Anaemia due to iron deficiency is the characteristic finding with a cancer of the colon (large bowel), stomach or gullet. Often the anaemia is the only clue to the presence of a bleeding source somewhere. Any person who develops iron deficiency anaemia with no obvious cause should be investigated for the presence of a bleeding point within the digestive system. Fortunately not all bleeding sources turn out to be cancers

1. ANEMIA By Dr Bashir Ahmed Dar Chinki pora sopore kashmir Associate professor of Medicine

2. Classification of Anemia I. Etiologic Classification 1. Impaired RBC production 2. Excessive destruction 3. Blood loss II. Morphologic Classification 1. Macrocytic anemia 2. Microcytic hypochromic anemia 3. Normochromic normocytic anemia

3. Impaired RBC Production 1. Abnormal bone marrow 1.1 Aplastic anemia 1.2 Myelophthisis : Myelofibrosis, Leukemia, Cancer metastasis 2. Essential factors deficiency 2.1 Deficiency anemia : Fe, Vit. B12, Folic acid, etc 2.2 Anemia in renal disease : Erythropoietin 3. Stimulation factor deficiency 3.1 Anemia in chronic disease 3.2 Anemia in hypopituitarism 3.3 Anemia in hypothyroidism

4. Excessive Destruction of RBC (cont.) Hemolytic anemia 1. Intracorpuscular defect 1.1 Membrane : Hereditary spherocytosis Hereditary ovalocytosis, etc. 1.2 Enzyme : G-6PD deficiency, PK def., etc. 1.3 Hemoglobin : Thalassemia, Hemoglobino- pathies

5. Excessive Destruction of RBC 2. Extracorpuscular defect 2.1 Mechanical : March hemolytic anemia MAHA (Microangiopathic HA) 2.2 Chemical/Physical 2.3 Infection : Clostridium tetani 2.4 Antibodies : HTR, SLE 2.5 Hypersplenism

6. Blood Loss 1. Acute blood loss : Accident, GI bleeding 2. Chronic blood loss : Hypermenorrhea Parasitic infestation

7. Macrocytic Anemia MCV > 94 MCHC > 31 1. Megaloblastic dyspoiesis 1.1 Vit. B12 deficiency : Pernicious anemia 1.2 Folic acid deficiency : Nutritional megaloblas- tic anemia, Sprue, Other malabsorption 1.3 Inborn errors of metabolism : Orotic aciduria, etc. 1.4 Abnormal DNA synthesis : Chemotherapy, Anticonvulsant, Oral contraceptives

8. Microcytic Hypochromic Anemia MCV < 80 MCHC < 31 1. Fe deficiency anemia : Chronic blood loss, Inadequate diet, Malabsorption, Increased demand, etc. 2. Abnormal globin synthesis : Thalassemia with or without Hemoglobinopathies 3. Abnormal porphyrin and heme synthesis : Pyridoxine responsive anemia, etc. 4. Other abnormal Fe metabolism :

9. Normocytic Normochromic Anemia MCV 82 - 92 MCHC > 30 1. Blood loss 2. Increased plasma volume : Pregnancy, Overhydration 3. Hemolytic anemia : depend on each cause 4. Hypoplastic marrow : Aplastic anemia, RBC aplasia 5. Infiltrate BM : Leukemia, Multiple myeloma, Myelofibrosis, etc. 6. Abnormal endocrine : Hypothyroidism, Adrenal insufficiency, etc. 7. Kidney disease / Liver disease / Cirrhosis

10. Hemolytic Anemia

21. Acquired hemolytic anaemia

25. Coombs Test Antiglobulin Test RBC Red cell with bound antibody to membrane antigen + Anti-immunoglobulin

26. Coombs Test Antiglobulin Test RBC RBC Agglutination