1. Anaemia
By Jeeves

2. Symptoms Fatigue Exertional Dyspnoea Palpitations Syncope Headaches
Angina (if server with underlying CAD)
Intermittent claudication (if server with underlying PVD)

3. 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

4. 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

5. 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)

6. 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.

7. 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

8. 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

9. Investigations
FBE
Hb concentration: normal =
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.

10. 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

11. Investigations
Iron studies

12. Investigations
Blood Film
Normal

13. Normal Red Cells

14. Reticulocyte No definite nucleus Reticulum of RNA Deep blue staining
Light blue cytoplasm
Cell size about 10 µ

16. Sickle cells
A genetic haemoglobinopathy

18. Spherocytes
Present in hereditary spherocytosis and autoimmune haemolytic anaemias.

20. 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.

22. Elliptocytosis
Hereditory elliptocytosis and B12/folate deficiency

24. Target Cells
Thalassemias
Liver disease
Sickle cell
Postsplenectomy

26. Hypochromic microcytic anaemia due to iron deficiency

28. Iron deficiency again!

29. Treatments

30. Quiz
What are some symptoms of anaemia?

31. References Oxford handbook Med note share