Anaemia is a blood disorder in which blood cannot carry the oxygen due to the deficiency of red blood cells (RBCs) i.e. the absences of haemoglobin in the red cell. This in turn causes anaemia.
Iron deficiency anaemia is a major cause of anaemia signified by lack of haemoglobin. Presence of insufficient iron level in the blood, body needs iron for haemoglobin and enzyme synthesize. Majority of the iron is located in the haemoglobin of red blood cells. Oldest people they are most likely to be at risk not only because of intake and using a little amount of iron, the reason for that it is chronic haemorrhage inside the body such as ulcer and tumour. Although pregnant woman at a high risk due to iron deficiency, as iron necessary for both unborn baby and mother as well. The body obtain the iron from the diet absorption. But mostly comes from recycling iron from RBCs.
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Iron stored as ferritin which is an iron storage protein, mainly found in the liver. In addition iron is also stored in haemosiderin (Pauline and Paolo 1996).
The symptom of iron deficiency initiate with tiredness and abnormal beating of heart (palpitation), fainting, headache, fatigue, plainness of muscle and epitaxis (bleeding from the nose, and investigation the medical history such as haemoptysis and other haemorrhage, manses and diet with iron supplementation (Craig 2006)
Complete blood count (CBC) can be used for iron deficiency anaemia which shows haemoglobin (HGB) to be low, and high value for red blood cell distribution width (RDW) because of the formation of various sizes of RBCs, low mean cell volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). The blood film indicates the shape and size of RBCs and shows hypochromatic , various size and shape poikilocytsis, anisocytosis, and a few target cells, pencil and teardrop cells come into view under the microscope. The number of platelet increase because of losing blood (Anatole Besarab et al. (2009). Microsytic and hypocromic anaemias are most prevalence in children and this are elevated because of iron deficiency.
Iron deficiency can be denoted by low serum ferritin, serum iron gives a good idea while it is present in iron deficiency and anaemia of chronic disease. From the biochemical test it is obvious that the serum is reduced than normal value in iron deficiency anaemia but normal or increased in anaemia of chronic disease, also it is normal or reduced in anaemia of chronic disease and iron deficiency, but it is normal in the thalassemia trait (Carlo Brugnara. 2003).
Macrocytic anaemia is one of the types of anaemia, where the sizes of RBCs become larger than normal size. This macrocytic anaemia can be categorize into two subgroup non megaloblastic and megaloblastic. The feature megaloblastic of anaemia is the maturation of erythroblasts nucleus in the bone marrow which is too slow due to the effect on the DNA synthesis and cell division which do not occur without DNA replication.
Vitamin B12 and folate deficiencies lead to macrocytic anaemia. The vitamin12 is present in meat, fish and those foods that are contaminated by bacteria such as yogurt and cheese. Vegetarian people are most likely to be involved with this kind anaemia particularly pregnant woman; these observations can helpful for diagnosis of this type of anaemia. Importantly, vitamin12 deficiency anaemia starts very slowly, destruction of large amount of haemoglobin results in a mild jaundice (Samuel C, et al 2005).
Full blood count (FBC) is a most common blood test; indicates important information about number, type and shape of blood cell. FBC can be used for detection of abnormality of blood such as anaemia. This test can not indicate the abnormality of red cell in child therefore it is necessary to use more test because the amount of haemoglobin level in adult is higher than the child. The FBC test also shows the white blood cell. The platelet count shows the anaemia is associated with another disorder.
Red cell count (RBC) is important to see hypochromic and microcytic anaemia, which is shows the absence of red cell production as seen as in iron deficiency anaemia where the counts lower than normal value or in thalassaemia increase the RBC.
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The red cell distribution width (RDW) is a measure of the size of cell (anisocytosis) which can be observed in the blood film. Increase of anisocytosis indicates the iron deficiency, RDW is normal in alpha and beta thalasseamia. RDW is normal in the chronic disease anaemia whereas RDW is increased in the microcytic anaemia (vitamin B12 and folate deficiency). Also, microangiopathic haemolytic anaemia causes increase the RDW.
The Mean Corpuscular Haemoglobin Concentration (MCHC) measures the haemoglobin concentration. MCHC concentration increase by losing the part of the red blood cell membrane for example hereditary spherocytosis. The blood film determine the causes of increased the MCHC (Angela. E2005).
Haemoglobin test can be used for the measurement and identification of haemoglobins types from the blood sample. HPLC is more accurate and sensitive test than haemoglobin electrophoresis; it can identify abnormal and unstable haemoglobin. Importantly, it can measure the quantity of the haemoglobin. On the other hand, Haemoglobin electrophoresis test functions to separate variants associated with haemoglobin. However the disadvantage with this method is that it cannot identify all the pathological variants and therefore haemoglobin quantification would be incorrect. Furthermore, individuals with thalassaemia have abnormality in alpha and beta haemoglobin chain.
There are many different type of haemoglobin can be found in the RBCs, the haemoglobin electrophoresis shows haemoglobin A2 which is associated with B-thalassaemia, but haemoglobin A does not show at all (Alla Joutovsky, et al 2004).
Normochromic, normocytic anaemia is a chronic disease; the reason of this disorder is due to lack of enzyme, abnormality of bone marrow and unstable haemoglobin. This is a condition which involves normal erythrocyte size and haemoglobin content, however the only problem is that there isnâ€™t enough amount of erythrocytes circulating within the body. This type of anemia is very rare with no specific grounds for the cause of this disease. It is often associated with five other conditions including Aplastic anemia, Posthemorrhagic anemia, Hemolytic anemia, Anemia of chronic disease and Sickle cell anaemia. It is often in this type of anemia to carry out investigations involving the examination of the blood film, and also a reticulocyte count.
Blood film can allow detecting spherocytes. Spherocytosis can often occur due to unstable erythrocyte membrane, typically hereditary spherocytosis or could be possible due to immune haemolysis. In order to identify whether it is immune or non-immune haemolysis, it useful to perform direct agglutination test (DAT) or could carry out Coombs test. If the test for DAT denotes negative this would be an indicative of hereditary spherocytosis whereas a positive would signify haemolysis to be immune related. Interestingly in a newborn a positive test would mean haemolytic disease of the newborn (HDNB). In addition, if the haemolysis is due to intravascular abnormality then presences of haemoglobinuria would be an obvious sign. Also, increased reticulocyte count would be seen however if there is no elevation in the reticulocyte this would suggest acute suppression of the bone marrow, which can result from folate deficiency or parvovirus infection. (Angela. E 2005)
Furthermore blood film could also allow observation of bite cells. The presences of these cells can be used as a marker of oxidative haemolysis, which is observed with the enzyme glucose-6-phosphate deficiency (G6PD) (L. Luzzatto 2006).
A reduced reticulocyte count suggests lack of erythrocyte production. This can be secondary to bone marrow failure or erythrocyte aplasia, which can be due to either hypoplastic or aplastic process or infiltration of the bone marrow. If instance infiltration is present then abnormal cells will be observed in the peripheral blood film (Ted Gordon2009).