ANAEMIA

1. DR NILESH KATE
MBBS, MD
ASSOCIATE PROF
DEPT. OF PHYSIOLOGY
ANAEMIA.

2. ANAEMIA
Definition:
 Anemia is defined as a
decreased O2 carrying
capacity due to quantitative
and qualitative Reduction in
RBC counts and Hemoglobin
levels.

3. ANAEMIA
 ANAEMIA is labelled
when Hb is less than
 13gm/dl in Males
 11 gm/dl in Females
 15gm/dl in Newborn.
Wednesday, February 24, 2016

5. MORPHOLOGICAL CLASSIFICATION:
normochromic

6. Etiological Classification

7. DUE TO DECREASED RBC
PRODUCTION.
IRON DEFICIENCY
ANAEMIA.
 Most common in India.
 In women of
reproductive age group
(20-45 yrs)
 In periods of active
growth of infancy,
childhood & adolescence
Wednesday, February 24, 2016

8. IRON METABOLISM
 Total body contains 4-5
gms
 Forms –
 Haemoglobin 70%
 Storage iron 20-23% 2/3rd
Ferritin & 1/3rd
Haemosiderin.
 Myoglobin in red muscles
5%
 Intracellular enzymes 2-3%
Wednesday, February 24, 2016

9. DAILY REQUIREMENTS &
SOURCES
 5-10 mg/day in Males
 20 mg/day in
Females.
 40 mg/day in
Pregnant & lactating
women.
 Meat, liver, egg, green
leafy veg, Jaggery &
whole wheat.
Wednesday, February 24, 2016

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11. IRON
ABSORPTION
 Mainly in duodenum &
upper jejunum.
 MECHANISM
 Transport across brush
borders
 Haeme iron
 Non-haeme iron.
 Fate in Enterocytes.
 Transport in plasma.
Wednesday, February 24, 2016

12. IRON ABSORPTION
 Transport across brush
borders.
 Absorption of Haeme
form
 Absorption of Non-
haeme form
 Fate in Enterocytes.
 Transport in plasma.
Wednesday, February 24, 2016

13. Factors affecting iron
absorption
 Form of dietary iron –
 haem iron
 Non-haem iron – ferrous form (Fe2+) > ferric form
(Fe3+)
 Meat & fish ,Human breast milk ,Acid gastric
juice – enhances absorption.
 Dietary factors – Phytates , phosphates, calcium,
egg white, phenols, tea, coffe wine reduces.
 Iron stores in body – Negative feedback effect.
Wednesday, February 24, 2016

14. STORAGE OF IRON
 As ferritin
 As haemosiderin.
Wednesday, February 24, 2016

15. REGULATION OF BODY IRON
 Mucosal block theory of absorption.
 Saturation of apoferritin & apotransferrin
 Decresed rate of apoferritin synthesis.
 Role of specific iron receptors in brush borders.
Wednesday, February 24, 2016

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18. APPLIED ASPECTS.
 Iron deficiency- iron
deficiency Anaemia
 Iron excess –
Haemosiderin
accumulation –
Haemosiderosis –
damages tissue –
Haemochromatosis.
Wednesday, February 24, 2016

19. CAUSES OF IRON DEFICIENCY
ANAEMIA.
 Inadequate dietary
intake.
 Increased loss of iron.
 Increased demand of
iron.
 Decreased absorption.
Wednesday, February 24, 2016

20. Megaloblastic Anaemia
 Megaloblast –
abnormally large cells
of Erythroid series.
 Caused by defective
DNA synthesis due to
deficiency of Vit B12 &
Folic acid.

21. Vit B 12 (Extrinsic Factor)
 Vit B12 –
Cyanocobalamin or
extrinsic factor.
 Daily need – 1-2 μg.
 Sources – Milk, Meat,
Liver of Animals
 Also synthesized by
bacterial Flora.
Wednesday, February 24, 2016

22. Vit B 12 (Extrinsic Factor)
 Absorption – need
Intrinsic Factor Of Castle ,
a glycoprotein secreted by
parietal cells of gastric
mucosa.
 With it form Intrinsic
Factor- Cyanocobalamin
complex
 Bound to sp receptors in
ileum & absorbed by
Endocytosis.
Wednesday, February 24, 2016

23. Vit B 12 (Extrinsic Factor)
 Transport – in blood
transported by
combining with
Transcobalamin-II
 Storage – In liver &
Muscle
 Role – required for
synthesis of DNA &
maturation of nucleus &
cell.
Wednesday, February 24, 2016

24. Folic Acid
 Folic acid –
Pteroylglutamic acid.
 Daily requirement –
100 μg.
 Sources – leafy veg,
pulses, yeasts, liver.
 From breakdown of
Polyglutamate to
Monoglutamates.
Wednesday, February 24, 2016

25. Aetiology.
 Due to vit B12
deficiency
 Causes –
 Inadequate dietary
intake
 Malabsorption due to
gastric cause
 Intestinal Cause.

26. Addisonian Pernicious
Anaemia.
 Aetiology – vit B12
deficiency due to
failure of secretion of
Intrinsic Factor by
stomach due to
Autoimmune
Atrophy of Gastric
Mucosa.
 Features.
 Features of
Megaloblastic anaemia
 Anti-intrinsic factor
antibodies.
 Schilling test.
(abnormal vit B12
absorption test
corrected by addition
of Intrinsic Factor)
Wednesday, February 24, 2016

27. Clinical Features:
 General features of Anemia
 Pallor, Weakness, Lethargy,
 Breathlessness on exertion
 Palpitations  heart failure  pedal edema
 Special features :
 Angular cheilitis, Atrophic glossitis,
 Oesophageal atrophy/web  Dysphagia,
 Koilonychia, brittle nails, gastric atrophy.

28. Special features :

29. LAB FINDINGS
 Blood picture & red cell
indices.
 Hb Decreased
 RBC – Microcytic,
Hypochromic in iron
deficiency
 Megaloblastic in vit B12 &
FOLIC ACID deficiency
 Red cell indices – MCV,MCH
& MCHC Decreases
Wednesday, February 24, 2016

30. BONE MARROW FINDINGS.
 Iron deficiency
anaemia
 Marrow Cellularity –
Erythroid Hyperplasia.
 Erythropoiesis –
Normoblastic
 Marrow Iron –
Deficient.
 Megaloblastic
anaemia.
 Marrow cellularity –
Megaloblastic
Hyperplasia.
 Marrow iron – by
Prussian Blue staining
increase in size & no of
iron granules.
Wednesday, February 24, 2016

31. BIOCHEMICAL FINDINGS.
 Iron deficiency
Anaemia
 Serum iron decreases
(below 50 mg%)
 Serum Ferritin – very
low.
 Total Iron Binding
Capacity – increased.
 Megaloblastic Anaemia.
 serum bilirubin –
increases.
 Urine Urobilinogen –
excretion increases.
 Serum iron & Ferritin –
increases.
 Serum vit B12,Folate levels
- decreased
Wednesday, February 24, 2016

32. MANAGEMENT
 General – correction
of causative factor if
possible.
 Special – oral
administration of fe
salts, FSFA TAB,
Intramuscular inj.
Wednesday, February 24, 2016

33. THANK
YOU