Anemia Classification and Clinical Manifestations

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Questions and Answers

What are some symptoms of acute anemia and their corresponding conditions?

10-15% --> hypotension and decreased organ perfusion; > 30% --> postural hypotension + bradycardia; > 40% --> hypovolemic shock

What are the symptoms associated with chronic anemia when Hb is less than 70-80 g/L?

Fatigue, loss of stamina, dyspnea, tachycardia, weakness, pallor, palpitations, tinnitus

Which conditions are associated with microcytic anemia (MCV < 80fl)?

Sideroblastic anemia (correct)

Globin deficiency (Thalassemia) (correct)

Iron deficiency (correct)

Anemia of chronic disease (correct)

Hyperchrome is a type of anemia where RBCs are paler than normal.

False Signup and view all the answers

Match the following causes with the corresponding types of anemia:

Iron deficiency = Microcytic anemia Megaloblastic: B12 / B9 deficiency = Macrocytic anemia Hemolytic Corpuscular (intrinsic) = Normocytic anemia Signup and view all the answers

What percentage of iron in the body is in the functional form?

75% Signup and view all the answers

What is the primary mechanism of iron excretion from the body?

Desquamation of epithelia Signup and view all the answers

Which protein regulates iron absorption in the gut?

Hepcidin Signup and view all the answers

What is the primary function of transferrin in iron metabolism?

Transport of iron Signup and view all the answers

What is the storage form of iron in the liver?

Ferritin Signup and view all the answers

Which of the following is an acute phase reactant and non-specific tumor marker?

Ferritin Signup and view all the answers

What is the estimated amount of iron lost during pregnancy?

500-1000mg Signup and view all the answers

Which of the following conditions is associated with increased demand for iron?

Growth (Infancy) Signup and view all the answers

What is the primary cause of iron deficiency anemia in the pre-latent stage?

Demands or losses exceeding iron absorption from diet Signup and view all the answers

What is the laboratory finding that indicates impaired erythropoiesis?

Normal or decreased reticulocyte count Signup and view all the answers

What is the characteristic of red blood cells in iron deficiency anemia?

Microcytic and hypochromic Signup and view all the answers

What is the significance of increased transferrin saturation in iron studies?

Excludes iron deficiency anemia Signup and view all the answers

What is the triad associated with an increased risk of esophageal SCC?

Iron deficiency anemia + dysphagia + esophageal webs Signup and view all the answers

What is the laboratory finding that indicates depletion of iron stores?

Increased TIBC Signup and view all the answers

Study Notes

Clinical Manifestation of Anemia

Symptoms and severity of anemia depend on the absolute value of Hb, speed of onset, age, and overall performance of the patient
Acute anemia is often due to acute blood loss
- 10-15% blood loss leads to hypotension and decreased organ perfusion
- >30% blood loss leads to postural hypotension and bradycardia
- >40% blood loss leads to hypovolemic shock (confusion, dyspnea, diaphoresis, hypotension, tachycardia)
Chronic anemia has different symptoms based on Hb levels
- Hb > 70-80 g/L: no signs or symptoms due to intrinsic compensatory mechanisms
- Hb < 70-80 g/L: anemic syndrome (fatigue, loss of stamina, dyspnea, tachycardia, weakness, pallor, palpitations, tinnitus)

Morphological Classification of Anemia

Based on MCV

Microcytic anemia (MCV < 80fl)
- Iron deficiency
- Anemia of chronic disease
- Globin deficiency (Thalassemia)
- Sideroblastic anemia
Macrocytic anemia (MCV > 100 fl)
- Megaloblastic: B12 / B9 deficiency
- Non-megaloblastic: chronic liver disease, alcoholism, aplastic anemia
Normocytic anemia (MCV 80-100 fl)
- Hemolytic
  - Corpuscular (intrinsic)
    - Membrane defects: hereditary spherocytosis
    - Enzymopathy: pyruvate kinase, Glc-6-P DH
    - Hemoglobinopathy: thalassemia, sickle cell disease, methemglobinemia, HbC, HbD, HbE
  - Extracorpuscular (extrinsic)
    - Mechanical/physical cause: heart valve, hemoglobinuria, microangiopathic hemolytic anemia
    - Metabolic cause: liver disease, alcoholism, hypophosphatemia, malnutrition, Cu overload, Wilson’s disease
    - Chemical substances: oxidative agents, snake venom
    - Infections: malaria, septicemia (clostridium perfringens), leptospira, borelia
- Non-hemolytic
  - Primary impairment of blood marrow: aplastic, MDS (some), PNH, myelofibrosis
  - Secondary impairment of blood marrow: infiltration, infection, endocrinological and systemic diseases, acute kidney disease
  - Acute hemorrhage

Based on MCHC

Hyperchrome
Normochrome
Hypochrome (RBCs are paler than normal): iron deficiency, anemia of chronic disease, sideroblastic anemia, lead poisoning

Based on Reticulocyte Count

Lowered number
Normal number
Increased number

Iron Deficiency Anemia (IDA)

Form of hypochromic microcytic anemia

Iron Metabolism

Functional iron: 75% of total iron, mainly in hemoglobin (70%) and myoglobin (4%)
Storage iron: 25% of total iron, mainly in liver as ferritin and hemosiderin
Dietary intake: 10-20mg, with 1-2mg absorption in gut, and loss of iron via epithelial desquamation
Pregnancy: 500-1000mg loss of iron

Iron Cycle

Hepcidin: regulates iron absorption in duodenum and upper jejunum
Hepcidin is regulated by HFE protein, which is low in iron deficiency
Acidic conditions in stomach release iron from food protein
Ferrireductase converts Fe3+ to Fe2+, which then enters enterocyte through DMT1
Vitamin C increases iron absorption, while calcium decreases it
Iron-containing heme enters via HCP1 and reaches plasma via ferroportin
Transferrin transports iron in plasma, converting Fe2+ to Fe3+ with ferroxidase (ceruloplasmin)
Ferritin stores iron in liver, mainly as Fe3+, with an outer protein shell and apoferritin
Hemosiderin is an insoluble protein-iron complex formed from ferritin in macrophages

Etiology of Iron Deficiency Anemia

Increased demand: growth, pregnancy, breastfeeding, EPO therapy
Increased loss: chronic bleeding, GIT ulcers, hookworm infestation, malignancy, diverticulitis, respiratory tract, UGT, NSAIDs, hemodialysis
Decreased intake/absorption: malnutrition, post-gastrectomy, Crohn's disease, celiac disease, SBD, achlorhydria/hypochlorhydria, H.pylori associated gastritis

Stages of Iron Deficiency Anemia

Pre-latent: negative iron balance, mobilization from reticuloendothelial storage sites
Latent: depletion of iron stores, gradual increase in TIBC
Manifestation: impaired erythropoiesis, decrease in Hb and hematocrit, hypochromia and microcytosis

Laboratory Findings

CBC: Hb < 120 g/L, low hematocrit, thrombocytosis (50% of patients)
Red blood cell indices: RDW > 15%, MCV < 80fl, MCH < 25pg, reticulocyte count normal or decreased
Peripheral blood smear: anisocytosis, hypochromasia
Iron studies: ferritin < 20ug/l, transferrin increased with saturation < 15%, TIBC increased, serum iron decreased (< 50 μg/dL)

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Description

Learn about the morphological classification of anemia and its clinical manifestations, including symptoms and severity factors. This quiz covers acute and chronic anemia, including hypotension, hypovolemic shock, and other related topics.