Anaemia in general medical patients

Why is recognition of anaemia important? 1) Anaemia itself can cause symptoms or worsen symptoms associated with other co-morbidities, e.g. ischaemic heart disease and heart failure. 2) Mortality in patients with heart failure and renal failure is increased in presence of concurrent anaemia. 3) Recognising anaemia and ensuring the diagnosis is on the EIDD means that this is coded and the trust gets paid appropriately. 4) Anaemia can be a consequence of underlying disease, e.g. malignancy Y
Is there evidence of bleeding? e.g. melaena, haematuria Request appropriate investigations e.g. OGD, exible cystoscopy

Is the patient anaemic? Hb < 12 (F); < 13 (M)

N Y
Microcytic? MCV < 80 Iron decient? low ferritin + iron + transferrin sat

N
Anaemia of chronic disease? low ironN + transferrin; high ferritin

N Y
Macrocytic? MCV < 100 B12, folate, LFTs, TFTs, blood lm

N N
Explanation for anaemia identied? Is there an underlying comorbidity to explain the anaemia? e.g. renal failure, cancer, sepsis, autoimmune disorder

Y Y
It may be appropriate not to investigatie further

Checklist for the EIDD Record anaemia as a primary or secondary diagnosis/active comorbidity as applicable Provide explanation for anaemia if found, e.g. iron deciency anaemia secondary to poor dietary intake If anaemia not investigated, then state why Recommend further outpatient investigation of anaemia by GP as appropriate

Consider further investigations including Blood lm Haemolysis screen (DCT, LDH, bilirubin, haptoglobin) Haemoglobinopathy screen

Matthew Sims, Catherine Hildyard & Chris Bunch 2013