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 Anaemia

Megaloblastic Anaemia

Pernicious Anaemia

Aplastic Anaemia

Anaemia of chronic disease

Erythrocytosis ( documented increase of red cell mass.)

Polycythaemia( any increase in red blood cells)

Haemolytic Anaemia

Congenital Haemolytic Anaemia

Hereditary spherocytosis

G6PD deficiency

Pyruvate kinase deficiency

Haemo-globinopathies

• Sickle cell anaemia
• Sickle cell haemoglobin disease
• Thalassaemias

Alpha -thalassaemia

Beta- thalassaemia (Major, Minor)

Acquired Haemolytic Anaemia

Immune haemolytic anaemia

Haemolytic disease of newborn                 

Autoimmune haemolytic anaemia          

• Warm autoimmune haemolytic anaemia
• Cold agglutinin disease           

Non-immune haemolytic anaemia

B.  

Normocytic Anaemia

Hypochromic Microcytic  Anaemia

Normochromic Microcytic Anaemia

Macrocytic Anaemia

Anaemia signs and symptoms

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

Anaemia 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

Anaemia Treatment

1. Correction of dietary deficiency
2. Treatment of underlying disease
3. Removal of toxic chemical/agent
4. Immediate blood transfusion
5. Administration of substance 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, schistosomiasis ; Infections like Amoebic/bacillary; peptic ulcers; Cirrhosis of liver with oesophagial 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 of Megaloblastic Anaemia. 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 vit 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, 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 limited to Megaloblastic anaemia. It is an auto-immune disease in which antibodies to gastric parietal cells produce gastric atrophy and achlorhydria and antibodies to intrinsic factor 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

Aplastic Anaemia 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( pencillamine, 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, monolilial)
• Haemorrhage(haematuria, epistaxis, Intracranial)

Treatment

• Medication
• Blood transfusions
• Stem-cell transplants.

Haemolytic Anaemia

Haemolytic Anaemia 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 in early age of life
• Haemolysis
• Jaundice
• Splenomegaly
  
  4. Sickle Cell Anaemia

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

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

• Profound hypochromic anaemia
• Erythroblastosis
• Head bossing
• Prominent malar eminencies
• Hair on end appearance of 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
• Hydops fetalis

Treatment

• Lifestyle changes

These include stress free healthy life, eating nutritious food, regular exercises, 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.