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Definition Men: Hb <14 g/dL Women: Hb <12 g/dL Symptoms: Fatigue Dyspnoea Palpitations Headache Di iness! postu"al hypo#$ #innitus %no"e&ia Dyspepsia 'o(el distu"bance %ngina ) p"e*e&isting +%D Pica,compulsi-e eating o. non*nut"iti-e substance e/g/ ice! di"t! paint
Causes of anaemia: +ommonest cause: Fe de.iciency due to blood loss/ Classification by mechanism of anaemia 1'+ p"oduction Fe! '12 o" .olate de.iciency Hypoplasia Malignant in-asion o. bone ma""o( 1'+ loss 'lood loss Haemolysis Hype"splenism Classification by MCV $o"mal / Lo( M+:: 1eticulocyte count
$o"mal / Lo( High
Signs: Pallo" Jaundice + pallor = Haemolytic anaemia until proven otherwise 0aundice 1etinal hemo""hages Hype"dynamic ci"culation #achyca"dia 2ystolic mu"mu"s +a"diac enla"gement 4 gallop Hea"t .ailu"e 3dema +a"diac dilatation 4.lo( mu"mu" Postu"al d"op in 'P History: Fe loss: 56 symptoms and menst"ual histo"y/ Poo" Fe / .olate inta7e * diet 8eg -egans9 and 2& "esection o. stomach / small bo(els +h"onic diseases FMH& o. haemolytic anaemia o" pe"nicious anaemia D"ugs ) may cause blood loss 8aspi"in! $2%6Ds9! haemolysis o" aplasia 0aundice ) haemolytic anaemias
P'F
'leeding Haemolysis
Dimo"phic
$on*speci.ic
Fe""itin
Lo(
Fe""itin
$o"mal o" high
2ide"oblastic
Fe de.iciency 8commonest
cause9
Haemolysis 'one ma""o( .ailu"e %naemia o. +h"onic D 1enal .ailu"e P"egnancy Hypothy"oidism High M+: '12 / .olate de.iciency 1eticulocytosis eg haemolysis Myelodysplastic synd"omes %nti.olate d"ugs eg phenytoin Ma""o( in.ilt"ation %lcohol +ytoto&ics Li-e" disease Hypothy"oidism <Haemolytic anaemias may be no"mo* o" mac"o*cytic/ 2uspect i. "eticulocytosis is p"esent Investigations Anaemia workup:
F'+ 1eticulocyte count P'F Fe / #6'+ / Fe""itin Folate = '12 Hb elect"opho"esis >/3/+" LF# ) li-e" d ? LDH in haemolytic anaemia #F# Fecal occult blood Di"ect +oomb@s test ) Haemolytic anaemias A5D .o" >56 bleed/colonoscopy .o" L56' 'one ma""o( biopsy
Hype"segmented polymo"phs Folate! '12 le-els #a"get cells! stomatocytes Dysplasia / cytopenia Ma""o( Dimo"phic Polych"omasia / High 1etic count ;'leeding 'ili"ubin ? LDH Haemolytic anaemias * loo7 .o" ."agments Lo(
D/ E/ F/ G/
A"al i"on 8eg Fe sul.ate 2HHmg/12*Fh PA9 ) should inc"ease Hb by 1 g/dl/(ee7/ 23: constipation! blac7 stools
Sideroblastic Anaemia Dyse"yth"opoiesis = i"on loading 8bone ma""o( = haemoside"osis ie endoc"ine! li-e" and ca"diac damage9 +auses: 6diopathic! +ongenital 8"a"e! J*lin7ed9! 3tAH o" lead e&cess! myelop"oli.e"ati-e disease! malignancy! malabso"ption! anti*#' d"ugs Hypoch"omic 1'+ on P'F = side"oblasts in ma""o(/
He"edita"y sphe"ocytosis 3lliptocytosis 5DPD de.iciency Py"u-ate 7inase de.iciency #halassaemia 2ic7le cell disease 6n.ection: Mala"ia! H>2 Hype"splenism Mechanical hea"t -al-es %utoimmune %b 8%6H%s9 2na7e -enom >nconIugated 'ili"ubin 1eticulocyte count D+#: = in %6H%
Anaemia of Chronic Disease +auses: 6n.ection! collagen -ascula" d ! "heumatoid a"th"itis! malignancy! "enal .ailu"e 1&: t"eat unde"lying cause/ 1ecombinant e"yth"opoietin .o" "enal .ailu"e