3D render of blood cells on abstract background
The Comprehensive Anemia Guide provides an authoritative exploration of anemia types, including insights into bone marrow functions and the intricacies of iron deficiency anemia.
From Pathophysiology to Clinical Management
1. Definition and Overview Anemia is a hematologic disorder characterized by:
Hemoglobin (Hb) levels below 13 g/dL (men) or 12 g/dL (women)Reduced oxygen delivery to tissues due to: Decreased red blood cell (RBC) production Increased RBC destruction Blood loss Key Pathophysiological Concepts Erythropoiesis : Bone marrow process regulated by erythropoietin (EPO)
Hemoglobin synthesis : Requires iron, globin chains, and porphyrin ring
2. Epidemiology Global Burden (WHO Data) Region Prevalence Affected Population Worldwide 24.8% 1.62 billion people Southeast Asia 48.7% Highest in women/children Africa 46.3% Malaria-endemic regions
Indian Scenario (NFHS-5) Population Prevalence Key Findings Children (6-59m) 67.1% Iron deficiency predominant Pregnant women 52.2% 30% of global maternal anemia Elderly (>60y) 42.1% Chronic disease association
3. Classification and Types A. By RBC Morphology (MCV-Based) Anemia Classification:
B. By Pathophysiological Mechanism 1. Hypoproliferative (Low reticulocytes)
Nutritional deficiencies (Fe, B12, folate) Bone marrow failure 2. Hemolytic (High reticulocytes)
Intrinsic RBC defects Extrinsic destruction
4. Iron Deficiency Anemia (IDA) Pathogenesis Stages of Depletion :
Iron stores depletion (↓ ferritin) Iron-deficient erythropoiesis (↑ TIBC, ↓ serum Fe) Frank anemia (microcytic RBCs) Diagnostic Approach Test Result Clinical Significance Serum ferritin <30 ng/mL Earliest marker Transferrin saturation <16% Functional iron deficiency RBC morphology Microcytic, hypochromic Pencil cells, anisocytosis
Management Oral therapy : Ferrous sulfate 325 mg tid + vitamin C
IV options : Ferric carboxymaltose (15 mg/kg)
Monitoring : Reticulocyte crisis at 5-7 days, Hb ↑ by 1 g/dL/week
5. Anemia of Chronic Disease (ACD) Key Features Causes :
Chronic infections (TB, HIV) Autoimmune disorders (RA, SLE) Malignancies Pathophysiology Inflammation → Cytokines → Hepcidin↑ → Iron Sequestration
Diagnostic Criteria Parameter ACD Pattern IDA Pattern Serum iron ↓ ↓↓ Ferritin Normal/↑ ↓ TIBC ↓ ↑
Treatment Underlying disease control ESA therapy (Epoetin alfa 50-100 U/kg TIW)IV iron if functional deficiency present
6. Thalassemia Syndromes Genetic Basis Type Defect Clinical Severity α-thalassemia α-globin gene deletion Silent → HbH disease β-thalassemia β-globin mutations Minor → Major
Diagnostic Workup CBC : Marked microcytosis (MCV often <70fL)Hb electrophoresis : β-thalassemia: ↑HbA2 (>3.5%), ↑HbF α-thalassemia: HbH inclusions Genetic testing : Definitive diagnosis Management Transfusion-dependent :
Regular PRBC + iron chelation Target Hb >9.5 g/dL Curative : Allogeneic HSCT
7. Sideroblastic Anemia Classification Hereditary : X-linked (ALAS2 mutations)Acquired : Myelodysplastic syndrome (MDS-RS) Toxins (lead, alcohol) Pathognomonic Findings Bone marrow :
Ring sideroblasts (>15% of erythroblasts) Prussian blue stain shows perinuclear iron Blood :
Dimorphic RBC population Basophilic stippling Treatment Pyridoxine : 100-200 mg/day (X-linked forms)Chelation therapy for iron overloadHSCT for MDS-associated cases
8. Diagnostic Algorithms Microcytic Anemia Workup [MCV<80]
9. Therapeutic Guidelines Blood Transfusion Thresholds Clinical Scenario Hb Threshold Stable outpatient <7 g/dL Cardiovascular disease <8 g/dL Active bleeding <9 g/dL
10. Complications Organ-Specific Effects System Complication Management Cardiac High-output failure Slow transfusions + diuretics Endocrine Hypogonadism (thalassemia) Hormone replacement Hepatic Cirrhosis (iron overload) Phlebotomy/chelation
11. Prevention Strategies Population-Level Iron fortification : Wheat flour, saltMalaria prophylaxis : In endemic regionsGenetic counseling : For thalassemia carriers High-Risk Groups Population Intervention Pregnant women 60 mg elemental Fe + 400 μg folate Elderly Annual CBC + nutritional screen
Key Takeaways Anemia is classified by RBC size (MCV) and underlying cause Iron studies differentiate between IDA, ACD, and sideroblastic anemia Thalassemia requires Hb electrophoresis for diagnosis Treatment must address both symptoms and underlying etiology
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