Hypochromic anemia is a type of anemia where red blood cells appear paler than normal. There are two main classifications - iron deficiency anemia and non-iron deficiency anemia which includes conditions like sideroblastic anemia, thalassemia, and anemia of chronic diseases. Iron deficiency anemia is caused by low iron intake, decreased absorption, blood loss, drugs, or transport defects. Clinical evaluation involves taking a thorough history and conducting a physical exam looking for pallor, nail changes, enlarged spleen or liver, and cardiovascular abnormalities. Investigations help determine the severity through tests like hemoglobin, ferritin, and peripheral smear examination. Treatment depends on the underlying cause but commonly involves oral or

1. HYP CHR MIC ANEMIA
PRESENTER - ASHWIN GOBBUR

2. Definition
• Hypochromic anemia is a generic term
for any type of anemia in which the red
blood cells (erythrocytes) are paler
than normal.
(Hypo - less, chromic - color.)

3. ETIOLOGIC CLASSIFICATION
1. IRON DEFICIENCY ANEMIA
2. NON-IRON DEFICIENCY ANEMIA
 Sideroblasic anemia
 Thalassaemia
 Anemia of chronic diseases
 Lead poisoning

4. IRON DEFICIENCY ANEMIA
i. LOW INTAKE -
ii. DECREASED ABSORPTION -
iii.BLOOD LOSS -
iv. DRUGS -
v. TRANSPORT DEFECT -

5. CLINICAL APPROACH
HISTORY :
• Age at presentation –
thalassamia by 4-6 months
• History of repeated blood transfusion
• Diet – poor intake of grean leafs, meat
• Recurrent diarrhea
• Passing worms …

6. Continued…
• Dysphagia
• PICA
• Drug intake: NSAID
• Surgery of stomach
• Recurrent upper resp. tract infection
• Consanguinity : Thalassemia
• Poor concentration
(enzyme co-factor)

7. SYMPTOMS

8. CLINICAL APPROACH
EXAMINATION :
GENERAL PHYSICAL
• pallor
• koilonychia
• platonychia
• hemolytic facies
• cirrhotic features

9. Examination contd…
SYSTEMIC :
Per abdomen –
• Firm spleno-hepatomegaly – hemolytic
anemia – thalassaemia
• Evidence of cirrhosis – spider naevi,
oedema, splenomegaly
CVS –
• Physiological murmr

10. INVESTIGATION
I. FINDING THE CAUSE
• USG
• Endoscopy - site of bleed ( portal
hypertension, hemorrhoids, worms … )
• Occult blood in stool (Benzidine test)–
GI bleed
• Stool examination –
Ova (hook/round)

11. Investigation contd…
II. Evaluating the severity
• Hb estimation
• Serum iron
• Serum ferritin –
Normal: 50-150 mic/dl
high in NIDA
low in IDA
• Serum TIBC
• MCV, MCHC
• RDW
* 14-16 – N, >16 – IDA, <13 – Th. minor
• RBC count : high NIDA
low chronic organ / disease.

12. Contd…
• Peripheral smear examination
o microctic hypochromic anemia
o IDA - poikilocytosis
o Thalassaemia - nucleated RBC,
target cells
o Sideroblastic anemia – Bone marrow
(ring sideroblasts)

13. PS examination
Normocytic Normochromic
Macrocytic – Megaloblastic anemia
Microcytic Hypochromic – IDA
Microcytic Hypochromic –
Thalassemia (Target cells, NRs)

14. TREATMENT
I. Treat underlying cause
II. Treat iron deficiency state
Ferrous sulphate – gold standerd. 3-5 mg/kg
(20% absorbable)
(ideally empty stomach, with food if GI upset)
Ferrous fumerate
Ferrous gluconate
Ferrous ascorbate
Ferrros EDTA

15. Rx contd …
• Ferric preparations available
good compliance, poor efficacy (<10%)
Ferric ammonium citrate
Ferric hydroxide
Colloidal iron …

16. Rx contd…
• Parenteral iron – mg =
2.4 x body wt kg x Hb deficit + 500mg
Iron sucrose
Iron polymaltose
Sideroblastic – give pyridoxine
supplement (5-10 mg/kg)
CRF – injection erythropoietin

17. Rx contd…
• BLOOD
Intolerance to oral and parenteral iron
Severe anemia
CRF – packed cell ( PCV 10ml/kg)
*5ml/kg packed cell Hb by 2g

18. RESPONSE
 24 hr – appetite
concentration
smiling child
 1 week – reticulocyte count – 10-15%
Hb slowly increases
(1-2g/dl at the end of 1 month)
 IF NO RESPONSE REVISE DIAGNOSIS