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Anemia

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)

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