2.  The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female.

3. Anaemia may be due to Anaemia may be due to DECREASED MARROW PRODUCTION lack of iron,vitB12,folate. Hypoplasia invasion by malignant cells. invasion by malignant cells. PERIPHERAL CAUSES blood loss haemolysis hypersplenism

4. MICROCYTIC iron deficiency thalassemia sideroblastic anaemia of chronic disease MICROCYTIC iron deficiency thalassemia sideroblastic anaemia of chronic disease MACROCYTIC MACROCYTIC megaloblastic megaloblastic normoblastic normoblastic liver disease liver disease hypothyroidism hypothyroidism hyperlipidaemia hyperlipidaemia

5. Alcohol pregnancy cytotoxic drugs reticulocytosis(haemolysis) cytotoxic drugs reticulocytosis(haemolysis) MDS,marrow infiltration MDS,marrow infiltration NORMOCYTIC NORMOCYTIC anaemia of chronic disease anaemia of chronic disease acute blood loss acute blood loss hypothyroidism hypothyroidism hemolytic hemolytic aplastic aplastic

6. HAEMOLYTIC HAEMOLYTIC CONGENITAL hereditary spherocytosis hereditary elliptocytosis.thalassemia.sickle-cell G-6-PD deficiency pyruvate kinase deficiency hereditary elliptocytosis.thalassemia.sickle-cell G-6-PD deficiency pyruvate kinase deficiency ACQUIRED IMMUNE autoimmune, warm/cold alloimmune (transfusion reaction, organ ACQUIRED IMMUNE autoimmune, warm/cold alloimmune (transfusion reaction, organ transplantation) transplantation)

7. NON IMMUNE PNH mechanical(prosthetic heart valve,march & microangiopathic haemoglobinuria) Infection;falciparum malaria,sepsis Chemicals,drugs(dapsone.sulphonamide) sec to other disease e.g renal or liver failure Extra-vascular ;sickle-cell,hereditary spherocytosis intra-vascular ;G6PD,acquired haemolytic anaemias

8. SYMPTOMS SYMPTOMSFatiguedyspnoeapalpitationsheadachedizzinesangina

9. SIGNS mucous membrane pallor tachypnoea postural hypotension high volume pulse SIGNS mucous membrane pallor tachypnoea postural hypotension high volume pulse severe anaemia<8g/dl tachycardia systolic flow murmurs raised JVP ankle oedema heart failure severe anaemia<8g/dl tachycardia systolic flow murmurs raised JVP ankle oedema heart failure

10. IRON DEFICIENCY koilonychia atrophic glossitis rarely post-cricoid webs. IRON DEFICIENCY koilonychia atrophic glossitis rarely post-cricoid webs.

11. Thalassemic facies, Thalassemic facies, bossing of skull, bossing of skull, prominent malar eminence, prominent malar eminence, skeletal deformities. Hepatosplenomegaly growth retardation intermittent fever haemochromatosis resulting in cirrhosis,cardiac failure, endocrinopathies. skeletal deformities. Hepatosplenomegaly growth retardation intermittent fever haemochromatosis resulting in cirrhosis,cardiac failure, endocrinopathies.

12. MEGALOBLASTIC ANAEMIA MEGALOBLASTIC ANAEMIA sore mouth smooth tongue angular cheilosis vitiligo grey hair weight loss pyrexia paresthesia,dorsal column loss, subacute combined degeneration of cord sore mouth smooth tongue angular cheilosis vitiligo grey hair weight loss pyrexia paresthesia,dorsal column loss, subacute combined degeneration of cord

13. HAEMOLYTIC mild jaundice hepatosplenomegaly (extravascular hemolysis) HAEMOLYTIC mild jaundice hepatosplenomegaly (extravascular hemolysis) haemosiderinuria (intravascular haemolysis) haemosiderinuria (intravascular haemolysis)

15. ACUTE SYNDROMES. ACUTE SYNDROMES. Precipitated by infection,hypoxia, dehydration and acidosis. Vaso-occlusive crises. Vaso-occlusive crises. acute severe bone pain. acute severe bone pain. tachycardia, tachycardia, sweating, sweating, fever fever sequestration crises sequestration crises sudden splenomegaly/hepatomegaly. sudden splenomegaly/hepatomegaly. aplastic crises. aplastic crises. sudden lethargy,pallor sudden lethargy,pallor

16. HEREDITARY SPHEROCYTOSIS mostly asymptomatic with chronic compensated haemolytic state mostly asymptomatic with chronic compensated haemolytic state there may be acute crisis. there may be acute crisis. Haemolytic crisis Haemolytic crisis Megaloblastic crisis Megaloblastic crisis aplastic crisis aplastic crisis pigment gallstones in 50% causing cholecystitis pigment gallstones in 50% causing cholecystitis

17. Haemoglobinuria only at night. Haemoglobinuria only at night. Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have thrombocytopenia,neutropenia thrombocytopenia,neutropenia

18.  Acute drug induced haemolysis presenting with haemoglobinuria, with analgesics.aspirin.phenacetin antimalarials antibiotics,sulphonamide,ciprofl oxacinmisc.vit K.quinidine.  Chronic compensated haemolysis.  Infection or acute illness.

19. Low Hb Low MCV<76fl Normal MCV High MCV>96fl

20. Low/norm MCV Blood film & retic count Hh retic(haemolysis) Norm/low retic Low MCH Low ferritin Iron deficiency Target cells, Basophilic stippling Hb electrophoresis High HbA2Norm HbA2 B-thalassemiaAlpha-thalassemia dimorphic Bone marrow sideroblastic Ferritin norm/high ACD Bone marrow Iron stores adequate?

21. Osmotic fragility test +v Blood film spherocytes No spherocytes fragmentation DCT + DCT _ autoimmune Hereditary spherocytosis haemolysis malaria Hereditary enzymopathies microangiopathic traumatic clostridium

22. A)iron deficiency anaemia B)sideroblastic anaemia C)anaemia of chronic disease D)thalassemia A)iron deficiency anaemia B)sideroblastic anaemia C)anaemia of chronic disease D)thalassemia

23. Ans)sideroblastic anaemia Ans)sideroblastic anaemia

24. A)hypothyroidism B)pregnancy C)haemolysis D)anaemia of chronic disease A)hypothyroidism B)pregnancy C)haemolysis D)anaemia of chronic disease

25. Ans) anaemia of chronic disease Ans) anaemia of chronic disease

26. A)thalassemia B)Leukemia C)Infective endocarditis D)sickle cell anaemia