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 Decreased production of Red Cells - Hypo proliferative, marrow failure, deficiencies Increased destruction of Red Cells - Hemolysis (decreased survival of RBC) Loss of Red Cells due to bleeding - Acute / chronic blood loss (hemorrhagic)

Classification by Causes Decreased 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 deficiency Extracorpuscular 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 Folate or B12 deficiency Haem defect Globin defect Defective DNA synthesis Fe deficiency Thalassemia Megaloblastic Anaemia Sickle cell A Macrocytic Anaemia Decreased reticulocytes Microcytic anaemia

Anaemia Workup - MCV Microcytic Normocytic Macrocytic MCV Iron Deficiency IDA Chronic Infections Thalassemias Hemoglobinopathies Sideroblastic Anemia (very rare) Chronic disease Early IDA Primary marrow disorders Renal failure Combined deficiencies Haemolysis (not always) Aplastic anaemia Megaloblastic anemias (Fe Liver disease/alcohol Metabolic disorders Increased destruction Reticulocytosis (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 FOB/colonoscopy/gastroscopy 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/Anaemia/Anaemia%20Comprehensive%20by%20Dr%20Sarma.ppt