Cause of Anemia

Anemia

Definition from WHO

 Anaemia is a condition in which the number of red blood cells or their oxygen-
carrying capacity is insufficient to meet physiologic needs, which vary by age,
sex, altitude, smoking, and pregnancy status.
 Iron deficiency is thought to be the most common cause of anaemia globally,
although other conditions, such as folate, vitamin B12 and vitamin A
deficiencies, chronic inflammation, parasitic infections, and inherited
disorders can all cause anaemia.
Etiology anemia

 are divided into three groups:

1. Anemia caused by blood loss
2. Anemia caused by decreased or faulty red blood cell production
3. Anemia caused by destruction of red blood cells
Tabel Etiology of Anemia

Mechanism Examples
Blood Loss
1. Acute Childbirth
GI Bleeding
Injuries
Surgery
2. Chronic Bladders Tumors
Cancer or Polyps in GI tract
Heavy Menstrual Bleeding
Kidney Tumors
Ulcers in Stomach or Small Intestine
Deficient Erythropoiesis
1. Microcytic
2. Normochromic- Normocytic
Iron Deficient
Iron Reutilization Defect ( Anemia of
Chronic Inflammation, infection,
cancer)
Iron Transport deficiency( Iron
Refractory Iron Deficiency Anemia)
Iron Utilization defect ( Inherited
Sideroblastic Anemia)
Thalassemias
Anemia of Chronic Inflamation,
Inefection, or Cancer
Kidney Diseases
Endocrine Failure ( Thyroid, Pitutary )
Malnutrition
Myelodysplasia
Myelophthisis
Pure Red Blood Cell Aplasia
3. Macrocytic Alcohol Use Disorder
Copper Deficiency
Folate Deficiency
Liver Disease
Malabsorption(eg, Tropical Sprue)
Myelodisplasia
Vitamin B12 Deficiency
Excessive Hemolysis due to Extrinsic RBC Defect

1. Reticuloendothelial Hyperactivity with Hypersplenism

Splenomegaly
2. Immunologic Abnormalities Cols Agglutinin Diseases
Drug Induced
Paroxysmal Cold Hemoglobinuria
Thrombotic Thrombocytopenic
Purpura and Hemolytic Uremic
Syndrome
Warm Antibody Hemolytic Anemia

3. Infection Clostridia Infection

Ebdtein barr Virus EBV Infection
Malaria
4. Mechanical Injury Cardiac Valvular Disease
Foot Strike Hemolysis
5. Drugs/Toxins Phenazopyridine
Ribavirin
Spider Bites
Excessive Hemolysis due to Intrinsic RBC Defect

1. Membrane Alterations, acquired Hypophosphatemia

Paroxyxsmal Nocturnal
hemoglobinuria
Stomatocytosis
2. Membrane Alterations, Congenital Hereditary Elliptocytosis
Hereditary Spherocytosis
3. Metabolic Disorders( Inherited Enzyme Embden-Meyerhof Pathway defect
Deficiencies) G6PD deficiency
4. Hemoglobinopathies Hb C diseases
Hb E diseases
Hb S-C disease
Hb S –beta-Thalassemia disease
Sickle cell disease
Thallassemias(beta,beta-delta and
alpha
 Blood loss can be acute or chronic. Anemia does not develop until several
hours after acute blood loss, when interstitial fluid diffuses into the
intravascular space and dilutes the remaining RBC mass. During the first few
hours, however, levels of polymorphonuclear granulocytes, platelets, and, in
severe hemorrhage, immature WBCs and normoblasts may rise. Chronic blood
loss results in anemia if loss is more rapid than can be replaced or, more
commonly, if accelerated erythropoiesis depletes body iron stores
 Deficient erythropoiesis has myriad causes. Complete cessation of
erythropoiesis results in a decline in RBCs of about 7 to 10%/wk (1%/day).
Impaired erythropoiesis, even if not sufficient to decrease the numbers of
RBCs, often causes abnormal RBC size and shape.
 Excessive hemolysis can be caused by intrinsic abnormalities of RBCs or by
extrinsic factors, such as the presence of antibodies or complement on their
surface, that lead to their early destruction. An enlarged spleen sequesters
and destroys RBCs more rapidly than normal. Some causes of hemolysis
deform as well as destroy RBCs. Hemolysis normally causes increased
reticulocyte production unless iron or other essential nutrients are depleted.
refference

1. http://www.who.int/topics/anaemia/en/
2. ttps://www.msdmanuals.com/professional/hematology-and-
oncology/approach-to-the-patient-with-anemia/etiology-of-anemia#v968431