ANEMIA

Definition

Reduction of RBCS volume or Hb

concentration below the normal range for a

particular age and sex of the patient . For men,

anemia is typically defined as hemoglobin

level of less than 13.5 gram/100ml and in

women as hemoglobin of less than 12.0

gram/100ml

What are the symptoms of anemia?

• tired, fatigue easily, appear pale,

palpitations , short of breath.

• hair loss, malaise.

• Tinnitus, Headache, Sense of taste is

affected, Sore tongue.

• Dysphagia

Classification of anemia

Morphologic

Normocytic: MCV= 80-100fL

Macrocytic: MCV > 100 fL

Microcytic : MCV < 80 fL

Hypochromic

Normochromic

Blood film (Hypochromic RBC)

Microcytic anemias

• Iron deficiency anemia

• Thalassemia

• Lead poisoning

Megaloblastic Macrocytic Anemias

• Vit B12 deficiency

• Folic acid deficiency

What is the type of anemia?

• History and physical exam.

• CBC

• Red cell morphology ( peripheral smear)

• Other Lab. investigations

Investigation of anemia(1)

• WBC count and differential

• Platelet count and morphology

• Biochemistry

• Bone marrow exam.

Investigation of anemia(2)

• Serum values of

• Iron

• TIBC

• Ferritin

• Bilirubins

• LDH

• Vit B12 and /or Folic acid

Investigation of anemia(3)

• Red cell enzymes

• Coombs tests

• Liver, renal, endocrin functional tests

IRON DEFICENCY ANEMIA

ETIOLOGY

• Increased demand for iron

• Increased iron loss

• Decreased iron intake or absorption

CLINICAL FEATURE

1. General feature of anemia.

2. Brittle nail and nail cracking are common but koilonychias may be present .

3. Angular stomatitis .

4. Atrophy of the papillae of the tongue.

5. Pica.

koilonychias

Atrophy of the papillae of the

tongue

Diagnosis

• Hemoglobin(Hb)- low

• Hematocrit (PCV)- low

• Microcytic (MCV-low )

• Serum ferritin-low

• Serum iron-low and iron binding capacity-high

• The gold standard investigation is BM iron store

Management

• Treat the cause.

• Iron replacement.

Iron can be supplemented by the oral or parenteral

iron therapy

Dental aspects

Local anaesthesia is usually satisfactory for pain

control.

Conscious sedation may be given only if there is

supplemental oxygen. Deeper levels of sedation are

more likely to lead to hypoxia.

When GA is given, it is vital to ensure full oxygenation.

Whenever possible, therefore, the anaemia should be

corrected pre-operatively and the haemoglobin level

must be raised, if necessary by transfusion.

The patient should be stabilized at least 24 h pre-

operatively

Some anaemias can also cause oral lesions such as

ulcers, glossitis or angular stomatitis

MEGALOPLASTIC ANEMIA

B12 DEFICIENCY

• Food Sources

• Vitamin B12 is found in:

• Eggs

• Fortified foods such as soymilk

• Meat

• Milk and milk products

• Organ meats (liver and kidney)

Causes of B12 deficiency

• Nutritional

– Rare

• Malabsorption

– Gatsric Disease

• Gastrectomy

• Pernicious Anaemia

– Terminal ileal disease

Ulcerative colitis

Ileal resections

Vitamin B-12 deficiency of any cause will result in

anemia and neurologic symptoms.

• Feelings of numbness

• tingling

• weakness

• lack of coordination

• impaired memory

• personality changes

Diagnosis

• A complete blood cell count (CBC)

• Hemoglobin(Hb)- low

• Hematocrit (PCV)- low

• Macrocytic (MCV-high )

• Examination of a blood smear

• Blood vitamin B-12 level measurements

• Finally, bone marrow aspiration or bone

marrow biopsy

Blood smear (macrocytic RBC)

Treatment

• Treatment of the cause.

• B12 replacment.

• Patients with B12 deficency anemia are

treated with parentral therapy.

vitamin B12

Sickle cell anaemia

It has no problem with simple dental care and

LA.

Patients Should be investigated if GA is to be

given. if the haemoglobin is less than 11 g/dl it

presents a hazard for GA.

Aspirin is best avoided as, in large doses, it may

cause acidosis and precipitate a crisis;

paracetamol and codeine are effective

alternatives.

Conscious sedation with relative analgesia can

be used safely. Benzodiazepines are best

avoided.

Elective surgery should be carried out in

hospital and during a phase when haemolysis is

minimal. Anaemia should be corrected before

GA and the haemoglobin brought up to at least

10 g/dl.

Exchange transfusion is occasionally required

for major surgery but only in selected patients.

Hepatitis B or C, or HIV carriage, may be a

complication in repeatedly transfused patients.

Since splenectomy results in an immune defect,

it may be prudent to cover surgical procedures

with prophylactic antimicrobials.

Local anaesthesia is safe.

β Thalassaemia

β Thalassaemia usually results from point

mutations within the β globin gene cluster, β thalassaemia can be classified according to the

severity of their symptoms into three groups:

1- β thalassaemia minor (or trait)

2- β thalassaemia major

β Thalassaemia minor

It's the mildest form, which arises from the

inheritance of a single abnormal β globin gene. Typically, the affected individual exhibits no

significant signs of the disease and generally live

a normal lifespan.

Investigation:

Microcytic hypochromic anaemia

β Thalassaemia major

β Thalassaemia major results from the inheritance of two b thalassaemia genes.

In the absence of treatment, the condition is

characterized by :

1- sever anaemia

2- Retarted growth

3- Facial mongoloid appearance

5- Rarely live beyond the second decay.

peripheral blood

• Sever haemolytic anaemia with Hb< 7.0 g/dl

• Microcytic hypochromic

Treatment:

Blood transfusion

Iron chelating agent

stem cell transplant

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