y Definition: Low Hemoglobin concentration.

14 .Reference ranges for Hbs at different ages Age group Newborn (< 1 week) 6 months old Children (1 16 years) Adults Men Women Hb range (g/dl) 14 22 11 14 11 15 13 16 12 .

lethargy Moderate (Hb 7 10 g/dl) Dyspnoea.Anaemia Clinical grading (Adults) Mild (Hb > 10 g/dl) Asymptomatic Pallor. vertigo headache Tachycardia Severe (Hb < 7 g/dl) hypotension .

y Decreased production Ineffective erythropoiesis y y Deficiency of B12/folate Abnormal synthesis of haemoglobin (thalassaemia) Aplastic anaemia/marrow failure y Decreased effective erythropoiesis y 2. y Increased destruction haemolysis . y Increased blood loss Gastrointestinal bleeding 3.Mechanisms of anaemia 1.

MCH N) 2. MCHq) Normochromic normocytic anaemia (MCV N. y Pathophysiological Based on causes of anaemia y y y Iron deficiency anaemia Megaloblastic anaemia Haemolytic anaemia . y Morphological Based on red cell indices and blood film y y y Hypochromic microcytic anaemia (MCV q. MCH N) Normochromic macrocytic anaemia (MCV o.Classification of anaemia 1.

32 pg) MCH (< 27 pg) Normocytic Microcytic Macrocytic Normochromic Hypochromic .Classification of anaemia y MCV mean corpuscular volume (fl) y MCH mean corpuscular Hb (pg) MCV (80 100 fl) MCV (< 80 fl) MCV (>100 fl) MCH (27 .

hair loss. palpitation. infections y Autoimmune ds oral ulcer. photosensitivity y Dietary intake y Sx of anemia lethargy. reduced effort tolerance. epigastric pain y Menorrhagia y Hemoptysis y Per rectal bleed y Family hx of blood transfusion y Traditional meds/ drugs ingestion y Bleeding tendency. LOA . syncope. LOW. giddiness. dyspnea.History Taking y Any blood loss y Melena. angina. recurrent fever.

Physical Examination y y y y y y y y y y y y y Conjunctiva pallor Jaundice Angular stomatitis Glossitis Gum hypertrophy Thalassemic facies (frontal bossing. malar prominence) Bruising Lymphadenopathy Koilonychia Leukonychia Cachexia Hepatosplenomegaly Propioceptive loss prenicious anemia .




Investigations y First step to diagnosis: look at MCV!!! y Microcytic anemia y Iron deficiency anemia y Thalassemia y Anemia of chronic disease y Sideroblastic anemia .

y Macrocytic anemia y Folate deficiency y B12 deficiency y Hypothyroidism y Chronic liver disease y Alcohol excess y Reticulocytosis eg with hemolysis y Myelodysplastic syndrome y Cytotoxic drugs .

y Normocytic anemia y Acute blood loss y Anemia of chronic disease y Bone marrow failure y Pregnancy y Hypothyroidism (can be macrocytic too) y Hemolysis (can be macrocytic too) .

PE suggestive) . ferritin y PBF y Stool occult blood y Stool ova and cyst y Endoscopy (if hx.Microcytic anemia y Serum Iron. TIBC.

High TIBC y Iron deficiency y y Causes: blood loss. ferritin y Hb electrophoresis Thalassemia . hookworm Stool occult blood. TIBC. ova & cyst. malabsorption (Celiac ds). Low TIBC y Anemia of chronic disease y Low Iron.y Low Iron. low intake. endoscopy y Normal Iron.

Macrocytic Anemia y PBF y B12 level y Folate level y LFT. TSH y Retic count y Bone marrow biopsy if cause not revealed by above tests . GGT y T4.

y B12 deficiency y Dietary e. anti-parietal cell Ab Post gastrectomy Ilieum resection Chron s disease .g vegans y Malabsorption y y y y Lack of intrinsic factor (pernicious anemia) Schilling test.

MTX. amy precipitate subacute combined degeneration of cord .y Folate deficiency y Dietary poverty y Pregnancy y Malabsorption .Celiac disease y Drugs phenytoin. sodium valproate ** never treat without folate in low B12 state.

Hemolytic Anemia y Causes: y Acquired y y y Immune mediated drug induced. sickle cell disease. pyruvate kinase deficiency Membrane defect: hereditary spherocytosis.malaria y Hereditary y y Enzyme defect: G6PD deficiency. Thalassemia . AIHA Isoimmune transfusion reaction Infection .

y Clues y Anemia normocytic y Jaundice y Dark colored urine hemoglobinuria y Hepatosplenomegaly .

Investigations (as appropriate) y FBC y Retic count y LDH y LFT y Bilirubins (direct. indirect) y UFEME y Coombs test direct y BFMP y G6PD level y Hb electrophoresis y Plasma haptoglobin .

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