ANEMIA

PHARMACY NOTES
 ANEMIA

• Anemia is a condition characterised by a decrease in

either the haemoglobin or the volume of red blood
cells which results in decreased oxygen carrying
capacity of the blood.
• Anemia is defined as Hbg<13g/dl in men or <12g/dl
in women(WHO)
• Is the inadequate level of heamoglobin in the body.
• When there is insufficient supply of oxygen to the
body by heamoglobin.
 CLASSIFICATON OF ANEMIA BY AGE
CATHEGORY NORMAL MILD MODERATE SEVERE

MEN>15 YEARS >13g/dL 11-12g/dL 8-10.9g/dL <8g/dL

WOMEN >12g/dL 11-11.9g/dL 8-10.9g/dL <8g/dL

PREGNANT >11g/dL 10-10.9g/dL 7-9.9g/dL <7g/dL

WOMEN

CHILD AGE >12g/dL 11-11.9g/dL 8-10.9g/dL <8g/dL

12-14 YEARS
CHILD AGE >11.5g/dL 11-11.9g/dL 8-10.9g/dL <8g/dL
5-11YEARS
CHILD AGE >11g/dL 10-10.9g/dL 7-9.9g/dL <7g/dL
6MONTH-5
YEARS
 PEOPLE AT RISK
NOTES
• Men are at low risk to acquire anemia.
• Women are the second groups at a risk.
• Pregnant women are the third vulnerable to
anemia.
• Children below the age of twelve their
vulnerability to anemia increases as the ages
go downs.
 CLASSIFICATION OF ANEMIA
• Morphology
• Etiology
• pathophysiology
 Morpholgy
1. Macrocytic.
2. Microcytic
3. Normocytic
 MORPHOLOGY
• macrocytics

Megoloblastic,vitamin B 12 deficiency and folic acid

deficiency.
Microcytic hypochromic
Iron deficiency, genetic abnomalities,sickle cell
anemia,Thelessemia.
Normocytics
Recent blood loss,hemolysis,bone marrow
failure,endocrine disorders.
 Etiology
Deficiency;
Iron deficency,lack of vitamin B12
(cyanocabolamine) and vitamin B6
Central impaired bone marrow.
Anemia due to chronic diseases, anemia in elderly.
And malignant anemia of none marrow.
Peripheral
Hemolytic and hemorrhage.
 Pathophysioloogy
Excessive blood loss
Hemorrhage,trauma,peptic ulcer gastritis
Chronic hemorrhage
Vaginal bleeding, peptic ulcer, intestinal parasite, administration of
NSAIDS.
Infiltration of bone marrows.
Luekemia,lymphoma,myelosuppresion and carcinoma.
Endocrine abnormalities.
Hyperthyriodism,adrenal insufficiency and pititutary insufficiency.
Chronic inflammatory disease
Granulomatous disease and collagen vascular disease.
Excess RBC destruction.
 CAUSES OF ANEMIA
1. Decreased production of red blood cells.
2. Increased destruction of red blood cells.
3. Loss of red blood cells.
 1.Decreased production of red blood
cells.

• Fe 2+ deficiency,vit B9 (folic acid

deficiency),vit B12(cyanocobalamine)
• Myelosuppresion (leukopenia,applasia)
• Infections(HIV, TB, Leishmaniasis)
 2.Increased destruction of red blood cells.
(hemolytic)
• Malaria
• Drugs side
effect(Dapsone,cotrimoxazole,AZT)
• Congenital disorders e.g. sickle cell anemia.
 3.Loss of red blood cells
We have both acute and chronic
A. ACUTE
• Accidental heamorhage,Abortion,Menstrual
bleeding.
B. CHRONIC
• Pregnancy, hookworm
menisfestation,schistosomiasis.
General clinical features of anemia
• Fat Pallor of conjunctiva,mucous
membranes,palms,sole.
• Fatique,dizziness,palpitation,headache,anorexia,wei
ght loss and exercise tolerance.
• Acute blood loss, postural hypotension, decreased
cardiac
output,tachycardia,sweeting,restlessness,and thirst.
• Testing for specific pathology such as
splenomegaly,malaria,nutritional deficiency and
hemolytic jaundice.
 Investigations of anemia.
• Complete blood count, Mean Corpuscular
volume(MCV),platelets, and a peripheral smear.
• Evaluate Hb levels according to the patients
age.
• Classify anemia according to the MCV
• Reticulocyte count ,sickle cell ,stool for ova,
parasites and occult blood and blood slides and
RTD for malaria.
 Megaloblastic Anemia
Megaloblastic anemia is an example of macrocytic
anemia.
This is anemia characterised by large red blood cells.
Macrocytosis as seen in megaloblastic anemia is due
to abnormalities in DNA metabolism resulting
from a deficiency in vitamin B12 or folate.
Can also be due to various drugs such as
hydroxyurea,zidovudine,cytocine,arabinoside,met
hotrexate,and azathioprine.
 Megaloblastic anemia continued
• In vitB12 or folate deficiency anemia,
megaloblastosis results from interference in folic
acid synthesis in the immature erythrocyte. The
rate of RNA and cytoplasm production exceeds the
rate of DNA production.the maturation process is
retarded, resulting in immature large red blood
cells(macrocytosis).synthesis of RNA and DNA
necessary for cell division depends on series of
reactions catalysed by vit B12 and folic acid,as they
have arole in the conversion ofuridine to thymidine.
 causes
• Law dietary intake of folate/increased need
e.g pregnancy and children.
• Malabsorpton of folate and vit B12
• Drugs e.g hydroxyurea,zidovudine,and
stavudine.
 Clinical features
o Pallor of conjunctiva,mucous membrane and
palms.
o Fatique, dizziness,palpitations,headache,,
anorexia,,weigt loss,low exercise tolerance.
 management
• General measures
• Identify and treat underlying cause of anemia.
• Dietary modification to ensure adequate intake of folate and vit B12
• Folic acid and vitB12 supplementation
• Folic acid. 5mg daily untill haemoglobin levels come back to normal.
• Vitamin B12 1mg IM daily for 5 days; then weekly for further 3 doses.
• Follow with 1mg every second month for life in patents with pernicious anemia.
• Don’t give folic acid alone but refer for further testing and treatment ,giving
folic acid alone in patients with B 12 deficiency may precipitate permanent
neurological deficit .
• Anemia normally corrects within 1-2 months .white cell counts and
thrombocytopenia normalize within 7-10 days.
• Do not use ferrous-folate in combination tablets to treat folic deficiency
because the quantity of folic acids is too low.
 HEMOLYTIC ANEAMIA
• When destruction of red blood cells outpaces
a persons bone marrow production .

Hemolytic aneamia occurs in two forms i.e

• Extrinsic aneamia
• Intrnsic aneamia
 Extrinsic anemia
Occurs when,
• spleen traps and destroy red blood cells
• Autoimmune disordersreactions due to
infections,tomours,medication side
effects,leukemia,lymphoma.
 Intrinsic anemia
Occurs when,
• Blood cells produced by the body don’t
functions properly.i.e sickle cell anemia and
thalassaemia,G6PD deficiency and red blood
cells membrane instability.
 CAUSES OF HEMOLYTIC ANEMIA
1- Extrinsic anemia
• Enlarged spleen
• Hepatitis
• Epstein-Bar virus
• E coli toxins
• Leukemia
• Lymphoma
• Tumors
• Lupus
• Wiskot-aldrich syndrome.
2-Intrinsic anemia
 Symptoms of hemolytic anemia
• Paleness of the skin
• Fatigue
• Fever
• Confusion
• Lightheadness
• Dizziness
• Splenomegaly
• Enlarged liver
• Increased heart rate
• Dark urine
 Hemolytic anemia in newborns.
• Occurs when a mother and baby has incompatible
blood types called erythroblastic fetalis
when a mother is Rhesus negative and her baby is
Rhesus positive ,there is a chance that hemolytic
disease of the new borne can occcur.the results
of this is like blood transfusion reaction.
This happen to a women in her second pregnancy.
This is how the body build defends against the
negative blood cells.
 Management

• Blood transfusion
• Intravenous immunoglobulin (IVIG)
RhoGam starts around 28 week of pregnancy if
she has Rh –negative blood group.
 Hemolytic anemia in children.
• Infections
• Auto-immune disease
• Cancer
• Medication
• Evans syndrome.
 Diagnosis
• Bilirubin
• Hemoglobin
• Liver function test
• Reticulocyte count
• Bone marrow aspiration(Biopsy)
 Management
• Blood transfusion
• Intravenous immunoglobulin
• Immunosuppressant
• Corticosteroid medication(extrinsic anemia)
• surgery