What is anemia

Anemia is considered to be present if the hemoglobin (Hb) concentration is below the lower limit of the 95% reference range for the individual's age, sex, and geografic location.

Causes of Anemia :

Impaired production due to:

- Deficiency of Iron, Vitamin B12, Folic acid
- Chronic disease,
- Certain congenital diseases
In India nutritional deficiency is most common cause for anemia.

Clinical signs and symptoms :

Easy fatigability, dyspnea on exertion, faintness, palpitation, headache. The physical findings are pallor, rapid pulse, low B.P., low fever, edema etc.

Nutritional Anemia (Iron Deficiency, Megaloblastic anemia) :

- Due to inadequate intake - Increased demand - Defective absorption

Iron deficiency anemia is more common in children, elderly, female in reproductive age group.

Sources : green leafy vegetables, cereals, pulses, animal foods(e.g. liver, kidney, meat, egg, yolk) ; cooking in iron vessels. Ascorbic acid (vitamin C) enhances the iron absorption.

Laboratory investigations required are

1. Complete blood check up - Hb, RBC count, WBC count, blood indices
2. Peripheral smear examination
3. Serum iron level
4. Total iron binding capacity etc.

Treatment

- If anemia not severe - modification of diet,Oral iron supplement; for three months.
- If anemia is severe - blood transfusion.

Megaloblastic anemia RBCs are larger in size Due to vitamin B12 Folic acid deficiency.

1. Vitamin B12

Sources of vitamin B12 : liver, eggs, fish, milk

Lab investigation required are

1. Complete blood check up
2. Peripheral smear examination
3. Vitamin B12 level
4. Therapeutic Trial helps in diagnosis.
5. Other tests

Treatment

- Vitamin B12 rich diet
- Medication

2. Folic acid deficiency :

- This also results in megaloblastic anemia
- More common in children, pregnant female,
- Human milk and cow's milk contains sufficient amount of folic acid - Ascorbic acid (vitamin C) enhances the folate absorption

Hemoglobin disorders Acquired; Extrinsic causes Immune hemolytic anemia

- Anemia that is due to increased red cell destruction is hemolytic anemia.
- Hemolytic anemia may be due to a defect of the red cell itself-intrinsic hemolytic anemia, these are usually hereditary and they are membrane disorders, hemoglobin disorders, metabolic disorders.
- Hemolysis may be due to a factor outside the red cells-extrinsic hemolytic anemia, almost always acquired.

Hemoglobin disorders - more common are Thalassemias Sickle cell anemia.

- Globin is the protein part is consists of four polypeptide chain.
- Hemoglobin A is the major normal adult hemoglobin, the polypeptide chains of the globin are of two types: two identical a each with 141 amino acid and two b each with 146 amino acid.

Sickle cell anemia

In Sickle cell anemia there is a change in one amino acid position of b chain , that makes change in normal hemoglobin. So when there is a change in oxygen tension polymerization of hemoglobin occurs forming tactoids that are rigid and deform the cells into the shape that gave the cells its name. These rigid cells are more vulnerable to hemolysis.

Thalassemia

The common characteristic of this disorder is that the rate of synthesis is diminished but the chain formed is in most of the cases structurally normal.

In b thalassemias, which are more common, b chain production is decreased.

Most of the patients require regular transfusion. 

For long period but in small quantity, e.g. peptic ulcer, malignancy.In case of trauma large quantity of blood is loss at a time may result into acute anemia.

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