BLOOD PICTURE OF ANAEMIA

INTRODUCTION
Anaemia is a medical condition in which the red blood cell count or the haemoglobin is less than normal.
In men, anaemia is typically defined as haemoglobin level of less than 13.5 gram/100 ml and in women as haemoglobin of
less than 12.0 gram/100 ml.
Anaemia is caused by either a decrease in production of red blood cells (decreased erythropoiesis) or haemoglobin, or an
increase in loss (usually due to bleeding) or destruction of red blood cells.
Some patients with anaemia have no symptoms. Those who do have symptoms may
 feel tired,
 become easily fatigued,
 appear pale,
 have a feeling of a heart racing,
 feel short of breath, and/or
 have worsening heart problems.
Anaemia can be detected with a simple blood test called a complete blood cell count (CBC).
Anaemia treatment varies greatly and depends on the particular cause.
Anaemia is the most common blood disorder, affecting about a third of the global population. Iron-deficiency anaemia
affects nearly 1 billion people. In 2013, anaemia due to iron deficiency resulted in about 183,000 deaths – down from
213,000 deaths in 1990. It is more common in women than men, during pregnancy, and in children and the elderly.
Anaemia increases costs of medical care and lowers a person's productivity through a decreased ability to work. The name
is derived from Ancient Greek: anaimia, meaning "lack of blood", from ‘an’-, "not" and ‘haima’, "blood".
DEFINITION
Anaemia is a medical condition in which the red blood cell count or the haemoglobin is less than normal. The normal level
of haemoglobin is generally different in males and females. For men, a normal haemoglobin level is typically defined as a
level of more than 13.5 gram/100 ml, and in women as haemoglobin of more than 12.0 gram/100 ml. These definitions
may vary slightly depending on the source and the laboratory reference used.
OR
Anaemia means a deficiency of haemoglobin, which can be caused by either too few red blood cells or too little
haemoglobin in the cells.
SIGNS AND SYMPTOMS
Some individuals with anaemia have no symptoms. Others with anaemia may:
 Feel tired
 Weakness
 Fatigue easily
 Appear pale
 Develop palpitations (feeling of heart racing)
 Shortness of breath
Additional anaemia symptoms may include:
 Hair loss
 Malaise (general sense of feeling unwell)
 Worsening of heart problems
 If anaemia is longstanding (chronic anaemia), the body may adjust to low oxygen levels and the individual may
not feel different unless the anaemia becomes severe. On the other hand, if the anaemia occurs rapidly (acute
anaemia), the patient may experience significant symptoms relatively quickly and with relatively mild fluctuations
of haemoglobin levels.

SYMPTOMS OF ANAEMIA
TYPES OF ANAEMIA
In general, there are three major types of anaemia, classified according to the size of the red blood cells:

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 1. If the red blood cells are smaller than normal, this is called microcytic anaemia. The major causes of this type are
iron deficiency (low level iron) anaemia and thalassemia (inherited disorders of haemoglobin).
2. If the red blood cells size are normal in size (but low in number), this is called normocytic anaemia, such as
anaemia that accompanies chronic disease or anaemia related to kidney disease.
3. If red blood cells are larger than normal, then it is called macrocytic anaemia. Major causes of this type are
pernicious anaemia and anaemia related to alcoholism.
TYPES OF ANAEMIA

CAUSES
Due to defective synthesis, either of haem or of globin, abnormalities may occur in the Hb molecule. Defect in the haem
part is usually rare. Defects in the globin chain are not infrequent. These may be as follows:
Some types of anaemia and their physiologic causes are the following:
BLOOD LOSS ANAEMIA
After rapid haemorrhage, the body replaces the fluid portion of the plasma in 1 to 3 days, but this leaves a low
concentration of red blood cells. If a second haemorrhage does not occur, the red blood cell concentration usually returns
to normal within 3-6 wks.

In chronic blood loss, a person frequently cannot absorb enough iron from the intestines to form haemoglobin as rapidly
as it lost. Red cells are then produced that are much smaller than normal to have too little haemoglobin inside them, giving
rise to microcytic, hypochromic anaemia.

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APLASTIC ANAEMIA
Bone marrow aplasia means lack of a functioning bone marrow. For instance, a person exposed to gamma ray radiation
from a nuclear bomb blast is likely to sustain complete destruction of bone marrow, followed in a few weeks by lethal
anaemia. Likewise excessive x-ray treatment, certain industrial chemicals, and even drug to which the person might be
sensitive can cause the same effect.

MEGALOBLASTIC ANAEMIA
Deficiency of Vitamin B12 , folic acid, and intrinsic factor from the stomach mucosa leads to slow reproduction of
erythroblast in the bone marrow. As a result, these grow too large, with odd shapes, and are called megaloblast. Thus
atrophy of stomach mucosa, as occurs in pernicious anaemia, or loss of the entire stomach as the result of surgical total
gastrectomy can lead to megaloblastic anaemia. Also patients who have intestinal sprue, in which folic acid, vitamin B 12 ,
and other vitamin B compounds are poorly absorbed, often develop megaloblastic anaemia. Because the erythroblast
cannot proliferate rapidly enough to form normal numbers of red blood cells, the cells are formed mostly oversized, have
bizarre shapes, and have fragile membranes. These cells rupture easily, leaving the person in dire need of an adequate
number of red cells.

Peripheral blood smear, megaloblastic anaemia

HAEMOLYTIC ANAEMIA
Different abnormalities of the red blood cells, many of which are hereditary acquired, make the cells fragile, so that they
rupture easily as they go through capillaries, especially through the spleen. Even though the number of red cells formed is
normal, or even much greater than normal in some haemolytic diseases, the red cell life span is so short that cells are
destroyed much faster than they can be formed, and serious anaemia results. Some of these types of anaemia are the
following:
In hereditary spherocytosis , the red cells are very small and spherical , rather than being biconcave discs. These cells
cannot withstand compression forces because they do not have the normal loose, baglike cell membrane structure of the
biconcave discs. On passing through the splenic pulp and some other tissues, they are easily ruptured by even slight
compression.

Haemolysis in hereditary spherocytosis

SICKLE CELL ANAEMIA/ HBS
It is an adult haemoglobin and also written as α2 β2.. In this haemoglobin, in the beta chain, one amino acid is different. The
glutamic acid is present at 6th position of normal beta chain is replaced by valine in HbS. When this HbS is reduced i.e. not
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in combination with O2, the Hb molecules interact to form thread like structures and becomes in soluble. This leads to
change in the shape of RBCs which then look like sickles and are called sickle cells. These cells are destroyed quickly
resulting in sickle cell anaemia. The heterozygous individuals named as sickle cell trait, may not have symptoms. These
people are seen to have protection against falciparum malaria. It is interesting to note that the parts of the world having
this malaria also shows HbS in the population. Other abnormal haemoglobins found are HbC, HbE, HbJ etc. all these defects
are due to chain abnormality and are called haemoglobinopathies.In sickle cell anaemia , which is present in 0.3 to 1.0 per
cent of West African and American blacks, the cells contain an abnormal type of haemoglobin called haemoglobin S ,
caused by abnormal beta chains of the haemoglobin molecule.

Sickle cell disease

In Erythroblastosis fetalis , Rh- positive red blood cells in the foetus are attacked by antibodies of Rh- negative mother.
These antibodies make the Rh-positive cells fragile, leading to rapid rupture and causing the child to born with serious
anaemia. The extremely rapid formation of new red cells to make up for the destroyed cells in erythroblastosis fetalis
causes a large number of early blast forms of red cells to be released into the blood.

effects of erythroblastosis fetalis

CONCLUSION

haemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon
dioxide back to the lung to exhale it out of the body. If the haemoglobin level is too low, this process may be impaired,
resulting in low levels of oxygen in the body (hypoxia).

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