Anaemia

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

Hypoch"omia Lo( M+:

#a"get cells 'asophilic stippling

Dimo"phic

$on*speci.ic

Fe""itin
Lo(

'one ma""o( biopsy

Fe""itin
$o"mal o" high

Hb elect"opho* "esis .o" Hb%2

1aised: thalassaemia $o"mal: thalassaemia

Fe De.iciency 6n-& cause

2ide"oblastic

;%naemia o. +h"onic D +onside" bone ma""o( biopsy and i"on studies

High M+: +hec7 H&:

3tAH Li-e" d FMH& pe"nicious anaemia Hypothy"oid D"ugs P"e-/ abdo 2& DGIM ast updated March !""#

Lo( M+: $o"mal M+:

Fe de.iciency 8commonest
cause9

P'F = 1eticulocyte count

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

#halassaemia 2ide"oblastic anaemia 8"a"e9

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"ugs/cytoto&ics 6n-& ? t"eat LF# ;Myelodysplasia ;2ide"oblastic

Interpreting Plasma Iron Studies

Fe de.iciency %naemia o. +h"onic d +h"onic haemolysis Haemch"omatosis P"egnancy 2ide"oblastic anaemia 6"on #6'+ /$ $ Fe""itin $

DGIM ast updated March !""#

Iron Deficiency Anaemia 1/ meno""hagia +auses: 2/ oesophagitis B/ P>D 4/ 56 +% C/ colitis 1&:

D/ E/ F/ G/

di-e"ticulitis haemo""hoids hoo7(o"ms poo" diet / special diet malabso"ption 8celiac d 9

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(/

Haemolytic Anaemias +auses: Memb"ane p"oblems 3n yme p"oblems Hb p"oblems Athe"s

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%

6n-estigations Hb LDH haptoglobulin

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

DGIM ast updated March !""#