Anaemia

Abstract Background: Anaemia is common worldwide specially in developing countries where nutrient deficiencies are prevalent. It is a common problem in the outpatient set but it’s always neglected and taken lightly which can cause hyperdynamic circulation disturbances and raise the rate of morbidity and mortality. Aim: To determine the prevalence of microcytic Hypochromic anaemia in medicine emergency room casualty in academy teaching hospital. Method: This is a descriptive cross-sectional study which was done in the Academy Teaching Hospital in which 75 of the emergency room patients participated in the study.The state of nutrition of the patients was evaluated by a questionnaire answered by the patients. Chapter One Introduction and Literature Review 1. 1 Introduction Anaemia Anaemia is defined as the reduction in the oxygen-transporting capacity of blood, which usually stems from a reduction of the total circulating red cell mass to below normal amounts. Blood haemoglobi n level is below 13. 5 g/dl in an adult male and below 11. 5 g/dl in an adult female. (1) Classification: Classified according to: 1. Causes: a. Inadequate production of RBC. b. Blood loss anaemia: * Acute: due to acute hemorrhage. * Chronic: due to GIT bleeding, menorrhagia. . Excessive destruction of RBC (haemolysis). 2. Morphology: a. Microcytic: * Iron deficiency. * Thalassemia. * Sideroblastic. b. Microcytic: * Folate deficiency. * B12 deficiency. c. Normocytic: * Aplastic anaemia. * Myelodysplastic anaemia. There are many undiagnosed cases of anaemia that if left undetected can lead to several complications, those include: (2) 1. Infections: people with the anaemia are more susceptible to getting infections from viruses and bacteria. 2. Severe bleeding: if bleeding is severe, internal and excessive then death can ensue if a blood transfusion is not given and the cause of the bleeding is not treated. . Stroke: if haemoglobin is defective, it can damage the walls of the red bloo d vessels and this can result in narrowing or even blockages in the brain, which can lead to serious, life threatening strokes. (2) Microcytic Hypochromic Anaemia Microcytic anemia is a blood disorder characterized by small red blood cells (erythrocytes) which have insufficient haemoglobin and hence have a reduced ability to carry oxygen through the body. The red blood cells are small due to a failure of haemoglobin synthesis or insufficient quantities of haemoglobin available. (3) Classification: 1. Iron deficiency anaemia . Sideroblastic anaemia. 3. Thalassemia. Iron deficiency anaemia It’s estimated to be the main cause of anaemia affecting about 10% of the population in developed countries and 25-50% in developing countries. The prevalence of iron deficiency anemia in the United States was 2 percent in adult men, but was found to be more common in child-bearing women age. (4) Total body iron content is about 2gm for females, and 6gm for males. Most of the iron within the body is found in hemoglobin within erythrocytes (80%), with the remainder being found in myoglobin and iron containing enzymes.Iron is stored in liver, spleen, bone marrow and skeletal muscle. This iron storage pool contains on average 15-20% of total body iron. (4) Iron is transported in the plasma by an iron binding protein called transferrin. In normal individuals, transferrin is about 33% saturated with iron. Dietary iron is obtained either from inorganic sources or animal sources. Dietary iron enters intestinal cells via specific transporters. The iron is then used by the cell, stored as ferritin or transferred to the plasma. (4) Erythropoiesis is the development process in which new erythrocytes are produced, through which each cell matures in about 7 days.Through this process erythrocytes are continuously produced in the red bone marrow of large bones, at a rate of about 2 million per second in a healthy adult. The blood's red color is due to the spectral properties of the he mic iron ions in hemoglobin. The red blood cells of an average adult human male store collectively about 2. 5 grams of iron, representing about 65% of the total iron contained in the body. (5)(6) Causes: * Poor intake. * Decreased absorption (celiac disease, gastrectomy). * Increased demand in growing adolescents and pregnancy. * Blood loss from GIT due to: * Hookworm infestation. Erosions associated with NSAID, peptic ulcer or neoplastic disease. * Hemorrhoids. * Blood loss from irregular or excessive menstruation. Symptoms and signs (7) Symptoms may include: * Fatigue. * Shortness of breath * Lightheadedness. * Palpitations. * Dizziness. * Chest pain. * Blurred vision. * Sleep disturbance. Signs may include: * Rapid heart rate. * Low blood pressure. * Rapid breathing. * Pale conjunctiva. * Cold skin. * Enlargement of the spleen. Diagnosis of iron deficiency anaemia: * Complete blood count and color: with iron deficiency anaemia red blood cells are smaller and paler in color than n ormal. Hematocrit: This is the percentage of blood volume made up by red blood cells. Normal levels are generally 41% for adult women and 47% for adult men. These values may change depending on your age. * Haemoglobin: Lower than normal hemoglobin levels indicate anemia (12-16 g/dl in an adult male and 13. 7-17. 5 g/dl in an adult female). * Ferritin: This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron. Some tests might be done to detect the underlying cause, like: * Endoscopy: Often to check for bleeding from a hiatal hernia, an ulcer or the stomach. Colonoscopy: To rule out lower intestinal sources of bleeding. * Ultrasound: Women may also have a pelvic ultrasound to look for the cause of excess menstrual bleeding, such as uterine fibroids. (8)(9) Sideroblastic anaemia It is a disease in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). [10] In Sideroblastic anemia , the body has iron available but cannot incorporate it into hemoglobin, which red blood cells need to transport oxygen efficiently.Sideroblasts are atypical, abnormal nucleated erythroblasts (precursors to mature red blood cells) with granules of iron accumulated in perinuclear mitochondria. [11] Sideroblasts are seen in aspirates of bone marrow. Causes: * Failure to completely form heme molecules, This leads to deposits of iron in the mitochondria that form a ring around the nucleus of the developing red blood cell. * Toxins: lead, copper or zinc poisoning * Drug-induced: ethanol, isoniazid, chloramphenicol, cycloserine, Oral Contraceptives * Nutritional: pyridoxine (Vitamin B6) or copper deficiency * Diseases: Rheumatoid arthritis, or multiple myeloma Genetic: ALA synthase deficiency (X-linked, associated with ALAS2)[12] Symptoms and signs: * Pale skin, eyelids and lips. * Fatigue and weakness. * Dizziness. * Enlarged liver and/or spleen. Diagnosis: Ringed sideroblasts are seen i n the bone marrow. Laboratory findings: * Increased ferritin levels * Normal total iron-binding capacity * Hematocrit of about 20-30% * Serum Iron: High * High transferrin saturation * The mean corpuscular volume or MCV is usually normal or low. * With lead poisoning, see coarse basophilic stippling of red blood cells on peripheral blood smear * Specific test: Prussian Blue stain of RBC in marrow.Shows ringed sideroblasts. * can also cause microcytic hypochromic anemia. (12) Thalassemia It is a group of inherited autosomal recessive blood disorders that originated in the Mediterranean region. In Thalassemia the genetic defect, which could be either mutation or deletion, results in reduced rate of synthesis, or no synthesis of one of the globins chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the Thalassemia. (13) Symptoms and signs: * Fatigue and weakness. * Shortness of brea th. * Pale appearance. Irritability. * Yellow discoloration of the skin. * Facial bone deformities. * Slow growth. * Abdominal swelling. * Dark urine. (14) Diagnosis: * Blood tests. * Prenatal screening. (14) Laboratory findings: * A low level of red blood cells * Smaller than expected red blood cells * Pale red blood cells * Red blood cells that are varied in size and shape * Red blood cells with uneven hemoglobin distribution, which gives the cells a bull's-eye appearance under the microscope. (14) 1. 2 Literature Review A study was done in Italy about prevalence and incidence and types of mild anaemia in the elderly.The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly. Design and Methods: This was a prospective, population-based study in all residents 65 years or older in Biella, Italy. Results: Blood test results were available for analysis from 8,744 elderly. Hemoglobin concent ration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10. 0-11. 9 g/dL in women and 10. 0-12. 9 g/dL in men) affected 11. % of the elderly included in the analysis, while the estimated prevalence in the entire population was 11. 1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, Thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. (15) A study was done in emergency ward, Mulago Hospital, Uganda. Anaemia is a common problem in Africa, with prevalence ranging from 21. 1% to 64. 4% 16-21 and a significant impact on morbidity and mortality. 22,23 in patients with AIDS low haemoglobin levels are associated with poor outcomes. 4-27 However, anaemia in Africa has multiple causes, with infectious diseases such as HIV, tuberculosis and malaria contributing significantly to the anaemia burden. 28 Hookworm is a major contributor to anaemia and even light hookworm loads are associated with low haemoglobin levels, 29-33 although Lewis et al. reported that hookworm was not a common cause of anaemia among medical patients in Malawi. In a cross-sectional descriptive study 395 patients were recruited by systematic random sampling and their socio-demographic characteristics and clinical details collected.A complete blood count and peripheral film examination were done and stool examined for hookworm ova.. Of the patients 255 (64. 6%) had anaemia. The prevalence was higher among males (65. 8%) than females (63. 7%). Fatigue (odds ratio (OR) 2. 1, confidence interval (CI) 1. 37 – 3. 24), dizziness (OR 1. 64, CI 1. 07 – 2. 44), previous blood transfusion (OR 2. 83, CI 1. 32 – 6. 06), lymphadenopathy (OR 2. 99, CI 1. 34 – 6. 66) and splenomegaly (OR 5. 22, CI 1. 78 – 15. 28) were significantly associated with anaemia. Splenomegaly, low body mass index (BMI) (