Types of Anaemia

CLASSIFICATION OF ANAEMIA

Anaemia can be classified in different classes depending on various factors and approaches of classification.Anaemia is classified into two broad categories:


1. Morphological

2. Etiological (pathophysiological)


1. MORPHOLOGICAL


This classification is based on the size of red blood cells, red cell indices and also haemoglobin concentration.Three types of anaemia exist in this class:


  • MICROCYTIC HYPOCHROMIC ANAEMIA

In this type of anaemia, size of RBC and haemoglobin is below normal. Example of this anaemia is iron-deficiency anaemia.

  • NORMOCYTIC NORMOCHRONIC ANAEMIA

Size of RBC is above normal but haemoglobin count is normal. Pernicious anaemia is an example of this type of anaemia.

  • MACROCYTIC NORMOCHRONIC ANAEMIA

In this anaemia, both size of RBC and haemoglobin is normal. Example is Aplastic anaemia.


2. PATHOPHYSIOLOGICAL OR ETIOLOGICAL

  • ANAEMIA DUE TO IMPAIRED PRODUCTION
    • Deficient globin synthesis: for example, thalassemia.
    • Vitamin B12 deficiency or folic acid deficiency: for example, Megaloblastic anaemia
    • Deficient haem synthesis: for example, iron-deficiency anaemia
  • ANAEMIA DUE TO INCREASED BLOOD LOSS
    • Acute posthemorrhagic anaemia
    • Chronic posthemorrhagic anaemia
  • Anaemia in Chronic disorders like liver and renal disease, infection and malignancy.
  • Anaemia due to bone marrow infection
  • Defects in stem cell prolification and differentiation: For example, Aplastic anaemia.
  • Congenital anaemia: Example, Sideroblastic anaemia.

Two other forms of anaemia can also be seen:


HYPERANAEMIA: A severe form of anaemia, in which the hematocrit count is below 10%.


REFRACTORY ANAEMIA: Anaemia which does not respond to treatment, and is often seen secondary to myelodysplastic syndromes.


ACUTE AND CHRONIC ANAEMIA

Acute anaemia is characterized by a sudden precipitous fall in the number of red blood cells which may be caused by excessive blood loss or red blood cell breakdown. Red blood cells transport oxygen from the lungs to other parts of body and carbon dioxide from tissues to lungs with the aid of haemoglobin. In case of severe anaemia, reduction in oxygen carrying capacity of blood is noted with the fall in total RBC count.


Acute anaemia is generally characterized by blood loss somewhere in the body, but at certain occasions, other conditions may also be the cause. Acute anaemia is taken very seriously by the doctors because it indicates or may lead to life-threatening conditions.


Causes

Internal bleeding due to ruptured blood vessels may be the reason behind the acute form of anaemia. Most often, blood loss from ulcers or other internal hemorrhaging can lead to sudden anaemia. Some of the diseases, like hemophilia, acquired platelet disorder etc, also cause acute type of anaemia. Apart from this, acute anaemia is also considered the first symptom of leukemia.


Symptoms

  • Weakness
  • Sleepiness
  • Pallor
  • Cold hands and feet
  • Feeling dizzy and disoriented
  • Fainting

Testing

  • Weakness
  • Blood culture

CHRONIC ANAEMIA

Chronic anaemia develops over a longer period of time rather than suddenly. Basically, it is associated with chronic disease processes such as kidney disease.


Symptoms

  • Sore mouth
  • Loss of appetite
  • Pale lips & eyelids
  • Brittle nails
  • Tiredness & Headache
  • Pallor
  • Concentration problems
  • Shortness of breath after exercise
  • Sleeping disorder
  • Difficulty swallowing
  • Rapid & Irregular heartbeat
  • Chest pain
  • Impaired cognitive ability
  • Dizziness
  • Cold skin
  • Flattened nails and Concave nails
  • Thin fingernails

Chronic anaemia as a complication of other diseased condition

Chronic anaemia often develops due to an underlying cause and may be the complication of that diseased condition. For example, sickle cell anaemia.

Chronic anaemia is often the symptom of other disease such as Persistent parvovirus infection, Rud Syndrome and Triose phosphate-isomerase deficiency.


Treatment (Only after consulting your doctor)

Treatment of chronic anaemia depends on the underlying disease process and upon the type, cause and severity of the anaemia, and also on the individual patient factors. Treatment is inclusive of:

  • Dietary review — to know nutritional causes of anaemia
  • Investigation, diagnosis and management of underlying causes such as coeliac disease, menorrhagia, nutritional deficiency

SICKLE CELL ANAEMIA

Sickle cell anaemia or drepanocytosis is an autosomal recessive genetic blood disorder characterized by abnormal, rigid, sickle shaped red blood cells. Sickling results in the decrease of blood flexibility and can lead to various health complications. The condition occurs due to a mutation in the haemoglobin gene.


The abnormal cells have shorter life-span and are not replaced as quickly as normal causing a shortage of red blood cells and therefore, anaemia.


Complications associated with SCA

Symptoms have significant impact on quality of life and in severe cases may be life threatening.


Symptoms include:

  • Increased vulnerability to bacterial infection
  • Acute chest syndrome: lungs lose the ability to breathe in oxygen.
  • Pulmonary hypertension: The blood pressure inside blood vessels, running from heart to lungs, becomes dangerously high
  • Stroke: Supply of blood to brain becomes limited

Causes of sickle cell anaemia

It is basically caused by a genetic mutation affecting normal development of red blood cells. A point mutation in the ß-globin chain of haemoglobin causes the replacement of hydrophilic amino acid glutamic acid with the hydrophobic amino acid valine at the sixth position.


The loss of RBC elasticity is central to the pathophysiology of the sickle-cell anaemia. The actual cause of illness is haemolysis, or the increased destruction of red blood cells, the loss which bone marrow fails to compensate for.


Diagnosis of sickle-cell anaemia

Following tests are preferred:

  • Full blood count: Reveals haemoglobin levels (in between 6-8 g/dl) & high reticulocyte count.
  • Sickle solubility test: Reveals the presence of sickle haemoglobin
  • Urinalysis

Known carriers are advised to undergo genetic counseling before having a child and if the carrier mother is expecting a child then amniotic fluid test is done to see if the unborn child has the disease.


Treatment/Management of sickle-cell anaemia
( The treatment is advised only after consultation with your doctor)

  • Malaria chemoprophylaxis: The protective effect of sickle-cell trait is not found in people with sickle-cell disease; in fact, they are uniquely vulnerable to malaria and may need anti-malarial chemoprophylaxis for life if they reside in malarial countries.
  • Folic acid and penicillin: Children with sickle-cell disease are closely observed by pediatrician and also need attention of haematologist. They may have to take 1 mg dose of folic acid for life and also, from birth to five years, they may have to take penicillin daily.
  • Bone marrow transplant: It is the only known cure for Sickle-cell disease.
  • Transfusion therapy: It is effective in acute cases to prevent complications by decreasing the number of red blood cells.

Special management for Acute chest crisis and Vaso-occlusive crisis.


FOLATE DEFICIENCY ANAEMIA

Folate deficiency anaemia is the medical term given to the health condition when there is a lack of folic acid in the body due to any reason. Folate deficiency leads to decreased production of red blood cells in the body or it may also lead to production of abnormally large red blood cells of very short life span.


Causes of folate deficiency anaemia *

  • Diet deficient in folate – this is the major cause of disease among the patients.
  • Medication – certain epilepsy medicines and drugs used to treat rheumatoid arthritis can also alter the level of folate present in the body.
  • Certain disease conditions like liver disease, kidney dialysis, celiac disease etc. can promote folate deficiency anaemia.
  • Additional demand of folate in the body – in conditions like pregnancy, there is an additional demand of folate in the body to meet the growth requirements of the baby.

Symptoms associated with folate deficiency anaemia

  • Weakness
  • Sore tongue
  • Heart palpitations
  • Behavioural disorders
  • Headache and irritability

Diagnosis


Doctors generally ask for symptoms and then recommend certain tests for the following:

  • Full blood count
  • Blood film
  • Test to measure the level of Vitamin B12, folate and iron

Size, shape and count of red blood cells, haemoglobin and platelets indicate whether the patient has folate deficiency anaemia or not.


Treatment (In consultation with your doctor)

General physicians prescribe folic acid tablets to be consumed orally. The duration of treatment depends on the severity of disease and the underlying causes, which may also alter the treatment plan.


Besides medical treatment, patients must also consider self-help treatment methods by changing eating habits and diet plans. Reduce alcohol intake and include broccoli, asparagus, chickpea, brown rice etc. in your diet to enhance folate level in the body.

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