1.Presented at:College Of Nursing Shifa Tameer-e-Millat University By: Muhammad Farooq RN, BSN, Dip Card.

2. At the end of this presentation, the audience willknow: What is Anemia Causes of Anemia What are different Types/classification of Anemia Clinical feature of anemia Diagnosis/investigation Of Anemia Treatment Of Anemia 3. Taken from Greek language (an meaning absence& hemia meaning blood), the term Anemia is use to describe a reduction in the hemoglobinconcentration or in the number of circulating RBCs below the level considered normal for the person's age, sex and locality. 4. Normal reference values of Hb% PopulationNormal Hb% (at sea level)Newborn14-22 g/dlChildren11-13 g/dlNon-pregnant women12-16 g/dPregnant women11-15 g/dMen14-18 g/dlGeriatric Age (Both Genders)12 16 g/dl 5. Normal Values of RBC Count PopulationRBCs Count (at sea level)Newborns6 months4.05.5 mil/lChildren4.04.9 mil/lFemale3.8 5.4 mil/lMale4.4 5.4 mil/l 6. Causes Of Anemia 7. There are many diseases, conditions and otherfactors causes anemia, few of which are: Nutritional deficiencies i.e. Iron, vit B12, folate etc. Hemolytic disorders e.g. Hypersplenism Acute or chronic Blood loss e.g. from G.I Tract,Hemorrhage Bone marrow disorder Chronic Diseases e.g. Renal failure, Liver disease andMalignancies 8. Causes Of Anemia (Cont.) Infections and inflammation e.g. Malaria, Cl.Tetani Toxicity (from drugs, metals and poisons)e.g. Lead Poisoning Autoimmune disorders .e.g. SLE, Heredity defect e.g. Thalassemia 9. Classification Of Anemia Classification of anemia can be made the bases of RBCs Morphology Etiology 10. Morphological Classification In morphological approach anemia is classified by thesize or volume of RBC which is expressed as Mean Corpuscular or Mean Cell Volume(MCV). On the basis of MCV, following are the types ofanemia: Microcytic Anemia (MCV98fl) Normocytic Anemia (MCV b/w 76 98 fl) 11. Microcytic Anemia (98fL)Normocytic Anemia (76-98 fL)1) Iron Deficiency anemiaVit. B12 & folate deficiencyVit B2 & B62) ThalassemiaAlcoholismHemolytic Anemia3) Sideroblastic AnemiaAcute Blood LossPost Hemorrhagic Anemia4) Lead Poisoning AnemiaLiver diseaseSickle Cell Anemia5) Chronic Disease AnemiaAplastic AnemiaAnemia in Pregnancy 12. Etiological Classification Etiological Classification of Anemia include Anemia due to impaired RBC production Anemia due to excessive destruction Anemia due to Blood loss 13. Clinical Features Of Anemia 14. Clinical Manifestations The clinical features of Anemia can result fromfollowing factors. 1.Tissue Hypoxia2.Compensatory Mechanism3.Rate of blood loss/destruction of RBCs4. Causes of Anemia 15. Symptoms of Tissue Hypoxia Largely affect Central Nervous System, Cardio-vascular system and Muscular system as their Oxygen requirement is high than other. 16. Neurological Symptoms: Dizziness, fainting, lack of concentration Blurred or diminished vision Headache, tinnitus, Vertigo Paraesthesia in the fingers and toes Insomnia, irritability, confusion 17. Cardio Vascular Symptoms Dyspnea Palpitation AnginaOn exertion or at rest (in sever cases) Intermittent claudication Heart Failure (high output) Orthostatic HypotensionCV Signs includes Tachycardia, bounding pulse Loud HS with S3 over mitral or tricuspid area Systolic murmur Raised JVP 18. Musculoskeletal symptoms Exercise intolerance Easy fatigability Tiredness Generalized Muscular weakness 19. Other Features Pallor of the skin, sclera and mucous membranes Jaundice Lymphadenopathy Hepatosplenomegally Bony Pain Petechiae Hair Loss Anorexia, Weight Loss 20. Compensatory Mechanism 1. Increase Cardiac Output (to maximize O2 delivery to tissue) Tachycardia, bounding pulse 2. Increase Erythropoiesis Liver and Yellow Bone marrow 3. Increase Plasma Volume 4. Redistribution of blood to more vital organs By selective vasoconstriction to non-vital organs 21. Specific Symptom due to Underlying Cause 22. Iron Deficiency Anemia People with an iron deficiency may experience thesesymptoms: 1.Pica habit2.Koilonychias (spoon shape nails)3.Red beefy tongue due to loss of papillae4.Angular stomatitis/ cheilitis5.Esophageal Web6.Dysphagia, Odynophagia7.RLS (Restless Leg Syndrome) in fewer casesPlummerVinson Syndrome 23. Pernicious/ vit. B12 Deficiency Anemia Paraesthesia and Numbness in hand and feet Dementia, disorientation Difficulty in walking Sore tongue Easy bruising or bleeding, including bleeding gums Mood changes or Depression 24. Sickle Cell Anemia 1.Leg Sore2.Swelling of hand and feet3.Sever Joint pain4. Splenomegaly & LUQ Abdominal Pain 5.Susceptibility to infection6. Delayed Growth in children 7.Retinopathy (visual disturbance) 25. Thalassemia (Major) Bony pain Bossing of head Delayed Growth Splenomegaly Hepatomegaly 26. Aplastic Anemia Frequent or prolonged infections Unexplained or easy bruising Nose & Gums bleeding Prolonged bleeding from cuts Skin rash 27. How To Diagnose Anemia 28. How To Diagnose Anemia History Physical examination Lab investigations 29. History Taking Diet (pure vegetarian) Fever Family history Related symptom Sign of other cytopenia 30. History Taking (Cont.) Last CBC Previous diagnosis as anemia or transfusion Medical history e.g. Chronic illness, drug use or abuse Surgical Hx: Partial or complete gastrectomy Previous jaundice, dark urine Blood loss Menstruation, Blood donation, GI loss, Concealedbleeding 31. Physical Examination Skin, sclera & Mucous membrane (for pallor) Lymph node enlargement Hepatosplenomegaly Watch for the specic feature for suspected disease Gum, Lips (Bleeding, cheliosis) Nail fold (Koilonychea) Facial or skull Bones abnormality 32. Lab Investigations 33. Lab Investigations 1) Complete Blood Count: Hemoglobin level Hematocrit Rate (M:40 52%, F: 35 46%) RBC Count (M: 4.5 6.5, F: 4.0 5.4 mil/mm3) MCV (76 98 fL) = (Hct/RBCs*10) MCH (27 32 pg) & MCHC (32 36%) WBCs and platelets 34. Lab Investigations S. Ferritin (M: 18-270 g/L F: 18-160 g/L) TIBC (250370 g/dl) Serum iron (M: 65177 g/dl, F: 50170 g/dl) Reticulocyte Count (