next we want to think about the signs and symptoms in anemia a sign is something that we detect with our senses a symptom is something the patient reports to us now clearly there's going to be signs and symptoms relating to the anemia so the fact that there's a reduced oxygen carrying capacity of the blood is going to generate a spectrum of clinical features as you would expect but before we go on to that I wanted to think about the signs and symptoms of the underlying cause because obviously there's going to be a cause of the anemia and we want to be able to recognize the signs and symptoms of the underlying cause as well and the main cause here that we're going to come across or globally certainly the main cause of anemia is iron deficiency so iron deficiency is remarkably common and the figures are hard to believe but true about a third of the world's population have iron deficiency so what are the signs and symptoms of iron deficiency well ion of course is essential for the formation of the hemoglobin molecule we we know this already so if there's ion deficiency there's going to be a reduction in the amount of hemoglobin in in the body and the hemoglobin is what makes blood red so there's going to be less redness if you like in the body because there's less hemoglobin and one of the features we get with reduced hemoglobin is uh Pala Pala just means pale really and we're going to see this in the Skin So in deficiency the person looks pale and we're going to get these features regardless of any features of anemia these are as well as any features of anemia that might be present pay on us in the skin pness in the mucosa so looking inside the mouth for example the lips can look pale classic one is the conjunct Iver if you just peel down the lower eyelid and look at the bottom of the conjunct I will sack it can appear pale and another classic place for seeing the pness is the nail beds pale looking nail beds so that group's caused by the uh reduction in the uh hemoglobin the iron deficiency and the reduction in the hemoglobin now another group of features um caused by the iron deficiency affect the the mouth mouths are very useful to look out for clinical indicators of all sorts of things and the first feature of ir deficiency that often presents and we do see quite commonly in iron deficiency areas is glossitis now glossitis is inflammation of the tongue the tongue can look inflamed and it feels sore the patient complains of a sore tongue and another feature relating to the mouth is angular stomatitis now IUS um means inflammation of um sto actually relates to opening of course the mouth is an opening and what you see particularly if these if this is the uh this is the mouth here these are the lips what you see particularly is uh inflammation at the corner of the lips there like that angular stomatitis and also affecting the mouth mouth also are more common so again the these are features of the iron deficiency rather than features of the anemia these ones affecting the mouth um another feature of iron deficiency is um hair loss always worth considering iron deficiency in in hair loss now another interesting feature of ir deficiency is called um uh P now if you've been pregnant or you're married to someone who's pregnant you know about P because because it's it's the uh it's the craving for different types of food so it's an eating craving you have cravings for foods but in iron deficiency the Pea is not really related to food it's strange so people have a craving for ice they'll suck ice and they'll eat ice and take ice drinks and then ridiculous things like uh clay soil they'll have a cring to eat these things sometimes paper uh starch uh Pebbles um that very strange but uh a feature of iron deficiency anemia so that's another sort of subset of features of iron deficiency so we've seen that these are looking at signs and symptoms in anemia but rather than looking at the anemia itself straight away looking at the signs and symptoms of the underlying cause underlying cause of the anemia so these are features of the underlying cause of the anemia and on this page we've looked at the particular features of deficiency anemia which tragically affects a third of the world's population and we see that can lead to uh symptoms signs from reduced hemoglobin things affecting the mouth hair loss and the uh the unusual appetite um but we can go on and look at other signs and symptoms of anemia sorry other signs and symptoms um not related to the anemia the other signs and symptoms related to the underlying cause so scrub that one actually be that one other signs and symptoms relating to the underlying cause and another one of these causes is B12 deficiency so we'll carry on this on a on a separate piece of paper think so what might we see in uh in B12 deficiency vitamin B12 deficiency well we know that vitamin B12 is essential for the formation of the red blood cells but we're not looking at that in this particular video because we're looking at the signs and symptoms of the underlying cause and the B12 deficiency is an underlying cause of the anemia so as well as the anemia what might we see well in vitamin B12 deficiency we often get uh neurological features because B12 is essential for the health and well-being of the nervous system so what we can see here is uh sometimes peripheral neuropathy this is disease of the peripheral nervous system often affecting the legs and another thing we do get here is um is uh restless legs restless leg syndrome very common I get it myself when I'm tired um now I don't know for sure that this is caused by the uh the B12 deficiency but it certainly occurs uh in anemic patients that's for sure and you just can't keep your legs still you got this sort of burning feeling in your legs really quite unpleasant um also in in B12 deficiency we get a spinal cord problems and particularly there's a condition called um Subacute degeneration of the spinal cord and because the spinal cord affects all of the body below the neck that that's what can be affected and so we can get weakness uh tingling and uh numbness and these start very gradually but can become more severe so B12 deficiency now there's other underlying causes that we can um think about so other lines that can go from this bit the underlying cause for example we could have um hemolytic anemia so there can be signs and features caused by the hemolysis um there can be a a plastic anemia and there can be a sickle cell disease so these are all underlying causes of anemia but they can gener at their own clinical features so we've looked at the clinical features of B12 deficiency let's look briefly at the clinical features of uh hemolysis that you get in hemolytic anemia a plastic anemia and sickle cell disease looking at the signs and symptoms of the cause well in uh hemolytic anemia in hemolytic anemia the anemia is caused by the excessive breakup of the red cells and this will release the pigment from the hemoglobin the uh Billy uh the Billy Rubin and in the tissues we see that as jundas so they can be jous it's normally not pronounced in hemolytic anemia although you can get a crisis it's um most observable and the the sclear of the whites of the eyes um another cause as we mentioned is a plastic anemia so in a plastic anemia we're going to get um a pan neutropenia the bow marrow is just not working properly and particularly the bow marrow won't produce a white cells so we risk of infection and it won't produce the platelets the thrombos site so we can get bleeding again clinical features not related to the anemia but caused by the deficiency the penia of other essential blood components um I think the last one I'll mention is the CLE cell so we know that CLE cell disease can cause CLE cell anemia but CLE cell disease can also lead to other clinical features such as legalis um stroke and features consistent with pulmonary arterial uh high blood pressure hypertension and this can cause features such as I won't write them all down but um shortness of breath might might few shortness of breath starts with shortness of breath on exertion then become shortness of breath um even at rest uh fatigue uh Syncopy um chest pain chest tightness especially uh can lead on to systemic edema um cyanosis Tachi cardus if you want to know that in detail look at the features of pulmonary arterial hyper tension but the point is all these things the uh hemolytic anemia the aplastic anemia the vitamin B12 deficiency the sickle cell disease all have their own ranges of clinical features in addition to the features of um anemia so having looked at the uh signs and symptoms of the underlying cause in the next video we want to think about the signs and symptoms of the anemia specifically the signs and symptoms caused by the reduced oxygen carrying capacity of the blood