistics reveal that every second Indian woman is anemic. oOne in every five maternal deaths is directly due to anemia. o Anemia affects both adults and children of both sexes, although pregnant women and adolescent girls are most susceptible and most affected by this disease
- 4. DEFINITION Anemia (An-without , emia-blood) It 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 .
- 5. PHYSIOLOGY
- 7. PATHOPHYSIOLOGY oDecreased RBC Production Iron deficiency anemia Folic acid deficiency anemia Aplastic anemia oIncreased RBC loss or destruction •Sickle cell anemia •Blood loss •Infection
- 8. NORMAL VALUES Category Value Reference Men >13g/dl Women >12g/dl Pregnant Women >11g/dl Infants from 2 to 6 months >9.5g/dl Children from 6 months to 24 months >10.5g/dl Children from 2years to 11 years >11.5g/dl Children above 12 years >12g/dl
- 9. TYPES OF ANEMIA Based on clinical picture- o Iron deficiency anemia. o Megaloblastic anemia. oPernicious anemia. oHemorrhagic anemia. oHemolytic anemia. -Thalassemia anemia -Sickle cell anemia o Aplastic anemia
- 10. TYPES OF ANEMIA o Iron deficiency anemia ♣ Excessive loss of iron . ♣ Women are at risk. - For menstrual blood and growing fetus. o Megaloblastic anemia ♣ Less intake of vitamin B 12 and folic acid. ♣ Red bone marrow produces abnormal RBC. e.g cancer drugs o Pernicious anemia ♣ Inability of stomach to absorb vitamin B 12 in small intestine.
- 11. TYPES OF ANEMIA oHemorrhagic anemia ♣ Excessive loss of RBC through bleeding,stomach ulcers,menstruation oHemolytic anemia ♣ RBC plasma membrane ruptures. ♣ may be due to parasites,toxins,antibodies. oThalassemmia ♣ Less synthesis of hemoglobin .Found in population of Mediterranean sea. o Sickle cell anemia ♣ Hereditary blood disorder, characterized by red blood cells that assume an abnormal, rigid, sickle shape oAplastic anemia ♣ destruction of red bone marrow . ♣ caused by toxins,gamma radiation.
- 12. TYPES OF ANEMIA 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 (these 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
- 13. RISK FACTORS oPoor socio economic class. oMultiparity oTeenage pregnancy o Menstural problem
- 14. CAUSES Increased Requirements •Menstruating Females •Pregnancy •Lactation •Growing infants and children •Erythropoietin treatment Increased Loss •GI Bleeding •Menorrhagia •Persistent Hematuria •Intravascular hemolytic anemia •Regular blood donars •Parasitic infections Decreased Intake •Vegetarian diet •Socioeconomic factors Decreased Absorption •Upper GI pathology(Eg:- Cellac and Crohn’s disease) •Gastrectomy •Medications(Antacids,zantac)
- 15. SIGNS AND SYMPTOMS Common symptoms of anemia:- oEasy fatigue and loss of energy oUnusually rapid heart beat, particularly with exercise oShortness of breath and headache, particularly with exercise oDifficulty concentrating oDizziness oPale skin oLeg cramps oInsomnia
- 16. Anemia Caused by Iron Deficiency People with an iron deficiency may experience these symptoms: o A hunger for strange substances such as paper, ice, or dirt (a condition called pica) o Upward curvature of the nails, referred to as koilonychias o Soreness of the mouth with cracks at the corners
- 17. Anemia Caused by Vitamin B12 Deficiency People whose anemia is caused by a deficiency of Vitamin B12 may have these symptoms: o A tingling, "pins and needles" sensation in the hands or feet o Lost sense of touch o A wobbly gait and difficulty walking o Clumsiness and stiffness of the arms and legs oDementia o Hallucinations, paranoia, and schizophrenia
- 18. SIGNS OF ANAEMIA o Brittle nails o Koilonychias (spoon shaped nails) o Atrophy of the papillae of the tongue o Angular stomatitis o Brittle hair o Dysphagia and Glossitis o Plummer vinson/kelly patterson
- 19. INVESTIGATIONS 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
- 20. 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) •Men - 14-17 gms/dl •Women - 12-16gms/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
- 21. 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
- 22. 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.
- 23. NON PHARMOCOLOGICAL MANAGEMENT oTea and coffee inhibit iron absorption when consumed with a meal or shortly after a meal. oVitamin 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. oGermination 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. oPromote and support exclusive breastfeeding for about 6 months followed by breastfeeding with appropriate complementary foods, including iron-rich through the second year of lif
- 24. RECOMMENDED DIETARY ALLOWANCE Recommended Dietary Allowance mg/Day Men Adult (50 years) 8mg Women Adult (50 years) 8mg Adult(Age 19 to 50 years) 18mg Pregnant 27mg Lactating 9mg to 10mg Adolescents (Age 9 to 18 years) Boys Girls 8 mg to 11mg 8 mg to 15mg Children (Age 4 to 8 Years) 10mg Infants ( Birth to 6 months) Infacnts ( 7 months to 1 Year) 0.27mg 11mg
- 25. MANAGEMENT Complimentary parasite control measures o 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. oChild - <2yrs-200mg/day single dose o Pregnancy - Albendazole is contraindicated in first trimester, can be administered in second or third trimester.
- 26. TREATMENT FOR 6 TO 24 MONTHS
- 27. TREATMEN OF MILD AND MODERATE oAnemia will correct within 2 to 4 months if appropriate iron dosages are administered and underlying cause of iron deficiency is corrected. oContinue iron therapy an additional 4 to 6 months (adults) after the hemoglobin normalizes to replenish the iron stores.
- 28. TREATMENT FOR SEVERE After completing 3 months of therapeutic supplementation, pregnant women and infants should continue preventive supplementation program.
- 29. TREATMENT FOR PREGNANT WOMEN
- 30. oIron absorption may be decreased by antacids or supplements containing aluminum, maganesium, calcium, zinc, proton pump inhibitors. oSpace administration apart by at least 2 hours. oOral iron preparations may cause nausea, vomiting, dyspepsia, constipation, diarrhea or dark stools. oStrategies 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. oAlthough 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
- 32. REFERENCES •ABC of clinical haematology by Drew Provan. 3rd edition. •Textbook of oral pathology by Shafer 4th edition •Practical Medicine by P.J Mehta 18th edition •Text book of Clinical Medicine by S.N Chugh •Burket’s textbook of Oral medicine by Malcom A Lynch 10th edition •Essentials of medical physiology by Sambulingum K and Sambulingum prema 3rd edition •Text book of Medical Physiology by Guyton and Hall 10th edition 100