ANEMIA AND ITS ANEMIA AND ITS COMPLICATIONS COMPLICATIONS

DR AMIT DR AMIT TIRTHTIRTH

DEPT OF COMMUNITY DEPT OF COMMUNITY DENTISTRYDENTISTRY

Introduction DefinitionDefinition GradingGrading Classification Classification 1- Morphological classification1- Morphological classification

2- Etiological classification2- Etiological classification Causes & SymptomsCauses & Symptoms Types of anemiaTypes of anemia DiagnosisDiagnosis TreatmentTreatment PreventionPrevention ConclusionConclusion ReferencesReferences

DEFINITION

Anaemia is defined as clinical Anaemia is defined as clinical condition characterized by condition characterized by reduction in the number of RBC reduction in the number of RBC less than 4 million/cc mm or the less than 4 million/cc mm or the or content of hemoglobin less or content of hemoglobin less than 12 gm% or both.than 12 gm% or both.

Decrease ODecrease O2 2 carrying capacity of carrying capacity of bloodblood

GRADINGMild Anaemia : Haemoglobin 8-12 Mild Anaemia : Haemoglobin 8-12

gm%gm%

Moderate Anaemia : Haemoglobin 5-8 Moderate Anaemia : Haemoglobin 5-8 gm%gm%

Severe Anaemia : Haemoglobin less Severe Anaemia : Haemoglobin less than 5 gm%than 5 gm%

Mild Anaemia : Haemoglobin 8-12 Mild Anaemia : Haemoglobin 8-12 gm%gm%Moderate Anaemia : Haemoglobin 5-8 gmModerate Anaemia : Haemoglobin 5-8 gm%%Severe Anaemia : Haemoglobin less Severe Anaemia : Haemoglobin less than 5 gm%than 5 gm%

Morphological classification

A- A- Normocytic Normochromic AnemiaNormocytic Normochromic Anemia (Hb % (Hb % &Size are normal only RBC count is reduced &Size are normal only RBC count is reduced

B- B- Macrocytic Normochromic AnemiaMacrocytic Normochromic Anemia (Hb% is (Hb% is normal onlyRBC cells are larger due to normal onlyRBC cells are larger due to which cell count is reducedwhich cell count is reduced

C- C- MacrocyticHypochromic AnemiaMacrocyticHypochromic Anemia (Hb%is (Hb%is reduced % RBC are larger and immaturereduced % RBC are larger and immature

D- D- Microcytic Hypochromic AnemiaMicrocytic Hypochromic Anemia (Hb% is (Hb% is less,RBC are smaller in sizeless,RBC are smaller in size

Etiological classification

A- A- Hemorrhagic AnemiaHemorrhagic Anemia

B- B- Hemolytic AnemiaHemolytic Anemia : : - hereditary spherocytosis- hereditary spherocytosis - Sickle cell anemia- Sickle cell anemia -Thalassemia-Thalassemia

C- C- Nutritional Deficiency AnemiaNutritional Deficiency Anemia : : - iron deficiendy anemia- iron deficiendy anemia - pernicius anemia- pernicius anemia - megaloblastic anemia- megaloblastic anemia

D- D- Aplastic AnemiaAplastic Anemia

Causes & symptoms Decreased red blood cell production, or Decreased red blood cell production, or

bleedingbleeding Increased red blood cell destruction.Increased red blood cell destruction. Poor diet can contribute to vitamin Poor diet can contribute to vitamin

deficiency and iron deficiency anemia. deficiency and iron deficiency anemia.

However, excessive bleeding is the most However, excessive bleeding is the most common cause of anemia, and the speed with common cause of anemia, and the speed with which which blood lossblood loss occurs has a significant occurs has a significant effect on the severity of symptoms. effect on the severity of symptoms.

Chronic blood loss may be caused by:

Heavy menstrual flow Heavy menstrual flow Hemorrhoids Hemorrhoids Nosebleeds Nosebleeds Cancer Cancer Gastrointestinal tumors Gastrointestinal tumors Stomach ulcers Stomach ulcers Long-term alcohol abuse Long-term alcohol abuse Acute blood loss is usually the result of::Acute blood loss is usually the result of:: Childbirth Childbirth Injury Injury Ruptured blood vessel Ruptured blood vessel Surgery Surgery

MICROCYTIC HYPOCHROMIC ANAEMIA or CHRONIC BLOODLOSS

Hemoglobin percententage decreases Hemoglobin percententage decreases due to deficiency of Fe due to deficiency of Fe

Fe deficiency also occurs due to more Fe deficiency also occurs due to more requirement of Fe in certain phases of requirement of Fe in certain phases of life as in growing children's, during life as in growing children's, during pregnancy and lactation pregnancy and lactation

Patient suffering from peptic ulcers, Patient suffering from peptic ulcers, piles, blood dysentery ,warm piles, blood dysentery ,warm infections, poor absorption of iron as infections, poor absorption of iron as in diarrheain diarrhea

Folic acid deficiency Anemia

Folic acid deficiency anemia is the Folic acid deficiency anemia is the most common type of most common type of megaloblasticmegaloblastic anemia anemia, in which red blood cells are , in which red blood cells are bigger than normal. It is caused by a bigger than normal. It is caused by a deficiency of folic acid, deficiency of folic acid, a vitamina vitamin that the body needs to produce that the body needs to produce normal cells.normal cells.

Folic acid anemia is especially Folic acid anemia is especially common in infants and teenagers. common in infants and teenagers. Although this condition usually Although this condition usually results from a results from a dietary deficiencydietary deficiency

Folic acid deficiency anemia

Smoking raises the risk of Smoking raises the risk of developing this condition by developing this condition by interfering with the absorption of interfering with the absorption of vitamin C, which the body needs vitamin C, which the body needs to absorb woman's body needs to absorb woman's body needs eight times more folic acid than it eight times more folic acid than it does otherwise.does otherwise.

Vitamin B12 deficiency

Vitamin B12 deficiency anemia is Vitamin B12 deficiency anemia is another type of megaloblastic anemia another type of megaloblastic anemia that develops when the body does not that develops when the body does not absorb enough of this nutrient. absorb enough of this nutrient. Necessary for the creation of red Necessary for the creation of red blood cells, B12 is found in meat and blood cells, B12 is found in meat and vegetables.vegetables.

Large amounts of B12 are stored in Large amounts of B12 are stored in the body, so this condition may not the body, so this condition may not become apparent until as long as four become apparent until as long as four years after B12 absorption slows years after B12 absorption slows down or stops. down or stops.

Pernicious Anemia The resulting drop in red blood cell production can causeThe resulting drop in red blood cell production can cause::

loss of sensation in the legs, hands, and feetloss of sensation in the legs, hands, and feet weight loss weight loss yellow-blue color blindness yellow-blue color blindness Since most people who eat meat or eggs get enough B12 in Since most people who eat meat or eggs get enough B12 in

their diets, a deficiency of this vitamin usually means that their diets, a deficiency of this vitamin usually means that the body is not absorbing it properly. This can occur the body is not absorbing it properly. This can occur among people who have had intestinal surgery. among people who have had intestinal surgery.

Symptoms of pernicious anemia include problems with Symptoms of pernicious anemia include problems with movement or balance, tingling in the hands and feet, movement or balance, tingling in the hands and feet, confusion, depression, and memory loss. confusion, depression, and memory loss.

Pernicious Anemia

Pernicious anemia (B12) usually strikes people 50–60 Pernicious anemia (B12) usually strikes people 50–60 years of age. Eating disorders or an unbalanced diet years of age. Eating disorders or an unbalanced diet increases the risk of developing pernicious anemia. increases the risk of developing pernicious anemia.

So do So do diabetes mellitus, gastritisdiabetes mellitus, gastritis, stomach cancer, , stomach cancer, stomach surgery, thyroid disease, and family history stomach surgery, thyroid disease, and family history of pernicious anemia of pernicious anemia

Vitamin C deficiency Anemia

A rare disorder that A rare disorder that causes the bone marrow causes the bone marrow to manufacture to manufacture abnormally small red abnormally small red blood cells, vitamin C blood cells, vitamin C deficiency anemia deficiency anemia results from a severe, results from a severe, long-standing dietary long-standing dietary deficiency.deficiency.

Hemolytic Anemia Some people are born with Some people are born with

hemolytic anemiahemolytic anemia. . Some acquire Some acquire this condition, in which infection this condition, in which infection or antibodies destroy red blood or antibodies destroy red blood cells more rapidly than bone cells more rapidly than bone marrow can replace them.marrow can replace them.

Hemolytic anemia can enlarge the Hemolytic anemia can enlarge the spleen and accelerate the spleen and accelerate the destruction of red blood cells destruction of red blood cells (hemolysis). Other complications (hemolysis). Other complications of hemolytic anemia may include of hemolytic anemia may include pain, shock, gallstones, and other pain, shock, gallstones, and other serious health problems.serious health problems.

An inherited form of hemolytic anemia, An inherited form of hemolytic anemia, thalassemia stems from the body's inability to thalassemia stems from the body's inability to manufacture as much normal hemoglobin as it manufacture as much normal hemoglobin as it needs. needs.

Characterized by production of red blood cells that Characterized by production of red blood cells that are unusually small and fragile, thalassemia only are unusually small and fragile, thalassemia only affects people who inherit the gene for it from each affects people who inherit the gene for it from each parentparent

Sickle cell AnemiaSickle cell Anemia Chronic, incurable condition that Chronic, incurable condition that

causes the body to produce defective causes the body to produce defective hemoglobin, which forces red blood hemoglobin, which forces red blood cells to assume an abnormal crescent cells to assume an abnormal crescent shape. shape.

Unlike normal oval cells, fragile sickle Unlike normal oval cells, fragile sickle cells cannot hold enough hemoglobin cells cannot hold enough hemoglobin to nourish body tissues.to nourish body tissues.

The deformed shape makes it hard for The deformed shape makes it hard for sickle cells to pass through narrow sickle cells to pass through narrow blood vessels. When capillaries blood vessels. When capillaries become obstructed, a life-threatening become obstructed, a life-threatening condition called sickle cell crisis is condition called sickle cell crisis is likely to occur.likely to occur.

Diagnosis Personal and family health history Personal and family health history

may suggest the presence of certain may suggest the presence of certain types of anemia. Laboratory tests types of anemia. Laboratory tests that measure the percentage of red that measure the percentage of red blood cells or the amount of blood cells or the amount of hemoglobin in the blood are used to hemoglobin in the blood are used to confirm diagnosis and determine confirm diagnosis and determine which type of anemia is responsible which type of anemia is responsible for a patient's symptoms. X rays and for a patient's symptoms. X rays and examinations of bone marrow may examinations of bone marrow may be used to identify the source of be used to identify the source of bleeding bleeding

Treatment Anyone who has anemia caused by Anyone who has anemia caused by

poor nutrition should modify his or poor nutrition should modify his or her diether diet

To include more vitamins, minerals, To include more vitamins, minerals, and iron. Foods such as lean red and iron. Foods such as lean red meats, dried beans and fruits, liver, meats, dried beans and fruits, liver, poultry, and enriched breads and poultry, and enriched breads and cereals are all good sources of iron.cereals are all good sources of iron.

In addition, eating foods rich in In addition, eating foods rich in vitamin C such as citrus fruits and vitamin C such as citrus fruits and juices can promote the absorption juices can promote the absorption of iron of iron

Treatment cont.. Patients diagnosed with iron-deficiency anemia should Patients diagnosed with iron-deficiency anemia should

undergo a thorough undergo a thorough physical examinationphysical examination and medical history and medical history to determine the cause of the anemia, particularlyto determine the cause of the anemia, particularly

If chronic or acute blood loss is suspected. The cause of a If chronic or acute blood loss is suspected. The cause of a specific anemia will determine the type of treatment specific anemia will determine the type of treatment recommended.recommended.

Anemia due to nutritional deficiencies can usually be treated Anemia due to nutritional deficiencies can usually be treated at home with iron supplements or self administered injections at home with iron supplements or self administered injections of vitamin B12. People with folic acid anemia should take oral of vitamin B12. People with folic acid anemia should take oral folic acid replacements. Vitamin C deficiency anemia can be folic acid replacements. Vitamin C deficiency anemia can be cured by taking daily supplements of vitamin C.cured by taking daily supplements of vitamin C.

Prevention

Avoiding excessive use of alcohol, eating a balanced diet Avoiding excessive use of alcohol, eating a balanced diet that contains plenty of iron-rich foods, and taking a daily that contains plenty of iron-rich foods, and taking a daily multivitaminmultivitamin can help prevent anemia can help prevent anemia

Avoiding lengthy exposure to industrial chemicals and Avoiding lengthy exposure to industrial chemicals and drugs known to cause aplastic anemia. drugs known to cause aplastic anemia.

Not taking medication that has triggered hemolytic Not taking medication that has triggered hemolytic anemia and not eating foods that have caused hemolysis anemia and not eating foods that have caused hemolysis (breakdown of red blood cells). (breakdown of red blood cells).

Receiving regular B12 shots to prevent pernicious Receiving regular B12 shots to prevent pernicious anemia resulting from gastritis or stomach surgery anemia resulting from gastritis or stomach surgery

Conclusion Anemia is most often recognized by abnormal Anemia is most often recognized by abnormal

screening laboratory testsscreening laboratory tests Patients less commonly present with advanced Patients less commonly present with advanced

anemia and its attendant signs and symptomsanemia and its attendant signs and symptoms Acute anemia is nearly always due to blood loss or Acute anemia is nearly always due to blood loss or

haemolysis.haemolysis. The evaluation of the patient with anemia requires The evaluation of the patient with anemia requires

a careful history and physical examinationa careful history and physical examination

References HARRISON’S PRINCIPLES OF INTERNAL MEDICINE-HARRISON’S PRINCIPLES OF INTERNAL MEDICINE-

1414THTH EDITION,VOL. 1 EDITION,VOL. 1

ESSENTIALS OF MEDICALPHYSIOLOGY-K ESSENTIALS OF MEDICALPHYSIOLOGY-K SEMBULINGAM – 3SEMBULINGAM – 3RDRD EDITION EDITION

CONCISE MEDICAL PHYSIOLOGY – CHAUDHURI -3CONCISE MEDICAL PHYSIOLOGY – CHAUDHURI -3RDRD EDITIONEDITION

HUMAN PHYSIOLOGY – SYSTEMIC AND APPLIED – HUMAN PHYSIOLOGY – SYSTEMIC AND APPLIED – SUBHASH SHALYASUBHASH SHALYA

TEXT BOOK OF CLINICAL MEDICINE FOR DENTAL TEXT BOOK OF CLINICAL MEDICINE FOR DENTAL STUDENTS – DR. S.N.CHUGSTUDENTS – DR. S.N.CHUG

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