Anemia (Classification, Types of Anemia With Clinical Features).

Anemia:- Clinical condition characterized by a reduction in the number of RBCs less than 4 million/μl or hemoglobin less than 12 gm/dl.

Grading:- 

1). Mild Anemia:- Hb-8-12 gm/dl 

2). Moderate Anemia:- Hb-5-8 gm/dl

3). Severe Anemia:- Hb<5 gm/dl

Classification:-

1). Etiological or Whitby's classification:- This is based on the cause of anemia.

A). Hemorrhagic:- Based on blood loss.

(a). Acute:- Sudden blood loss.

(b). Chronic:- Slow blood loss due to piles, peptic ulcer, etc.

B). Dietary:- Due to iron, vitamins, proteins, etc.

C). Dyshemopoiesis or abnormal hemopoiesis:- Resulting in Aplastic anemia.

Causes:-

I). X-rays radiation                         II). Hypersensitivity of bone marrow to 

a). Cytotoxic drugs                         b). Chemicals

D). Hemolytic anemia:- Due to excessive destruction of RBCs

Intrinsic

Extrinsic

Intrinsic defect(hereditary)

(a). Congenital

(b). Hemoglobinopathies

I). Sickle cell anemia 

II). Thalassemia

Extrinsic defects(Acquired)

(a). Antigen-Antibody reaction

(b). Infections Example:- Malaria

(c). Drugs or poison Example:- Quinine, aspirin

Morphological or Wintrobe  classification:-

1). Normocytic:- Hemolytic anemia except thalassemia.

2). Macrocytic:- All Megobolastic anemia due to deficiency of vitamin B12 and folic acid.

3). Microcytic:- Iron deficiency anemias and thalassemia.

Types of Anemia

(1). Pernicious anemia

(2). Folic acid deficieny anemia

(3). Iron deficiency anemia

(4). sickle cell anemia

(1). Pernicious anemia:- (Destructive or injurious)

Causes:- Lack of intrinsic factors leads to failure in the absorption of vitamin B12.

Clinical Features:

[a]. Bone marrow:- Anemia produced hypoxia(lack of oxygen at tissue level) Anemia result in hypoxia in which results in stimulation of erythropoiesis in the bone marrow becomes hyperplastic. This over activities on bone marrow is called Megaloblastic hyperplasia of bone marrow.

Diagram:-

[b]. Blood changes:- 

(I). RBCs count decrease less than 1 million/μl.

(II). Hemoglobin less than 12 gm/dl.

(III). Reticulocyte count increases more than 5% excessive destruction of RBCs in the spleen, liver, and bone marrow.

(IV). WBC, Platelets both decrease.

[c]. Changes in GIT(gastrointestinal tract)

(I). Deficiency of intrinsic factor.

(II). Atrophy and destruction of gastric mucosa containing oxyntic cell that produces a lack of HCL .

(III). Inflammation of tongue:-

5 signs of inflammation:-

(I). Redness

(II). Swelling

(III). Pain 

(IV). Temperature

(V). Loss of functions

[d]. Changes in the nervous system:

(I). Tingling and numbness in hands.

(II). Psychological disturbances.

Laboratory:- 

(1). Plasma concentration of vitamin B12 decreases to 1/10 of normal.

(2). Vitamin B12 excretion in faces increases up to 90%.

(3). Urinary excretion of vitamin B12 decreases because of poor absorption of vitamin B12 from the intestine and its low plasma level.

[2]. Folic acid deficiency anemia:- 

(a). Folic acid deficiency also produced Megaloblastic anemia as seen with vitamin B12 deficiency.

Causes:-

(1). Less dietary intake

(2). Poor Absorption

(3). Increase demand eg: Pregnancy

(4). Antifolate drug eg:- anticancer drugs.

Clinical Feature:-

-> Fatigue

-> Lack of energy

-> Feeling short of Breath

-> Headaches

-> Pale skin

-> Weight loss

-> Not feeling hungry

Laboratory:- Red Blood cells look changed and immature in a blood tests.

[3]. Iron Deficiency Anemia:- 

(a). Most common in India.

(b). Inadequate dosage of Iron is called Iron deficiency Amenia.

Causes:-

(1). Decrease intake - Milk - Fed Infants.

(2). Increase  Loss

(a). Acute Hemorrhage

(b). Chronic Hemorrhage

Eg:- peptic ulcer, Piles, etc.

(3). Increased Demand - Infancy, Childhood, pregnancy.

Clinical Feature:- 

(1). Nails-Dry, soft, spoon-shaped later develop longitudinal striation.

(2). Tongue:- Angry Red.

(3). CVS (Cardiovascular system)

        -> Breathlessness

        -> Repeated chest Infections.

(4). Nervous system:-

-> Irritability

-> Loss of concentration

-> Headache

-> Generalized body pain

[4] Sickle Cell Anemia:- 

-> Interited Red blood cell disorder in which there is not enough blood cell to carry O2.

-> Normal Blood Cells are flexible, round, and move easily through blood vessels.

-> In sickle cell amenia the blood cells are shaped like sickle or crescent moons.

-> These cells can get stuck in small blood vessels. Which slows or blocks the blood flow and O2 Throughout the body.

Clinical Features:-

(a). Episodes of pain.

(b). Swelling of hands and feet.

(c). Frequent infections.

(d). Vision Problems.

(a). Delayed growth

Laboratory:- Genetic screening is done when a body is born.