Anaemia

Anaemia

1. Definition: Anaemia is a condition characterized by a decrease in the number of red blood cells or the amount of hemoglobin in the blood, resulting in reduced oxygen carrying capacity of the blood. It is a common clinical condition caused by nutritional deficiencies, chronic diseases, blood loss, bone marrow disorders, and genetic abnormalities.

Additional context: Anaemia may occur due to deficiency of iron, vitamin B12, folic acid, chronic infections, renal disorders, malignancy, hemolysis, or inherited hemoglobinopathies.

2. Synonyms: Anaemia, anemia, deficiency disease.

3. Causes / Etiology: Anaemia is caused by one or more of the following mechanisms: • Decreased red blood cell production • Increased red blood cell destruction • Blood loss

Etiological factors include: • Iron deficiency due to poor intake, malabsorption, chronic blood loss • Vitamin B12 deficiency due to pernicious anaemia, malabsorption • Folate deficiency due to poor diet, malabsorption, increased demand • Chronic diseases such as chronic kidney disease, tuberculosis, malignancy, HIV/AIDS • Genetic disorders such as thalassemia, sickle cell disease, hereditary spherocytosis • Bone marrow failure such as aplastic anaemia • Increased destruction of RBCs as seen in hemolytic anaemias

4. Types / Classification:

Anaemia can be classified as follows:

A. Based on Etiology

• Blood loss anaemia – Acute blood loss anaemia – Chronic blood loss anaemia

• Anaemia due to decreased RBC production – Iron deficiency anaemia – Megaloblastic anaemia – Aplastic anaemia – Anaemia of chronic disease – Sideroblastic anaemia

• Anaemia due to increased RBC destruction – Hemolytic anaemia

B. Hemolytic Anaemia

• Intrinsic hemolytic anaemia – Hereditary spherocytosis – Sickle cell anaemia – Thalassemia – G6PD deficiency

• Extrinsic hemolytic anaemia – Autoimmune hemolytic anaemia – Malaria – Drug induced hemolysis – Toxins and burns

C. Based on Morphology

• Microcytic hypochromic anaemia – Iron deficiency anaemia – Thalassemia – Sideroblastic anaemia

• Normocytic normochromic anaemia – Acute blood loss anaemia – Aplastic anaemia – Hemolytic anaemia – Anaemia of chronic disease

• Macrocytic anaemia – Megaloblastic anaemia – Liver disease related anaemia – Alcoholism related anaemia

D. Specific Types

• Iron deficiency anaemia • Vitamin B12 deficiency anaemia • Folate deficiency anaemia • Pernicious anaemia • Aplastic anaemia • Sideroblastic anaemia • Anaemia of chronic disease • Sickle cell anaemia • Thalassemia • Hemolytic anaemia

Acute iron deficiency anaemia: • Causes: Acute blood loss, trauma, surgery • Clinical features: Severe weakness, pallor, tachycardia • Duration: Rapid onset • Difference: Sudden onset and severe symptoms

Chronic iron deficiency anaemia: • Causes: Hookworm infestation, menorrhagia, poor diet • Clinical features: Fatigue, pallor, koilonychia • Duration: Gradual onset • Difference: Long-standing and milder symptoms

5. Pathophysiology / Pathology: Anaemia develops due to impaired erythropoiesis, excessive RBC destruction, or blood loss → reduced hemoglobin synthesis → reduced oxygen delivery to tissues → tissue hypoxia.

Stages: • Depletion of iron or vitamins • Reduced hemoglobin synthesis • Reduced RBC count • Tissue hypoxia

6. Clinical Features:

General features: • Fatigue • Weakness • Dyspnea on exertion • Pallor • Giddiness

Specific features: • Iron deficiency anaemia → koilonychia, pica • Megaloblastic anaemia → glossitis, neuropathy • Hemolytic anaemia → jaundice, splenomegaly

7. Complications:

Acute complications: • Cardiac failure • Severe hypoxia

Chronic complications: • Growth retardation • Cognitive impairment • Cardiomegaly

8. Investigations / Diagnosis:

• Complete blood count • Peripheral blood smear • Serum iron studies • Vitamin B12 and folate levels • Reticulocyte count • Hemoglobin electrophoresis • Bone marrow examination

9. Differential Diagnosis:

• Thalassemia • Sickle cell anaemia • Leukemia • Pernicious anaemia

10. Management / Treatment:

General management: • Treat underlying cause • Nutritional supplementation • Rest and balanced diet

Modern medicine treatment: • Oral or parenteral iron therapy • Vitamin B12 and folic acid therapy • Blood transfusion in severe cases • Erythropoietin in renal anaemia

11. Homeopathic Therapeutics:

• Arsenicum album: Causation: Poor digestion, stress, and anxiety; Characteristic symptoms: Fatigue, weakness, and pale skin; Modalities: Better with rest, worse with exertion; Mental state: Anxiety, restlessness; Thirst and appetite: Increased thirst, poor appetite; Nature of discharges: Pale, watery stools; Physical generals: Pale skin, weakness, and fatigue; Suitable constitution: Sanguine; How it helps: Relieves fatigue, weakness, and pale skin.

• Cinchona: Causation: Poor digestion, stress, and anxiety; Characteristic symptoms: Fatigue, weakness, and pale skin; Modalities: Better with rest, worse with exertion; Mental state: Anxiety, restlessness; Thirst and appetite: Increased thirst, poor appetite; Nature of discharges: Pale, watery stools; Physical generals: Pale skin, weakness, and fatigue; Suitable constitution: Sanguine; How it helps: Relieves fatigue, weakness, and pale skin.

• Ferrum metallicum: Causation: Iron deficiency; Characteristic symptoms: Fatigue, weakness, and pale skin; Modalities: Better with iron supplements, worse with exertion; Mental state: Fatigue, weakness; Thirst and appetite: Increased thirst, poor appetite; Nature of discharges: Pale, watery stools; Physical generals: Pale skin, weakness, and fatigue; Suitable constitution: Sanguine; How it helps: Relieves iron deficiency, fatigue, and weakness.

• Phosphorus: Causation: Poor digestion, stress, and anxiety; Characteristic symptoms: Fatigue, weakness, and pale skin; Modalities: Better with rest, worse with exertion; Mental state: Anxiety, restlessness; Thirst and appetite: Increased thirst, poor appetite; Nature of discharges: Pale, watery stools; Physical generals: Pale skin, weakness, and fatigue; Suitable constitution: Sanguine; How it helps: Relieves fatigue, weakness, and pale skin.

• Sulphur: Causation: Poor digestion, stress, and anxiety; Characteristic symptoms: Fatigue, weakness, and pale skin; Modalities: Better with rest, worse with exertion; Mental state: Anxiety, restlessness; Thirst and appetite: Increased thirst, poor appetite; Nature of discharges: Pale, watery stools; Physical generals: Pale skin, weakness, and fatigue; Suitable constitution: Sanguine; How it helps: Relieves fatigue, weakness, and pale skin.

12. Prognosis: Depends on cause, severity, duration, and response to treatment. Nutritional anaemias have good prognosis, genetic and chronic disease related anaemias have guarded prognosis.

13. Prevention:

• Balanced diet rich in iron and vitamins • Iron supplementation in pregnancy • Deworming programs • Early treatment of chronic diseases

14. Diet:

Recommended foods: • Green leafy vegetables • Pulses and legumes • Meat, fish, eggs • Fortified cereals

Avoided foods: • Excess tea and coffee • Junk and processed food