Anaemia

Reduced haemoglobin level below the reference level for the age and sex of the individual

CAUSES OF ANAEMIA

« Nutritional

« Reduced absorption

« Blood loss

« Haemolysis

« Bone marrow suppression Chronic infection

« Other chronic diseases

CLINICAL FEATURES OF ANAEMIA

« Fatigue

« Headache

« Faintness

« Breathlessness

« Angina

« Intermittent claudication

« Palpitations

« May be asymptomatic

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

ü Hb level

ü WBC count

ü Platelet count

ü Reticulocyte count (Indicates marrow activity)

ü Blood picture (indicated probable aetiology)

ü Bone marrow

TYPES OF ANAEMIA

According to the blood picture,

HYPOCHROMIC MICROCYTIC ANAEMIA

ü Iron deficiency anaemia

ü Thalassaemia

NORMOCHROMIC NORMOCHROMIC ANAEMIA

ü Anaemia of chronic disease

MACROCYTIC ANAEMIA

ü Vit B12, Folate deficiency

DIAMORPHIC BLOOD PICTURE

ü Mixed deficiency or following treatment

IRON DEFICIENCY ANAEMIA

(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 â

· Total iron binding capacity (TIBC) á

· 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)