 The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female.

Anaemia may be due to DECREASED MARROW PRODUCTION lack of iron,vitB12,folate. Hypoplasia invasion by malignant cells. PERIPHERAL CAUSES blood loss haemolysis hypersplenism

MICROCYTIC iron deficiency thalassemia sideroblastic anaemia of chronic disease MACROCYTIC megaloblastic normoblastic liver disease hypothyroidism hyperlipidaemia

Alcohol pregnancy cytotoxic drugs reticulocytosis(haemolysis) MDS,marrow infiltration NORMOCYTIC anaemia of chronic disease acute blood loss hypothyroidism hemolytic aplastic

HAEMOLYTIC CONGENITAL hereditary spherocytosis hereditary elliptocytosis.thalassemia.sickle-cell G-6-PD deficiency pyruvate kinase deficiency ACQUIRED IMMUNE autoimmune, warm/cold alloimmune (transfusion reaction, organ transplantation)

NON IMMUNE PNH mechanical(prosthetic heart valve,march & microangiopathic haemoglobinuria) Infection;falciparum malaria,sepsis Chemicals,drugs(dapsone.sulphonamide) sec to other disease e.g renal or liver failure Extra-vascular ;sickle-cell,hereditary spherocytosis intra-vascular ;G6PD,acquired haemolytic anaemias

SYMPTOMS Fatigue dyspnoea palpitations headache dizzines angina

SIGNS mucous membrane pallor tachypnoea postural hypotensionhigh volume pulse severe anaemia<8g/dl tachycardia systolic flow murmurs raised JVP ankle oedema heart failure

IRON DEFICIENCY koilonychia atrophic glossitis rarely post-cricoid webs.

Thalassemic facies, bossing of skull, prominent malar eminence, skeletal deformities. Hepatosplenomegaly growth retardation intermittent fever haemochromatosis resulting in cirrhosis,cardiac failure, endocrinopathies.

MEGALOBLASTIC ANAEMIA sore mouth smooth tongue angular cheilosis vitiligo grey hair weight loss pyrexia paresthesia,dorsal column loss, subacute combined degeneration of cord

HAEMOLYTICmild jaundice hepatosplenomegaly (extravascular hemolysis) haemosiderinuria (intravascular haemolysis)

ACUTE SYNDROMES. Precipitated by infection,hypoxia, dehydration and acidosis. Vaso-occlusive crises. acute severe bone pain. tachycardia, sweating, fever sequestration crises sudden splenomegaly/hepatomegaly. aplastic crises. sudden lethargy,pallor

HEREDITARY SPHEROCYTOSIS mostly asymptomatic with chronic compensated haemolytic state there may be acute crisis. Haemolytic crisis Megaloblastic crisis aplastic crisis pigment gallstones in 50% causing cholecystitis

Haemoglobinuria only at night. Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have thrombocytopenia,neutropenia

 Acute drug induced haemolysis presenting with haemoglobinuria, with analgesics.aspirin.phenacetin antimalarials antibiotics,sulphonamide,ciprofloxacin misc.vit K.quinidine.  Chronic compensated haemolysis.  Infection or acute illness.

Low Hb Low MCV<76fl Normal MCV High MCV>96fl

Low/norm MCV Blood film & retic count Hh retic(haemolysis) Norm/low retic Low MCH Low ferritin Iron deficiency Target cells, Basophilic stippling Hb electrophoresis High HbA2Norm HbA2 B-thalassemiaAlpha-thalassemia dimorphic Bone marrow sideroblastic Ferritin norm/high ACD Bone marrow Iron stores adequate?

Osmotic fragility test +v Blood film spherocytes No spherocytes fragmentation DCT + DCT _ autoimmune Hereditary spherocytosis haemolysis malaria Hereditary enzymopathies microangiopathic traumatic clostridium

A)iron deficiency anaemia B)sideroblastic anaemia C)anaemia of chronic disease D)thalassemia

Ans)sideroblastic anaemia

A)hypothyroidism B)pregnancy C)haemolysis D)anaemia of chronic disease

Ans) anaemia of chronic disease

A) thalassemia B) Leukemia C) Infective endocarditis D) sickle cell anaemia

Ans Sicle cell anaemiaAns Sicle cell anaemia