Anaemia
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Anaemia. A comprehensive review. Definition. Blood haemoglobin concentration below the normal range for sex and age. Adult male <13.5 g/dl Adult female <11.5 g/dl. Symptoms. Fatigue Headaches Faintness SOB Palpitations Angina Intermittent Claudication Pica

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Anaemia l.jpg

Anaemia

A comprehensive review


Definition l.jpg
Definition

  • Blood haemoglobin concentration below the normal range for sex and age.

  • Adult male <13.5 g/dl

  • Adult female <11.5 g/dl


Symptoms l.jpg
Symptoms

  • Fatigue

  • Headaches

  • Faintness

  • SOB

  • Palpitations

  • Angina

  • Intermittent Claudication

  • Pica

  • Recurrent minor infections…….


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Signs

  • Pallor – face, lips, tongue, conjunctivae etc.

  • Glossitis, Angular stomatitis, Oesophageal webs

  • Koilonychia

  • Hypersplenism

  • Bleeding………


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Primary Investigations

  • FBC

    • Hb

    • RBCs

    • HTC/PCV

    • MCV (79-96fl)

    • MCHb

    • MCHbC (27-32pg)

    • Reticulocyte count

    • White cells + plts


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Classification

Normocytic

Acute Blood

Haemolysis

Pregnancy

Renal failure

Chronic disease

Bone marrow failure

Macrocytic

B12 deficiency

Folate deficiency

Liver Disease

Alcohol

Myelodysplasia

Hypothyroidism

Microcytic

Fe deficiency

Thalassaemias

Chronic disease



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Blood Loss

  • Acute

    • Following initial hypovolaemia, fluid shift produces a normochromic normocytic anaemia

    • Full rbc restoration may take up to 6 weeks

  • Chronic

    • Commonest cause of Fe deficiency anaemia

    • Common Sites – GI&GU tracts

    • Menorrhagia


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    Haemolysis

    • Reduced rbc lifespan and increased rbc destruction

    • Assoc. w/ Reticulocytosis, Splenomegaly, Jaundice, Haemoglobinuria


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    Haemolysis

    • Hereditary

      • Haemoglobinopathies eg. Sickle cell, Thalassaemia

      • Cell membrane defects eg. Spherocytosis

      • Enzyme deficiencies eg. G6PD & PK deficiency

    • Acquired

      • Incompatible Blood product transfusion/Haemorrhagic disease of the newborn

      • Auto Immune (Cold IgM & Warm IgG)

      • Mechanical (Heart valves, DIC, HUS)

      • Infectious eg. Malaria


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    Micronutrient deficiencies:

    Macrocytic anaemias

    • Vit B12: serum level < 100pg/ml

    • Dietary deficiency (rare)

    • ↓production of IF: pernicious anaemia, gastrectomy, HP infection, congenital

    • Competition for vit B12 binding sites in gut: blind loop syndrome, fish tapeworm,

    • Pancreatic insufficiency

    • Decreased absorption: ileal resection, Crohn’s

    • Transcobalamin def (rare)


    Treatment b12 def l.jpg
    Treatment B12 def:

    • IM B12 100ug

    • Daily for 1 week, Weekly for 1st month

      OR Alt days for 2 weeks

    • Monthly for life

    • Respond immediate sense of well being

    • CNS signs reversible if short duration

    • cont


    Slide13 l.jpg

    2. Folic acid: normal serum B12 levels

    • Dietary def: fruit and veg

    • Decreased absorption: Tropical sprue, Drugs: phenytoin, sulfasalazine, trimethoprim- sulfa methoxazole

    • Increased requirements: Chronic haemolytic anaemia, preg, exfoliative skin disease

    • Loss: dialysis


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    Folic acid def. Rx:

    • 1mg/d orally

    • Rapid improvement


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    Fe def anaemia: < 12micrograms or absent bone marrow stores

    • microcytic

    • Deficiency in diet: sources

    • Decreased absorption: tannins, phosphates

    • Increased requirements: preg, lactation

    • Blood loss: GI, menstrual, blood donation

    • Haemoglobinuria


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    Rx Fe deficiency:

    • Oral: FeSO4 200mg 12-8hrly

    • Continue until Hb is normal

    • 3 months to replenish stores

    • Dietary advice


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    Dyserythropoiesis

    • Defective RBC formation

    • Anaemia of chronic disorders:

      • TB, RA, Cancer, renal/liver failure

      • Normocytic + normochromic

      • Failure of macrophages to transfer iron to bone marrow

      • ↓marrow response to epo


    Dyserythropoiesis18 l.jpg
    Dyserythropoiesis

    • Myelodysplastic/Refractory

      • Increasing marrow failure

      • Similar etiology to leukaemias (can be 2° to chemo)

    • Sideroblastic

      • Defective haem synth → accumulation of iron in reticulocyte cytoplasm transforming to

      • ring sideroblasts + hypochromic


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    Aplastic anaemia

    • Severe life threatening, bone marrow failure

    • Etiology idiopathic or autoimmunity, radiation, drugs, toxins, viruses.

    • Peripheral blood smear pancytopenia


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    Marrow infiltration

    • Leukaemias

    • Myelofibrosis

    • Disseminated carcinoma

    • Disseminated lymphomas



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