Aplastic anaemia

Causes of aplastic anaemia;

• Exposure to radiation and chemotherapy (cancer) treatment.
• Toxic chemicals; pesticides, insecticides, benzene (plane fuel).
• Use of some drugs;
• Autoimmune disorders; in which the bone marrow is attacked and destroyed by immune cells.
• Viral infections, such as Epstein Barr virus (EBV), Cytomegalovirus (CMV)
• In some cases its idiopathic (no known cause).
• Specific clinical features; purplish or red spots (petechiae and purpura), nose and gum bleeding, frequent infections, fever, fatigue and dizziness.
• Specific diagnostic investigations; Bone marrow biopsy (a small piece of bone is taken off for analysis under a microscope), a complete blood count (to check the level of all the blood cells).
• Specific treatment; blood transfusion (usually whole blood), stem cell (bone marrow) transplant, immunosuppresants, antibiotics, anti-virals.

Haemorrhagic Anaemia

• This is anaemia due to blood loss (haemorrhage). The degree/severity of anaemia depends on the severity of blood loss. It can be;
• Acute haemorrhagic anaemia, as in accidents, surgery, Ante-partum haemorrhage (APH) and post-partum haemorrhage (PPH). This is of sudden onset usually severe and life threatening.

OR

• Chronic haemorrhagic anaemia, as in bleeding peptic ulcers, pile (haemorrhoids), worm infestations in the gut, intestinal malignancies, epistaxis. This anaemia tends of occur episodically, usually less severe.

Haemolytic Anaemia

This anaemia occurs due to increased destruction/ breakdown of RBCs (hemolysis), at a rate faster than the body can replace them. It can be;

• Intracorpurscular haemolytic anaemia; in which the problem is within the RBCs either their membrane or haemoglobin, hence resulting into a reduced life span. Examples of this type anaemia are;
• Sickle –cell anaemia; the RBCs adopt a sickle shape other than their normal biconcave shape, hence break easily.
• Thalassemia; genetic disorder in which there are few haemoglobin chain, hence the oxygen carrying capacity becomes reduced. There are two type beta-thalassemia and alpha thalassemia depending on which type of haemoglobin chain is affected.
• Enzymatic deficiency in RBCs; such as G-6-PD (glucose-6-phosphate dehydrogenase) deficiency and PK (phosphokinase)deficiency. Without these enzymes, the RBC membrane becomes fragile and breaks.
• Hereditary spherocytosis,; in this type the RBC membrane is abnormal and becomes spherical in shape, hence breaking easily.

Haemolytic anaemia

OR

• Intracorpurscular; in which the problem is not with RBCs, but rather external and causing the RBCs to be destroyed at a faster rate. The causes of this include;
• Infections; bacterial, protozoan eg malaria etc.
• Haemolytic disease of the new bone; in which maternal antibodies enter foetal blood and cause RBC destruction.
• Blood transfusion reactions; as a result of transfusing incompatible blood type of the patient.
• Some drugs.

Diagnosis of anaemia

• Usually anaemia can be diagnosed by clinical features;
• Based on history of; trauma resulting into blood loss, infections such as severe malaria etc.
• Based on physical examination; such as pallor of the mucous membrane
• Diagnostic investigations such as;
• CBC (complete blood count); to check of RBC number, Hb level and hematocrit
• Peripheral blood film to comment on the red blood cell indices, in order to determine the type of anaemia.

General management of anaemia

• The management depends on the cause and severity of anaemia, however generally;
• Haematinics,
• eg ferrous sulphate, iron sucrose, iron sulphate, folic acid etc. can be given especially in mild to moderate or resolving anaemia.
• Blood transfusion; with blood products.
• Blood products, are blood components that are that are prepared and made safe for therapeutic purposes, these are whole blood (WB), packed red blood cells (PCs), fresh frozen plasma (FFP), platelets these can be given differently as per the type of anaemia.