HAEMATOLOGICAL
DISORDERS
PREPARED BY MR. ABHIJIT DAS
IRON DEFICIENCY ANAEMIA
DEFINITION
Iron deficiency anemia is a medical condition
characterized by low levels of hemoglobin, a protein found in red blood cells
that carries oxygen throughout the body. This low level of hemoglobin occurs
due to insufficient iron in the body, which is essential for the production of
hemoglobin.
ETIOPATHOGENESIS
1.
Inadequate dietary intake: Iron is
obtained through the diet, and a lack of iron-rich foods can result in iron
deficiency. This is particularly common in vegetarians and vegans who do not
consume meat, which is a rich source of iron.
2.
Impaired iron absorption: Certain
medical conditions such as celiac disease, inflammatory bowel disease, and
other gastrointestinal disorders can interfere with the body's ability to
absorb iron from the diet.
3.
Blood loss: Blood loss can occur due to
various reasons such as heavy menstrual bleeding, gastrointestinal bleeding,
surgery, or injury. Chronic blood loss can lead to iron deficiency anemia.
4.
Increased iron demand: Iron is required
for the production of red blood cells, and an increased demand for iron, such
as during pregnancy or growth spurts in children, can result in iron deficiency
anemia.
5.
Other factors: Chronic infections,
certain medications, and other medical conditions such as chronic kidney
disease, cancer, and heart failure can also lead to iron deficiency anemia.
CLINICAL MANIFESTATIONS
1.
Fatigue and weakness: Reduced oxygen
delivery to the tissues due to low hemoglobin levels can cause fatigue and weakness.
2.
Pale skin and mucous membranes: Iron
deficiency anemia can lead to pale skin and mucous membranes.
3.
Shortness of breath: Reduced oxygen
delivery to the tissues can cause shortness of breath, especially during
exertion.
4.
Headaches and dizziness: Reduced oxygen
delivery to the brain can cause headaches and dizziness.
5.
Brittle nails and hair: Iron deficiency
can cause brittle nails and hair.
6.
Restless leg syndrome: Iron deficiency
anemia can cause an unpleasant sensation in the legs that causes an irresistible
urge to move them.
7.
Increased risk of infections: Iron
deficiency anemia can increase the risk of infections.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Dietary changes: Eating a balanced diet
rich in iron can help increase iron levels in the body. Foods that are high in
iron include red meat, poultry, fish, beans, lentils, tofu, and spinach.
Vitamin C can also enhance iron absorption, so consuming foods that are high in
vitamin C, such as citrus fruits, strawberries, and bell peppers, can be
helpful.
2.
Iron-rich cooking methods: Cooking food
in cast iron pans can increase the iron content of the food.
3.
Avoidance of certain foods: Certain
foods, such as dairy products and caffeine, can interfere with iron absorption.
It is best to avoid consuming these foods at the same time as iron-rich foods
or iron supplements.
4.
Blood transfusion: In severe cases of
iron deficiency anemia, a blood transfusion may be necessary to quickly
increase hemoglobin levels.
5.
Lifestyle modifications: Engaging in
regular physical activity can help improve overall health and increase
hemoglobin levels. Avoiding alcohol and smoking can also improve iron
absorption.
PHARMACOLOGICAL MANAGEMENT
1.
Oral iron supplements: These are
available over the counter and typically contain ferrous sulfate, ferrous gluconate,
or ferrous fumarate. They are usually taken once or twice daily with food to
improve absorption. Common side effects include constipation, nausea, and
stomach upset.
2.
Intravenous (IV) iron therapy: This
involves the administration of iron directly into the veins, usually in a
hospital or outpatient setting. IV iron therapy is typically reserved for cases
where oral iron supplements are ineffective or cannot be tolerated. It can
cause side effects such as allergic reactions, headache, and low blood
pressure.
3.
Blood transfusion: In severe cases of
iron deficiency anemia, a blood transfusion may be necessary to quickly
increase hemoglobin levels. Blood transfusions are typically reserved for cases
where other treatments have been unsuccessful or when hemoglobin levels are
critically low.
MEGALOBLASTIC ANAEMIA
DEFINITION
Megaloblastic anemia is a type of anemia
characterized by the presence of megaloblasts, which are immature and larger
than normal red blood cells, in the bone marrow. This type of anemia is
typically caused by a deficiency of vitamin B12 or folate, which are essential
for the normal maturation of red blood cells. Without adequate amounts of these
vitamins, the bone marrow produces immature red blood cells that are larger
than normal, leading to the characteristic macrocytic (large cell) appearance
of megaloblasts.
ETIOPATHOGENESIS
1.
Vitamin B12 deficiency: This can occur
due to a variety of factors, including inadequate dietary intake (as vitamin
B12 is mostly found in animal-based foods), malabsorption (as in pernicious
anemia, where the body is unable to absorb vitamin B12 from food due to lack of
intrinsic factor), or certain medications that interfere with vitamin B12
absorption.
2.
Folate deficiency: Folate is found in a
variety of foods, such as green leafy vegetables, fruits, and grains. Folate
deficiency can occur due to inadequate dietary intake, malabsorption, or
increased demand (such as during pregnancy).
3.
Impaired DNA synthesis: Both vitamin B12
and folate are essential for DNA synthesis, and a deficiency in either vitamin
can impair this process, leading to the formation of abnormal, large red blood
cells (megaloblasts).
4.
Disruption of cell division:
Megaloblasts are formed due to impaired cell division, which is a result of the
disruption of DNA synthesis caused by vitamin deficiencies.
5.
Inherited disorders: In rare cases,
megaloblastic anemia can be caused by inherited disorders that affect the
metabolism of vitamin B12 or folate.
CLINICAL MANIFESTATIONS
1.
Fatigue and weakness: Reduced oxygen-carrying
capacity of the blood due to fewer and larger red blood cells can cause fatigue
and weakness.
2.
Shortness of breath: Anemia can cause
reduced oxygen supply to the body, leading to shortness of breath.
3.
Pale skin: The reduced number of red
blood cells can lead to pale skin.
4.
Dizziness or lightheadedness: Anemia can
cause reduced blood flow to the brain, leading to dizziness or lightheadedness.
5.
Rapid or irregular heartbeat: Anemia can
cause the heart to work harder to compensate for the reduced oxygen-carrying
capacity of the blood, leading to a rapid or irregular heartbeat.
6.
Mouth ulcers: Folate deficiency can
cause the development of mouth ulcers.
7.
Glossitis: A swollen and sore tongue,
known as glossitis, can occur in vitamin B12 deficiency.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Increase intake of foods rich in vitamin
B12 and folate: Foods such as meat, fish, poultry, eggs, dairy products, green
leafy vegetables, and legumes are good sources of these vitamins. Including
these foods in the diet can help to increase vitamin levels.
2.
Consider fortified foods or supplements:
For those who are not able to get enough vitamin B12 or folate from their diet,
fortified foods or supplements may be recommended.
3.
Avoid excessive alcohol consumption:
Alcohol can interfere with the absorption of vitamin B12, and excessive
consumption can lead to vitamin deficiencies.
4.
Quit smoking: Smoking can increase the
risk of vitamin deficiencies, including vitamin B12 deficiency.
PHARMACOLOGICAL MANAGEMENT
1.
Vitamin B12 supplements: Oral vitamin
B12 supplements are often used to treat vitamin B12 deficiency. However, for
individuals with pernicious anemia, which is caused by a lack of intrinsic
factor, which is needed for the absorption of vitamin B12, injections of
vitamin B12 may be necessary.
2.
Folic acid supplements: Folic acid
supplements are often used to treat folate deficiency. These supplements can be
taken orally and are usually effective in correcting the deficiency.
3.
Combination supplements: In some cases,
a combination of vitamin B12 and folate supplements may be recommended to
correct deficiencies of both vitamins.