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