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    Anaemia

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    Naveen Kumar
    This document discusses anaemia, its causes, symptoms, diagnosis and management. It defines anaemia as insufficient haemoglobin to meet the oxygen requirements of tissues. The three main causes of anaemia discussed are nutritional, haemorrhagic, and haemolytic. Iron deficiency is noted as the most common cause of anaemia in pregnancy. The document outlines oral iron therapy as the preferred treatment, while noting challenges with compliance and absorption. It also discusses other causes like folate deficiency, worm infestations, and haemoglobinopathies like thalassemia and sickle cell disease. The take home message emphasizes that anaemia remains a significant global health problem, particularly in pregnancy, despite being largely preventable with supplementation and treatment of

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    Anaemia

    Uploaded by

    Naveen Kumar
    652 views40 pages
    This document discusses anaemia, its causes, symptoms, diagnosis and management. It defines anaemia as insufficient haemoglobin to meet the oxygen requirements of tissues. The three main causes of anaemia discussed are nutritional, haemorrhagic, and haemolytic. Iron deficiency is noted as the most common cause of anaemia in pregnancy. The document outlines oral iron therapy as the preferred treatment, while noting challenges with compliance and absorption. It also discusses other causes like folate deficiency, worm infestations, and haemoglobinopathies like thalassemia and sickle cell disease. The take home message emphasizes that anaemia remains a significant global health problem, particularly in pregnancy, despite being largely preventable with supplementation and treatment of

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    This document discusses anaemia, its causes, symptoms, diagnosis and management. It defines anaemia as insufficient haemoglobin to meet the oxygen requirements of tissues. The three main causes of anaemia discussed are nutritional, haemorrhagic, and haemolytic. Iron deficiency is noted as the most common cause of anaemia in pregnancy. The document outlines oral iron therapy as the preferred treatment, while noting challenges with compliance and absorption. It also discusses other causes like folate deficiency, worm infestations, and haemoglobinopathies like thalassemia and sickle cell disease. The take home message emphasizes that anaemia remains a significant global health problem, particularly in pregnancy, despite being largely preventable with supplementation and treatment of

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    652 views40 pages

    Anaemia

    Uploaded by

    Naveen Kumar
    This document discusses anaemia, its causes, symptoms, diagnosis and management. It defines anaemia as insufficient haemoglobin to meet the oxygen requirements of tissues. The three main causes of anaemia discussed are nutritional, haemorrhagic, and haemolytic. Iron deficiency is noted as the most common cause of anaemia in pregnancy. The document outlines oral iron therapy as the preferred treatment, while noting challenges with compliance and absorption. It also discusses other causes like folate deficiency, worm infestations, and haemoglobinopathies like thalassemia and sickle cell disease. The take home message emphasizes that anaemia remains a significant global health problem, particularly in pregnancy, despite being largely preventable with supplementation and treatment of

    Copyright:

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    Download as ppt, pdf, or txt
    of 40

    ANAEMIA: Preventable, Yet a Problem!!

    Definition
    j

    Anemia - insufficient Hb to carry out O2 requirement by tissues. WHO definition : Hb conc. 11 gm %

    j j

    CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester For developing countries : cut off level suggested is 10 gm %
    - WHO technical report Series no. 405, Geneva 1968 Centre for disease control, MMWR 1989;38:400-4

    WHO Classification of Anaemia


    Degree Hb% Haematocrit (%)

    Moderate Severe Very Severe

    7-10.9 4-6.9 <4

    24-37% 13-23% <13%

    Magnitude of Problem
    j j

    Globally, is about 30 % In developing countries & India, incidence is around 40 90%. Responsible for 40% of maternal deaths in third world countries. Important cause of direct and indirect maternal deaths
    - Vitere FE Adv Exp Med Biol 1994;352:127

    Symptoms
    Lack of Concentration

    Irritability

    Fatigue Infection
    Palpitation

    Weakness Dizziness

    Clinical Features
    Soft ejection systolic murmur
    Pallor of skin And m/m

    Edema

    Signs
    Tachycardia Glossitis Stomatitis Platynychia Koilonychia

    Causes of Anaemia Physiological Pathological


    j Nutritional j Haemorrhagic j Haemolytic

    Iron Requirement Iron Absorption

    1 Amount of iron in the body


    Skin

    Iron Loss

    Urine Feces Menstruation

    1-2mg/d

    20-30mg/c

    Iron Requirement During Pregnancy


    32 to 40 weeks Early Pregnancy 2.5 mg / day TOTAL 800 1000 mg RBC Fetus+Placenta Third stage blood loss Total =500mg =450mg =200mg = 1150mg 20 to 32 weeks 5.5 mg / day 6.8 mg / day

    Normal Levels
    Hb R.B.C. Serum Iron TIBC Transferrin saturation S. Ferritin level Red Cell protoporphyrin Erythropoietin MCV MCH MCHC PCV 13.5 14 gm % 4.5 4.7 million/cu mm 50 150 g / dL 300 360 g / dL 25 50 % 30 g / Lit 30 g / dL 15.20 U / Lit 76 100 fL 27 33 pg 33.37 gm / dL 32 40 %

    Laboratory Diagnosis of Anaemia


    IDA Serum Iron TIBC Transferrin Saturation Serum Ferritin Marrow Iron Therapeutic test with oral iron Decreased Decreased / absent Rise in Hb N or Increased N or Increased No rise in Hb N N No rise Decreased Increased Decreased Thalassemia Normal / Increased Normal N or Increased Chronic Diseases Decreased Decreased or N N or Decreased

    Nutritional Anaemia : Major Health Problems


    National Nutrition Anaemia Prophylaxis Programme (NNAPP 1971 - 72)

    Pregnancy FS + FA Lactating mothers Family planning acceptors Children Anaemia continues 1 to 11 years

    Major health problem

    Reason For Increased Incidence Of Anemia


    j

    Poor pre-pregnancy iron balance due to preuntreated systemic diseases & menstrual disorders Improper supplementation of iron in pregnancy ( late registration and poor follow up) Repeated childbearing Lack of awareness and illiteracy

    j j

    Reason For Increased Incidence Of Anemia


    j j j

    Low socioeconomic status and poor hygiene Chronic malnutrition Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. Food and religious taboos GI infections and infestations (e.g. Kala azar, worm infestations)

    Complications - Pregnancy
    IUGR PIH CCF
    INFECTION

    IUD

    IUH Medical Disorder


    PRETERM LABOUR

    Complications - Labour PPH


    Instrumental delivery

    CCF

    Foetal Distress

    MATERNAL PERINATAL

    Morbidity Mortality

    Management Options
    Pre pregnancy :

    j Treat the cause before conception j Pre-pregnancy balanced diet, education


    and health support.

    j Build up iron stores during adolescent


    phase

    Modalities of Management

    Oral Iron

    Parenteral

    Blood transfusion

    Injectable Iron

    Human Recombinant Erythropoietin

    Oral Iron
    100 mg elemental Iron ------Iron absorption -ve Bioavailability of Iron

    0.18 gm % day

    Phosphate phytate

    Worm infestation

    Iron stores poor

    Oral Iron Therapy


    j Ideal dose 100mg per day (prophylactic) j Ferrous gluconate, ferrous fumarate, ferrous succinate, ferrous sulphate, ferrous ascorbate citrate j Rise in Hb 0.8 gm / dl / week j Side effects -G I upset most common j Pt. compliance not guaranteed j Ineffective in pts with worm infestations j Inconclusive evidence on benefit of controlled release Iron preparation

    Absorption of Ferrous Salts


    Uncontrolled Passive Absorption
    j Iron salts are dissociated into bivalent or trivalent iron salts j Diffuses as free iron ions through the upper part of the gastrointestinal mucosa j Taken up by transferrin and incorporated into ferritin. j For binding to ferritin and transferrin ferrous iron has to be converted into ferric iron by oxidation j Highly reactive free radicals are produced during this process j All ionic iron including carbonyl iron are absorbed similarly
    Borbolla JR. Cicero RE, Dibilox MM, Sotres RD et al.. Rev Mex Pediatr 2000; 67(2): 63-67 Heubers KA, Brittenham GM, Csiba E, Finch CA. J Lab Clin Med 1986 ; 108 ; 473-8.

    Gut Lumen
    Iron salts

    Mucosal Cell
    Fe+3

    Blood

    Free Radical Transferrin


    Fe+2

    Ferritin

    Dissociation
    Fe+2

    Fe+2

    Fe+2 Fe+2

    Fe+2 Fe+2

    Fe+3

    Passive diffusion
    Fe+2 Fe+2 Fe+2 Fe+2 Fe+2 Fe+2 Fe+2 Fe+2

    Free Radical

    Fe+2

    Fe+2

    Incorporation into Hb

    Parenteral Therapy
    I.M. 100 mg elemental Iron Anaphylactic reaction Hb 0.21 gm % Anaphylactic reaction I.V.

    Fractionated Irondextran [Iron hydroxide dextran complex]

    Parenteral Therapy : Traditional Indications


    j

    Intolerance to oral iron Poor compliance to oral iron Gastrointestinal disorders Malabsorption syndromes Rapid blood loss

    Parenteral Therapy : Traditional Indications


    j

    Inability to maintain iron balance (haemodialysis) Patient donating large amount of blood for auto-transfusion programme auto? Pregnant women with severe IDA, presenting late in pregnancy

    The

    World Health Organisation


    states

    transfusion should be prescribed ONLY for conditions for which there is NO OTHER TREATMENT

    Diagnosis of Folate Deficiency Anemia (FDA)


    Special considerations in diagnosis

    FDA is suspected when the expected response


    to adequate iron therapy is not achieved

    Macrocytosis can occur in pregnancy in absence


    of FDA

    If FDA + IDA present, it will be masked by IDA Definitive diagnosis Bone marrow aspirate

    Megaloblastic Anemia - Diagnostic Problems


    j j j j j j j

    HB estimation Peripheral smear MCV estimation Serum folate Red cell folate FIGLU estimations Marrow aspirate

    Management of FDA
    j Strong case for routine prophylaxis j Prophylaxis with anti convulsants j Continue routine oral therapy for

    hemolytic anaemia
    j Parenteral therapy for severe deficiency

    Worm Infestations
    j Common cause of anaemia in developing countries j Most common hookworm infestation, Round

    worm, whip worm, etc.


    j Oral iron therapy becomes ineffective j Treatment by antihelminthics is a must

    Treatment
    j Mebendazole : 100mg twice daily for three days j Pyrantel pamoate : 10mg / kg in single dose. j Albendazole : 400mg once a day for three days

    Hemoglobinopathies
    A collective term for the inherited disorders of Hb synthesis
    j Disorders

    of globin synthesis e.g. Thalassemia Hb variants e.g. Sickle cell anemia, HbC

    j Structural

    Thalassemia
    j

    Genetic disorders; lack or qsed synthesis of globin chains Two types : E & F thalassemia E chains encoded by 2 pairs of genes on chromosome 16 F chains encoded by single pair of genes on chromosome 11 F thalassemia more common and presents as either F(major) or F+ (minor)

    j j

    Diagnosis of Thalassemia
    j j j j j

    Hb estimations Peripheral smear qsed MCV qsed MCH HbA2 (E 2H2)

    Diagnostic Strategy for Thalassemias


    Hb Electrophoresis + CBC Abnormal band MCV MCH Normal qsed No action Examine partners blood

    Quantitative Hb electrophoresis Raised Hb A2

    Normal

    ?X Thalassemia

    B Thalassemia

    DNA analysis for x gene defects

    Sickle Cell Disease


    j j

    Structural Hb variant Exists in homo & heterozygous forms Under hypoxic conditions, HbS polymerizes, gels or crystallizes. @ hemolysis of cells, & thrombosis of vessels in various organs In long standing cases, multiple organ damage.

    Take Home Message


    j Anaemia although preventable is a global problem j Anaemia still is the commonest cause of maternal mortality

    and morbidity in spite of easy diagnosis and treatment


    j Anaemia can be due to a number of causes,

    including certain diseases or a shortage of iron, folic acid or Vitamin B12.


    j The most common cause of anemia in pregnancy is

    iron deficiency.
    j Iron therapy is best given orally

    Take Home Message


    j

    The youth need to be educated about diet, sanitation and personal hygiene Hookworm infestation should be treated Pregnant women should be given Iron and folate supplements

    j j

    Concept Dr. Duru Shah


    jContributors jDr jDr. jDr.

    Editors :
    j Dr.

    Duru Shah Sarita Bhalerao Manisha Bandgar

    Sangeeta Agrawal Reena Wani

    j Dr.

    We acknowledge the efforts of our :


    Coordinators : Dr. Sangeeta Agrawal Dr. Narendra Malhotra Dr. Hema Divakar Dr. P. C. Mahapatra Dr. Uday Thanawala - Central - North - South - East - West

    In bringing the FOGSI YOUTH EXPRESS to your city.

    This Youth Express Has Been Possible Due To The Educational Grant From :
     Charak Pharma Pvt. Ltd  CIPLA Ltd.  Emcure Pharmaceuticals Ltd  GlaxoSmithKline Pharmaceuticals Limited  Glenmark Pharmaceuticals Ltd.  Metropolis Health Services (India) Pvt.Ltd.  Organon India Ltd  Roche Pharmaceuticals Ltd.  Sandoz Private Limited  USV Limited  Wyeth Limited

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