Anaemia-Types, causes, symptoms

Iron deficiency anaemia occurs when there is a reduced number
of red blood cells because the body does not have enough iron to
produce them. But it is just one type of anaemia. Anaemia is a
common disease and is of various types. Each type has a different
cause, symptom and so the treatment.

Anaemia Types

There are two types of classifications
A.  

• Iron deficiency
• Megaloblastic
• Pernicious
• Aplastic
• Anaemia of chronic disease
• Erythrocytosis (a documented increase in red cell mass.)
• Polycythaemia( any increase in red blood cells)

Haemolytic Anaemia

1. Congenital Haemolytic 

• Hereditary spherocytosis
• G6PD deficiency
• Pyruvate kinase deficiency
• Haemoglobinopathies — Sickle cell anaemia
• Thalassaemias
• Alpha -thalassaemia
• Beta- thalassaemia (Major, Minor)

2. Acquired Haemolytic

• Immune haemolytic anaemia
• Haemolytic disease of the newborn                 
• Autoimmune haemolytic anaemia          

1. Warm autoimmune haemolytic
2. Cold agglutinin disease           

Non-immune haemolytic anaemia

B.  

• Normocytic
• Hypochromic Microcytic 
• Normochromic Microcytic
• Macrocytic

Signs and symptoms

Symptoms	Signs
Lassitude	Pallor of skin
Fatigue	The pallor of the mucous membrane
Breathlessness on exertion	The pallor of the palms of hands
Palpitations	Pale conjunctivae
Throbbing in head and ears	Tachycardia
Dizziness	Cardiac dilatation
Tinnitus	Systolic flow murmurs
Headache	Oedema
Dimness of vision
Insomnia
Paraesthesia in fingers and toes
Angina

Investigations

1. Blood test

• Haemoglobin
• Peripheral Blood film
• TLC/DLC
• ESR
• Bone marrow iron store
• Ferritin
• Total iron binding capacity
• LFT
• Red cell folate level
• Coomb’s test
• MCV

2. Barium meal
3. Endoscopy
4. Urine and stool examination

Treatment

• Correction of dietary deficiency
• Treatment of underlying disease
• Removal of toxic chemical/agent
• Immediate blood transfusion
• Administration of substances specifically lacking

Iron Deficiency Anaemia

Causes

• Blood Loss. It may be due to many factors like–

1. Bleeding (Haemorrhagia; bleeding gums; Ante-partum;
   Post-partum; bleeding piles)
2. GI Tract (Intestinal infestations like Ankylostomiasis,
   whipworm, giardiasis, Hookworm, and schistosomiasis;
   Infections like Amoebic/bacillary; peptic ulcers; Cirrhosis
   of the liver with oesophagal varices; Hiatus hernia;
   Intestinal polyposis; Tuberculous ulcers; Crohn’s disease;
   Malignancy of stomach/colon)
3. Urinary tract (Recurrent haematuria; Haemoglobinuria)
4. Premature Infants

• Pregnancy
• Adolescence
• Inadequate Diet. It may be due to –

1. Poverty
2. Consumption of polished rice, white bread
3. Pure Vegetarian diet

• Malabsorption due to Coeliac syndrome; Achlorhydria;
  Gastrectomy

Symptoms and Signs

• Angular stomatitis
• Glossitis
• Nail cracking
• Koilonychia
• Dysphagia
• Pica
• Splenomegaly

Megaloblastic Anaemia

Causes

• Vitamin B12 Deficiency. This is the main cause. It may be
  due to-

1. Inadequate diet (Pure vegetarian diet or extremely poor diet)
2. Diseases of the terminal ileum like Crohn’s disease
3. Removal of vitamin B12 from the  gut(bacterial proliferation
   in stagnant loops, parasites)
4. Intrinsic factor deficiency (Pernicious anaemia, Congenital
   deficiency without gastric atrophy, gastrectomy)

• Folic acid deficiency. This deficiency is due to many reasons
  and is very prevalent also.

1. Inadequate diet. It may be because of poor intake of vegetables, Poverty, Old age, Alcoholism, Scurvy, Goat’s milk, Kwashiorkor
2. Malabsorption due to Tropical sprue, Gluten-induced
   enteropathy, Dermatitis herpetiformis
3. Increased demand in Pregnancy, Prematurity, Malignant
   diseases (Lymphoma, carcinoma Myesclerosis), Chronic Inflammation (Tuberculosis, Rheumatoid Arthritis)
4. A metabolic disorder like Homocystinuria
5. Drugs induced like some anti-convulsant (phenytoin),
   Contraceptive pills, and Cytotoxic drugs

Signs and Symptoms

• Angular cheilosis
• Glossitis
• Mild Jaundice
• Weight loss
• Mild pyrexia
• High stepping, stamping gait
• Optic neuropathy
• Retinal haemorrhage
• Purpura
• Sterility

Pernicious Anaemia

Causes

It is an auto-immune disease in which antibodies to gastric
parietal cells produce gastric atrophy and achlorhydria and
antibodies to intrinsic factors interfere with its role in
vitamin B12 absorption.

Symptoms and Signs

• Soreness of tongue
• Periodic Diarrhoea
• Weight loss
• Dementia
• Infertility

Treatment

Intake of Vitamin B12-rich food like-

Low-fat milk, Fortified plant-based milk, Fortified cereals, Yogurt,
Cheese, Eggs, Nutritional yeast, Tuna, Shrimp, Sardines, Salmon,
Turkey

Aplastic Anaemia

It is a  rare and serious condition, in which the body stops producing enough new blood cells.

Causes

1. Drugs

• Cytotoxic drugs
• Antibiotics (chloramphenicol, sulphonamides)
• Anti-rheumatic agents( penicillamine, gold)
• Anti-thyroid drugs
• Anticonvulsants

2. Chemicals

• Glue sniffing
• Insecticides (DDT, organo-phosphates and carbonates)

3. Radiations
4. Viral hepatitis
5. Pregnancy
6. Paroxysmal nocturnal haemoglobinuria

Signs and Symptoms

• Infections (necrotic mouth, throat ulcers, monilial)
• Haemorrhage (haematuria, epistaxis, Intracranial)

Treatment

• Medication
• Blood transfusions
• Stem-cell transplants.

Haemolytic Anaemia

It is of two types.

Congenital and Acquired.

Causes

1. Congenital.
   It is due to-

• Membrane abnormalities (Hereditary spherocytosis,
  Elliptocytosis, Stomatocytosis, Acanthocytosis)
• Red cell enzyme defect(G6PD deficiency, pyruvate
  kinase deficiency)
• Haemoglobinopathies (Lack of haemoglobin chain synthesis, Thalassaemias, Amino acid substitution on the haemoglobin chain, Haemoglobin S, C, D
  
  2. Acquired.
  It is due to-

• Immune (Isoimmune, Autoimmune like cold antibody or warm antibody, Alloimmune)
• Non-immune ( Mechanical like Microangiopathic or Burns or Artificial cardiac valves or Haemoglobinuria, Infections like
  Malaria or Clostridium, Drugs like Dapsone or  salazopyrin, Chemicals like Arsenic gas or Copper or Chlorate or nitrites)

Symptoms and Signs

1. Hereditary Spherocytosis

• Episodic jaundice
• Liability to form gallstones
• Cholecystitis
• Leg ulcers

2. G6PD deficiency

• Fever
• Malaise
• Prostration
• Neonatal jaundice
• Severe, rapid anaemia
• Haemoglobinuria
• Anuria
  
  3. Pyruvate Kinase Deficiency Anaemia

• Usually present at an early age in life
• Haemolysis
• Jaundice
• Splenomegaly
  
  4. Sickle Cell Anaemia

• Retarded Growth
• Delayed puberty
• Rapid enlargement of spleen and liver
• Increased susceptibility to infections
• Cardiomegaly
• Cholelithiasis
• Bossing of skull
• Prominent malar bones
• Protuberant teeth
• Infarction in bones and spleen
• Dactylitis in infants
• Salmonella osteomyelitis
• Hyposplenism
  
  5. Beta  Thalassaemia

While the minor one has only anaemia as its main symptom.
Major beta Thalassaemia has the following symptoms-

• Profound hypochromic anaemia
• Erythroblastosis
• Head bossing
• Prominent malar eminencies
• Hair on end appearance of the skull
• Widening of medullary spaces
• Retarded growth
• Hepatomegaly
• Cardiac enlargement
• Cardiac failure
  
  6. Alpha thalassaemia

• Mild hypochromic anaemia
• Haemoglobin H
• Hydrops fetalis
  
  7. Haemolytic Disease Of Newborn

• Kernicterus
• Immature liver
• Hydrops fetalis

Treatment

• Lifestyle changes

These include stress-free healthy life, eating nutritious food,
regular exercise, and ample sleep and rest.

• Medicines

These are cause-specific and can’t be described here. These medicines
are to be strictly taken under the supervision of qualified doctors.

• Blood transfusions
• Bone marrow transplants
• Surgery to remove the spleen.