ANEMIA :

CLINICAL APPROACH AND MANAGEMENT

Dairion Gatot, Savita Handayani

Divisi Hematology -Onkology Medic

Internal Departement of Medical Faculty of North Sumatera University /
Haji Adam Malik General Hospital,
Medan 2014
 ANEMIA

Is defined as a condition in which the

haemoglobin concentration is below reference
range for the age, sex, method & altitude

Deficient in O2 carrying capacity hypoxia

CUT OFF POINT ANAEMIA IN INDONESIA

Pre school age 11 g/dL

School age 12 g/dL
Pregnant women 11 g/dL
3 month post partum 12 g/dL
Female 12 g/dL
Male 13 g/dL
 Prevalence

Anaemia is thought to affect 1.62 billion people on a

daily basis (WHO); this is 24% of the worlds
population.

Anaemia affects both developing and developed

nations.

Women (both pregnant and non-pregnant) and

children suffer most from the condition.
 Cause of Anemia
Decreased RBC production :
- Insufficient production
- Inefficient production (erythropoiesis)

Increased RBC loss or destruction exceeds the maximal

capacity of bone marrow RBC production :
- Reduced RBC lifespan
- Excessive Loss of RBC
 Signs and symptoms of anemia
Central nervous system Immune system
Debilitating fatigue Impaired T-cell and
Dizziness, vertigo macrophage function
Depression
Cardiorespiratory system
Impaired cognitive function
Exertional dyspnoea
Tachycardia, palpitations
Gastro-intestinal system Cardiac enlargement,
Anorexia hypertrophy
Nausea Increased pulse pressure,
systolic ejection murmur
Vascular system Risk of life-threatening cardiac
Low skin temperature failure
Pallor of skin, mucous Genital tract
membranes and conjunctivae Menstrual problems
Loss of libido

Adapted from Ludwig H. Semin Oncol. 1998;25(suppl 7):2-6.

7
 Signs and symptoms of anemia

The signs and symptoms of anemia range from slight

fatigue to life threatening reactions depending upon :
Rate of onset
Severity
Ability of the body to adaptive
 Diagnosis of Anemia

1. Patient history
2. Patient physical examination
3. Hematologic laboratory findings

Identification of the cause of anemia is important so

that appropriate therapy is used to treat the anemia.
 Diagnosis of Anemia
1. History
- Symptoms of anemia (Acute vs. Chronic)
- The severity of cerebral and circulatory symptoms relative to
the severity of anemia.
- The possibility of chronic blood loss (GI, Gynecological).
- The possibility of episodes of hemolysis.
- The presence of neurological symptoms.
- Prior therapy of anemia.
- Use of other medications and exposure to toxins.
- Dietary history.
- Family history.
- Social history
- Underlying disease.
- Effect of symptoms (Quality of Life)
 Diagnosis of Anemia
2. Clinical Presentation and Physical Examination
General findings might include
Skin pallor
Hepato or splenomegaly
Heart abnormalities
Specific findings may help to establish the underlying cause:
In vitamin B12 deficiency there may be signs of
malnutrition and neurological changes
In iron deficiency there may be severe pallor, a smooth
tongue, and esophageal webs
In hemolytic anemias there may be jaundice due to the
increased levels of bilirubin from increased RBC
destruction
 Angular cheilosis Koilonychia

Leg ulcer (HbSS)

 Diagnosis of Anemia
3. Laboratory Investigations
Initial Tests :
- CBC (Hb, RBC indices, RDW, WBC, Platelets)
- Reticulocyte count
- Peripheral blood smear (PBS)

Specific Tests :
- Iron Studies (s-ferretin, iron profile).
- Vitamin B12 and Folate levels.
- Hemoglobin electrophoresis.
- Work up for hemolysis.
- Renal Function Test.
- Liver Function Test.
- Endocrine Evaluation.
- Bone marrow examination.
 CLASSIFICATION OF ANAEMIA

Morphologic classification :
1. Macrocytic anaemia
2. Microcytic hypochromic anaemia
3. Normocytic anaemia.
Macrocytic Microcytic hypochromic

Normocytic normochromic
Penggolongan menurut Morfologi
volumetrik

Mikrositik Normositik
hipokrom normokrom Makrositik
MCV < 80 fL 80 100 fL > 100 fL
MCH 27 pg > 27 pg > 27 pg
MCHC < 30 g/dL 30 g/dL 30 g/dL

MCV= (Ht/Eritosit)x10 fL
MCH=(Hb/Eritrosit)x10 pg
MCHC=(Hb/Ht)x100 g/dL
HYPOCHROMIC, MICROCYTIC ANEMIAS
NORMOCHROMIC, NORMOCYTIC ANEMIAS
MACROCYTIC ANEMIAS
MORPHOLOGICAL CLASSIFICATION OF ANEMIAS
 Treatment of Anemia

Specific treatment of underlying disorder caused anemia.

Replacement of missing factors (iron, vitamin B12, folate, Epo)

In many chronic anemias regular blood transfusions are needed

(thalassemia, myelodysplastic syndrome)

Blood transfusion is usually needed in acute blood loss or if the

patient has severe symptoms or in heart failure
Blood transfusion