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Anaemia: Classification, Diagnosis & Prevention

Bello Victoria Olaoluwa
20/0251
Department of Medical Laboratory Science
(Haematology & BGS unit)
Babcock University Ilisan, Remo, Ogun State, Nigeria
Dr. Udofia S. S
October 9th, 2024
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Summary

As presented
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Outline

 Definition,
 Classification of Anaemia
 Morphologic Classification
 Etiological Classification
 Causes of Anaemia
 Signs & Symptoms
 Diagnosis
 Prevention
 Recommendation
 Conclusion
 Reference
 Definition 4

 Anaemia is a blood disorder in which the blood has a reduced ability to deliver
oxygen. This can be due to a reduced number of red blood cells, a reduction in
the amount of haemoglobin available for oxygen transport.
 Anaemia may result from blood loss, increased destruction of RBCS
(haemolysis), or decreased production of RBCs.
 The most serious complications of severe anaemia arise from tissue hypoxia.
Shock, hypotension, or coronary and pulmonary insufficiency can occur. This is
more common in older individuals with underlying pulmonary and
cardiovascular disease.
(Vos, et al. 2022)
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Classification of Anaemia

Classification of Anaemia

Morphology Etiology

Genetic Anaemia of Nutritional

Microcytic Macrocytic Chronic Disease
Mutation Deficiencies
Bone Marrow
Failure Iron Folate
Normocytic
Sickle Cell Deficiency Deficiency
Anemia
Thalassemia
Normocytic Vitamin B12
Hypochromic Aplastic Myelodysplastic Leukemia
Normochromic Deficiency
Microcytic Anemia Syndrome

Fig.1 The Classification of Anaemia

 Based on morphology 6

1. Microcytic anaemia:
RBCs are lesser in size than normal.
MCV <80fL
 MCHC <32 g/dL
Microcytic Hypochromic Anaemia:
 Erythrocytes contain less haemoglobin and are usually also hypochromic, This can be reflected by a
low mean corpuscular haemoglobin concentration (MCHC).
 In hypochromic cells, this area of central pallor is increased.
 This decrease in redness is due to a disproportionate reduction of red cell haemoglobin (the pigment
that imparts the red colour) in proportion to the volume of the cell.
 reference range: adult 27–33 pg/cell in adults or 33–36 g/dL in adults.
(Chauddhry et al, 2022)
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Fig. 2 Slide of microcytic hypochromic anaemia

Source: www.istockphoto.com
2. Normocytic anaemia 8
Common form of anaemia that occurs with older age.
 Manifests with a decrease in haemoglobin and haematocrit but not MCV or MCH or MCHC.
 Causes include:
 Recent blood loss
 Haemolysis
 Bone marrow failure
 Anaemia of chronic disease
 Myelodysplastic anaemia(Blood cancer)
 Anaemia of chronic disease is a hypo-proliferative anaemia associated with chronic infectious or
inflammatory processes, tissue injury, or conditions that release pro-inflammatory cytokines.
 The pathogenesis is based on shortened RBC survival, impaired bone marrow response, and disturbance
of iron metabolism.
(Brill, et al, 2020)
3. Macrocytic anaemia: 9
 It’s defined as blood with an insufficient concentration of haemoglobin in which the erythrocytes
are larger than their normal volume.
 cells are larger than normal.
 Mean corpuscular volume(MCV) >100 fL

Megaloblastic anaemia:
 Cells are larger than normal in size because of impaired DNA synthesis and repair, often from
deficient thymidine production.
 Characterized by certain morphologic abnormalities like the presence of enlarged oval-shaped red
blood cells (macro-ovalocytes) and hyper-segmented neutrophils
 Can be caused by Inadequate dietary intake, decreased absorption and inadequate utilization.
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Megaloblastic anaemia cont’d
 Medications can interfere with DNA synthesis or with the absorption or metabolism of Vitamin
B12 or folate
 Folate deficiency can be caused due to hyper utilization during pregnancy, haemolytic anaemia,
myelofibrosis, malignancy, chronic inflammatory disorders, long-term dialysis or growth spurt.

Non-Megaloblastic anaemia
 They are disorders associated with increased red cell membrane surface area, such as
pathologies of the liver and spleen which produce "target cells.

(Imelda et al, 2021)

 Based on Etiology 11
1. Nutritional Deficiency anaemia
Iron-deficiency anaemia:
Iron deficiency anaemia develops when body stores of iron drop too low to support normal red
blood cell (RBC) production.
 Inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine
may be the cause. (Naghavi et al, 2019)
Vitamin B12 & folate:
 Vitamin B12 deficiency, also known as cobalamin deficiency, is the medical condition in which
the blood and tissue have a lower than normal level of vitamin B12.
 Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects
the body's ability to produce fully functioning red blood cells. (Langan et al, 2017)
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2. Aplastic Anaemia
 Aplastic anaemia (AA) is a severe hematologic condition in which the body fails to make blood cells
in sufficient numbers. Blood cells are produced in the bone marrow by stem cells that reside there.
Aplastic anaemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and
platelets.

 It occurs most frequently in people in their teens and twenties but is also common among the elderly.
It can be caused by heredity, immune disease, or exposure to chemicals, drugs, or radiation.
However, in about half of cases, the cause is unknown.

 Aplastic anaemia can be definitively diagnosed by bone marrow biopsy. Normal bone marrow has
30–70% blood stem cells, but in aplastic anaemia, these cells are mostly gone and are replaced by
fat.
(Young, 2018)
3. Haemolytic anaemia 13

 A condition in which there is premature destruction of RBCs before their life span of 120 days is
completed and the bone marrow is not able to compensate for the RBC loss.
 Mild anaemia is asymptomatic but severe anaemia can be life threatening and can cause angina and
cardiopulmonary decompensation.
 Hereditary disorders may cause haemolysis as a result of erythrocyte membrane abnormalities,
enzymatic defects, and haemoglobin abnormalities. Hereditary disorders include the following:
 Glucose-6-phospate dehydrogenase deficiency
 Sickle cell disease
 Hereditary spherocytosis

(Philadelphia, 2020)
 Causes of Anaemia 14
 Impaired Red Blood Cell (RBC) Production
 Disturbance of proliferation and differentiation of stem cells.
 Anaemia of kidney failure due to insufficient production of the hormone erythropoietin.
 Disturbance of proliferation and maturation of erythroblasts.
 Increased destruction of the RBC's (Haemolytic anaemia)

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These types of anaemia generally feature jaundice, and elevated levels of lactate dehydrogenase.
 Intrinsic (intra-corpuscular) abnormalities cause premature destruction.
 Haemorrhage (Blood loss)
 Trauma or surgery, causing acute blood loss.
 Gastrointestinal tract lesions, causing either acute bleeds.
 Pooling of the RBC’s by the spleen(Hypersplenism)
 This occurs when an excessive number of RBCs are trapped within the spleen, reducing their
availability for circulation in the body.
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Signs & symptoms

Fatigue.
Headaches.
Problems concentrating or thinking.
Irritability.
Loss of appetite.
 Numbness and tingling of hands and feet.
 Dizziness.
 Shortness of breath
 Laboratory Diagnosis 16
 Complete Blood Count (CBC): Haemoglobin (Hb) and Haematocrit (Hct):
 Red Blood Cell Indices:
 Mean Corpuscular Volume (MCV): Helps classify anaemia is microcytic, normocytic, or macrocytic.
 Mean Corpuscular Haemoglobin (MCH) and Mean Corpuscular Haemoglobin Concentration (MCHC):
Further characterize anaemia and help differentiate between types.
 Red Cell Distribution Width (RDW): Measures variability in RBC size; elevated RDW can suggest a mixed
deficiency (e.g., iron and B12).
 Blood Smear Examination:
 Macrocytosis, anisocytosis, poikilocytosis, spherocytes, schistocytes, or target cells can suggest specific types
of anaemia
 Reticulocyte Count:
 Assesses bone marrow response to anaemia. An elevated count suggests active RBC production (e.g.,
haemolysis, acute blood loss), while a low count indicates inadequate marrow response (e.g., marrow failure,
iron deficiency).
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Prevention

 Eating a healthy diet with a variety of foods

 Taking supplements recommended by the doctor.
 Regular check-ups
 Limit the consumption of substances that can hinder iron absorption like tennis and phytates
 Other health conditions can cause anaemia include:
 prevent and treat malaria
 prevent and treat heavy menstrual bleeding and haemorrhage before or after birth
 Treat inherited red blood cell disorders like sickle-cell disease and thalassemia.
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Conclusion 8

Anaemia is a condition characterized by a decrease in red blood cells or haemoglobin levels,

leading to reduced oxygen delivery to tissues. It can result from various causes, including
nutritional deficiencies (iron, vitamin B12, folate), chronic diseases, bone marrow disorders, or
increased RBC destruction (haemolytic anaemia). Symptoms often include fatigue, weakness,
and pallor. Prevention involves a balanced diet and managing underlying health conditions,
while diagnosis and treatment depend on identifying and addressing the specific cause. Early
recognition and appropriate management are essential to improve patient outcomes.
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Recommendation
 Iron-rich foods: Consume foods like red meat, poultry, fish, legumes, spinach, fortified
cereals, and dark leafy greens.
 Avoid hindering factors: Limit consumption of tannins (found in tea and coffee) and
phytates (found in whole grains and legumes) as they can interfere with iron absorption.
 Iron supplements: If the doctor recommends it, take iron supplements as prescribed. They
can help increase iron levels in the body.
 Regular check-ups: If you have a history of anaemia or are at risk, schedule regular check-
ups with the doctor.
 Avoid excessive bleeding: If you have heavy menstrual bleeding or other sources of blood
loss, discuss ways to manage it with the doctor.
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Selected References

Brill, J. R., & Baumgardner, D. J. (2020). Normocytic anemia. American Family Physician, 62(10), 2255– 2264.
PMID 11126852. Archived from the original on 2021-06-06. Retrieved July 12, 2023.

Green, R., & Dwyre, D. M. (2021). Evaluation of macrocytic anemia. Seminars in Hematology, 52(4), 279–
286. https://doi.org/10.1053/j.seminhematol.2015.06.001 PMID 26404440.

Halterman, J. S., Kaczorowski, J. M., Aligne, C. A., Auinger, P., & Szilagyi, P. G. (2021). Iron deficiency and
cognitive achievement among school-aged children and adolescents in the United States. Pediatrics, 107(6),
1381–1386. https://doi.org/10.1542/peds.107.6.1381 PMID 11389261. S2CID 33404386.

Janz, T. G., Johnson, R. L., & Rubenstein, S. D. (2023). Anemia in the emergency department: Evaluation and
treatment. Emergency Medicine Practice, 15(11), 1–15.
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Selected Reference

Stein, J., Connor, S., Virgin, G., Ong, D. E., & Pereyra, L. (2019). Anemia and iron deficiency in
gastrointestinal and liver conditions. World Journal of Gastroenterology, 22(35), 7908–7925.
https://doi.org/10.3748/wjg.v22.i35.7908 PMC 5028806. PMID 27672287.

Weksler, B. (2019). Wintrobe's atlas of clinical hematology. Lippincott Williams & Wilkins.

World Health Organization. (2021). WHO global anaemia estimates, 2021 edition. Retrieved
February 27, 2022.

National Heart, Lung, and Blood Institute. (2014, March 26). How is iron-deficiency anemia
diagnosed? Archived from the original on July 15, 2017. Retrieved July 17, 2017.
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