Anemia
Definition
Reduced haemoglobin level below the reference level for the age and sex of the individual
CAUSES OF ANEMIA
- Nutritional
- Reduced absorption
- Blood loss
- Haemolysis
- Bone marrow suppression Chronic infection
- Other chronic diseases
CLINICAL FEATURES OF ANEMIA
- Fatigue
- Headache
- Faintness
- Breathlessness
- Angina
- Intermittent claudication
- Palpitations
SIGNS
1. Pallor
2. Tachycardia
3. Bounding pulse
4. Systolic flow murmur
5. Evidence of cardiac failure
Rarely, Papilloedema,
Retinal haemorrhages
SPECIFIC SIGNS
Signs of Nutritional deficiency +
Koilonychia (Fe Deficiency)
Jaundice (Haemolytic anaemia)
Bone deformities (Thalassaemia)
Leg ulcers (Sickle cell disease)
Lymphadenopathy/Hepatosplenomegal
(Myeloproliferative/lymphoproliferative disorders)
Telengiectasia
(Hereditary haemorrhagic telengiectasia)
INVESTIGATIONS
- Hb level
- WBC count
- Platelet count
- Reticulocyte count (Indicates marrow activity)
- Blood picture (indicated probable aetiology)
- Bone marrow
TYPES OF ANEMIA
According to the blood picture,
HYPOCHROMIC MICROCYTIC ANAEMIA
- Iron deficiency anaemia
- Thalassaemia
NORMOCHROMIC NORMOCHROMIC ANAEMIA
- Anaemia of chronic disease
MACROCYTIC ANEMIA
- Vit B12, Folate deficiency
DIAMORPHIC BLOOD PICTURE
- Mixed deficiency or following treatment
IRON DEFICIENCY ANEMIA
(Hypochromic microcytic anaemia)
CAUSES
- Blood loss
- Decreased absorption
- Poor intake
- Increased demand
(Growth, Pregnancy)
HISTORY
- Detailed dietary history
- Menstrual history
- Evidence of chronic infection
- Possibility of GI haemorrhages
- Drugs – NSAIDs
CLINICAL FEATURES
FEATURES OF ANAEMIA +
- Brittle nails
- Koilonychia (spoon shaped nails)
- Atrophy of the papillae of the tongue
- Angular stomatitis
- Brittle hair
- Dysphagia and Glossitis
- (Plummer vinson/kelly patterson)
INVESTIGATIONS
- Blood counts and Red Cell Indices
- MCV <80 fl Microcytic
- MCH <27 pg Hypochromic
- Blood picture
- Hypochromic microcytic with poikylocytosis (variation in shape) and anisocytosis (variation in size)
- Serum Fe
- Total iron binding capacity (TIBC)
- Transferrin
- saturated
Low serum ferritin confirms the diagnosis
Normal level : Male = 30-300u
Female = 15-200u
Bone marrow is not needed to diagnose iron deficiency anaemia
Other causes of hypochromic microcytic anaemia
- Thalassaemia
- Anaemia of chronic diseases
Treatment
- Find out and treat the underlying cause
- Oral iron therapy
(ferrous sulphate 200mg tds)
