Anaemia
By Jeeves
Symptoms
• Fatigue• Exertional Dyspnoea• Palpitations• Syncope• Headaches• Angina (if server with underlying CAD)• Intermittent claudication (if server with
underlying PVD)
Signs
•Pallor (palmar creases & conjunctiva)When Hb drops below 7-8 g/L the body makes compensatory changes (if left untreated)•Tachycardia•Murmurs•Cardiomegaly•Heart failure
Clinical Signs to be looked for
• Breathlessness• Skin dryness, palmar creases• Purpura• Lymph adenopathy• Jaundice• Skin / mucosal pallor• Bald tongue, Glossitis • Tachycardia, CHF• Hepato-splenomegaly• Rectal exam (blood/melena) • Bleeding, Occult Blood
Causes of Anaemia
1. Decreased production of Red Cells- Hypo proliferative, marrow failure, deficiencies
2. Increased destruction of Red Cells- Hemolysis (decreased survival of RBC)
3. Loss of Red Cells due to bleeding- Acute / chronic blood loss (hemorrhagic)
Classification by CausesDecreased Production Increased destruction
(haemolytic anaemias)Blood Loss
•Iron deficiency•B12 or folate deficiency•Renal failure (no EPO)•Thalassemia (is also haemolytic)•Anaemia of chronic disease•Bone marrow infiltration (eg Leukemia)
Intracorpuscular abnormalities•Sickle cell•Heriditory spherocytosis•Heriditory elliptocytosis•Glucose-6-phosphate dehydrogenase deficiency•Pyruvate kinase deficiencyExtracorpuscular abnormalities•Autoimmune- warm & cold haemolytic anaemias.•Microangiopathic haemolytic anaemias (eg DIC)•Artificial heart valves•Paroxysmal nocturnal haemoglobinuria
•Menstrual loss•Menorrhagia•GIT loss•Trauma•Surgery
Can result in jaundice and LDH increase.
Hypoproliferative Anaemias
Failure of cell maturation
Nuclear breakdown Cytoplasmic breakdown
Megaloblastic Anaemia
Defective DNA synthesis
Folate or B12 deficiency
Globin defect
Thalassemia
Sickle cell A
Fe deficiency
Haem defect
Macrocytic Anaemia
Decreased reticulocytesMicrocytic anaemia
Anaemia Workup - MCV
Microcytic
MCV
Normocytic Macrocytic
Iron Deficiency IDAChronic InfectionsThalassemiasHemoglobinopathiesSideroblastic Anemia (very rare)
Chronic diseaseEarly IDAHemoglobinopathiesPrimary marrow disordersRenal failureCombined deficienciesHaemolysis (not always)Aplastic anaemia
Megaloblastic anemias (FeLiver disease/alcoholHemoglobinopathiesMetabolic disordersIncreased destructionReticulocytosis (eg haemolysis) Myelodysplastic syndromes
Investigations
• FBE– Hb concentration: normal =125-180– Red cell count– Haematocrit: RBC conc in blood volume 38-50%– Mean Corpuscular Volume: av RBC size– Mean Corpuscular Hb: Hb/RBC– RBC Distribution Width: measures variation in RBC
size. It’s increased in Fe deficeincy & haemolysis.– White cells
• Reticulocyte count- ↑ in increased destruction and ↓ with decreased production.
Investigations
• Haematinics– Folate – B12– LDH: ↑ in haemolysis but also AMI and liver
disease not specific– Serum Haptoglobin: ↓with moderate-severe
haemolysis• FOB/colonoscopy/gastroscopy• Bone marrow biopsy• Coomb’s test- Autoimmune haemolysis
Investigations
• Iron studies
Investigations
• Blood Film
Normal
Normal Red Cells
Reticulocyte
No definite nucleus
Reticulum of RNA
Deep blue staining
Light blue cytoplasm
Cell size about 10 µ
• Sickle cells– A genetic haemoglobinopathy
• Spherocytes– Present in hereditary spherocytosis and
autoimmune haemolytic anaemias.
• Schistocyte– A fragmented part of a red blood cell. – Several microangiopathic diseases,
including disseminated intravascular coagulation andthrombotic microangiopathies, generate fibrin strands that sever red blood cells as they try to move past a thrombus, creating schistocytes. They also result from dysfunctional prosthetic heart valves.
• Elliptocytosis– Hereditory elliptocytosis and B12/folate deficiency
• Target Cells– Thalassemias– Liver disease– Sickle cell– Postsplenectomy
• Hypochromic microcytic anaemia due to iron deficiency
• Iron deficiency again!
Treatments
Quiz
• What are some symptoms of anaemia?
References
• Oxford handbook• Med note share• http://www.drsarma.in/files/medicine/Anaem
ia/Anaemia%20Comprehensive%20by%20Dr%20Sarma.ppt