• ANAEMIA

    Deficiency of qualitative and quantitative hemoglobin content in blood.

     

     

    Classification

    Based on Etiology

    Blood loss:

    • Acute
    • Chronic.
    • Haemolytic anaemia
    • Impaired RBC production and  maturation:
    • Iron deficiency
    • Anemia due to vitamin B12, folic deficiency.
    • Aplastic anaemia
    • Thalassemia.
    • Sickle cell anaemia.
    • Anemia of chronic  disease (refractory anaemia)

     

    Based on RBC morphology
    Normocytic: (MCV: 76 96 fl MCHC 30-35g / dl)

    • Acute bloood loss
    • Anemia of chronic disease,
    • Infection

    Macrocytic : (MCV> 96 fl MCHC 30-35 g di)

    • Vitamin B 12 and folic acid  deficiency
    • Iatrogenic

    Microcytic : (MCV<76 fl MCHC<30G g/dl)

    •  Iron deficiency anaemia.
    • Thalassaemia.

    IRON DEFICIENCY ANAEMIA

    ETIOLGY

    Deficient intake:
    –   Low iron diet
    Poor absorption:
    –         In presence of wheat eggs soyabean
    –         Diarrhea
    –         Vomiting
    Poor utilization:
    –         Infection.
    –         Chronic decease.
    Excessive demand:
    –         children 6 months to 2 years
    –         Adolescents
    –         Females of child bearing age

    Blood loss:
    –         External hemorrhage
    –         peptic ulcer
    –         Hemorrhoids
    –         Portal hypertension
    Parasitic infestations
    –         Ankylostomiasis
    Excessive iron loss:
    –         Exfoliative dematitis

    Clinical features

    Symptoms:

    • Onset: insidious
    • Lassitude.
    • weakness
    • Fatigue
    • Headache
    • Bodyache
    • Precordial pain (angina pectoris)
    • Palpitation.
    • Dyspnoea.
    • Pain in abdomen.
    • Aain in abdomen
    • Anorexia.
    • pica
    • Eructations.
    • Sense of fullness after meals,
    • Amenorehea
    • Hair loss
    • Dizziness.
    • Numbness, tingling
    • Lack of concentration
    • Loss of  Weight.

     

    Signs:
    On general examination:

    • Pallor
    • Skin: pale, Dry, Lustrelress
    • Hair: Thin, Lustreless.
    • Nails: Brittle, Platynychia, Koilonychia
    • Oedema : Bilateral, Pitting
    • Angular Stomatitis
    • Tongue: Smooth, bald, pale.
    • Pulse: rapid
    • Blood pressure: low

    On cardiac examination :Soft systolic  murmur at apex
    On abdominal examination : Spleen may be palpable (Plummer- vinson syndrome)
    Chronic iron deficiency anemia associated with:

    • Koilonychia
    • Glossitis.
    • Dysphagia
    • Splenomegaly

    Investigations

    Blood:

    • Hb%: variably reduced.
    • RBC count: low
    • Colour index: less than
    • MCV: low (50-80 fl)
    • MCH: low (15-26 pg)
    • MCHC: low(24-30 g/dl)
    • Peripheral smear

    –   Hypochromia
    –   Microcytosis.
    –   Anisocytosis
    –   Poikilocytosis
    Blood biochemistry
    –         Serum iron: low (<60mg/dl) -         Iron binding capacity: increased (>400 mg dl)
    –         Plasma ferritin : low (< 10 mg/ml) Bone marrow

    • Normoblastic hyperplasia
    • frequent malformed cells
    • haemoglobinistiion deficientin proportion to nuclear maturity.
    • Microthromboblasts numerous in severe cases.

    Stool examination

    • Ova of ankylostoma may be positive.
    • Amoebic cysts (amoebic colitis).
    • Voluminous fatty stools (malasorption).
    • Occult blood (upper gastro-intestinal bleeding).

    Endoscopy

    •   For evidence of peptic ulcer

    Proctoscopy
    For cvidence of : Haemorrhoids, Malignancy
    Urinalysis : For  haematuria.
    Prognsis : Severity of anemia reflects activity of underly ing cause
    Miasmatic Cleavage

    • Anemia is not a disease but a manifstation of anunderlying disease.
    • Miasmatic analysis is done according to cause
    • If nutritional pseudo miasmatic disease.

    Therapeutic Aim

    • To cure
    • to correct cause
    • to remove obstruction to recovery

    General Management

    • Correct and treat the underlying cause: ie menorrhagia in womene gastrointestinal blood loss in age groups including hookworm in fastation dietary deficiency and rarely malab sorption.
    • provide diet rich in iron and proteins.
    • Blood transfusion if haemoglobin is less then 4g%
    • Iron preparation not to be taken along with meals containing wheat eggs and soyabean(as these interfere with iron absorption)

     

    Homoeopathic Treatment

    Nutritonal disorders
    –         Aletris Farinosa
    –         Alfalfa
    –         Alumina
    –         Avena sativa
    –         Calcrea Phosphora
    –         China
    –         Ferrum Mentallicum
    –         Haemorrhages
    –         Arsenicum Album
    –         Ferrum Phosphoricum
    –         Lachesis
    –         Phosphorus.
    –         Menstrual Derangements
    –         Ferrum Metallicum
    –         Graphites
    –         Natrum Muriaticum
    –         Pulsatilla
    –         Sepia
    –         Worms
    –         Carbon Tetrachloride
    –         Chelone
    –         Chenopdium
    –         Cina
    –         Thymolum
    –         Supplementary Therapy Indications
    –         Nutritional iron deficiency other causes where iron deficiency can occur are pregnancy lactation, infants children.}

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