Anaemia Summary


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Anaemia Summary

  1. 1. AnaemiaDefinition Classification by mechanism of anaemia Men: Hb <14 g/dL ↓ RBC production Fe, B12 or folate deficiency Women: Hb <12 g/dL Hypoplasia Malignant invasion of bone marrowSymptoms: ↑ RBC loss Blood loss Fatigue Anorexia Haemolysis Dyspnoea Dyspepsia Hypersplenism Palpitations Bowel disturbance Headache Angina – pre-existing CAD Classification by MCV Dizziness, postural hypoTN Pica—compulsive eating of Normal / Low MCV: Tinnitus non-nutritive substance e.g. ice, Reticulocyte count dirt, paint Normal / Low HighSigns: Pallor Jaundice + pallor = Haemolytic anaemia until proven otherwise Jaundice Retinal hemorrhages PBF Bleeding Hyperdynamic circulation ∼ Tachycardia Haemolysis ∼ Systolic murmurs ∼ Cardiac enlargement Heart failure ∼ Edema ~ gallop ∼ Cardiac dilatation ~flow murmur Hypochromia Target cells Dimorphic Non-specific• Postural drop in BP Low MCV Basophilic stippling Bone marrow FerritinHistory: Ferritin biopsy Normal or high Fe loss: GI symptoms and menstrual history. Low Poor Fe / folate intake - diet (eg vegans) and Sx resection of stomach / Hb electropho- small bowels resis for HbA2 Chronic diseases FMHx of haemolytic anaemia or pernicious anaemia Fe Deficiency Raised: β Sideroblastic ?Anaemia of Drugs – may cause blood loss (aspirin, NSAIDs), haemolysis or thalassaemia Chronic Dz aplasia Normal: α Jaundice – haemolytic anaemias Invx cause thalassaemiaCauses of anaemia: Consider bone marrow biopsy∼ Commonest cause: Fe deficiency due to blood loss. and iron studies
  2. 2. High MCV Low MCV Fe deficiency (commonest Thalassaemia cause) Sideroblastic anaemia (rare) Check Hx: Normal MCV Haemolysis Bone marrow failure EtOH Anaemia of Chronic Dz Renal failure Liver dz Pregnancy Hypothyroidism FMHx pernicious anaemia High MCV B12 / folate deficiency Reticulocytosis eg haemolysis Hypothyroid Antifolate drugs eg phenytoin Myelodysplastic syndromes Drugs Alcohol Marrow infiltration Prev. abdo Sx Liver disease Cytotoxics Hypothyroidism *Haemolytic anaemias may be normo- or macro-cytic. Suspect if reticulocytosis is present PBF + Reticulocyte count Investigations – Anaemia workup: • FBC • U/E/CrHypersegmented polymorphs Drugs/cytotoxics • Reticulocyte count • LFT – liver dz & ↑LDH in haemolytic anaemia • PBF • TFT • Fe / TIBC / Ferritin • Fecal occult blood • Folate + B12 • Direct Coomb’s test – Haemolytic anaemiasFolate, B12 levels Low Invx & treat • Hb electrophoresis • ± OGD for UGI bleed/colonoscopy for LGIB • ±Bone marrow biopsyTarget cells, stomatocytes LFT Interpreting Plasma Iron Studies Iron TIBC FerritinDysplasia / cytopenia ?Myelodysplasia Fe deficiency ↓ ↑ ↓ Marrow Anaemia of Chronic dz ↓ ↓ ↑ Chronic haemolysis ↑ ↓ ↑Dimorphic ?Sideroblastic Haemchromatosis ↑ ↓/N ↑ Pregnancy ↑ ↑ N Sideroblastic anaemia ↑ N ↑ Polychromasia / High Retic count ?Bleeding ↑ Bilirubin & LDH Haemolytic anaemias - look for fragments
  3. 3. Iron Deficiency Anaemia Sideroblastic Anaemia Causes: 1. menorrhagia 6. diverticulitis Dyserythropoiesis + iron loading (bone marrow + haemosiderosis ie 2. oesophagitis haemorrhoids endocrine, liver and cardiac damage) 3. PUD 7. hookworms Causes: Idiopathic, Congenital (rare, X-linked), EtOH or lead excess, 4. GI CA 8. poor diet / special diet myeloproliferative disease, malignancy, malabsorption, anti-TB drugs 5. colitis 9. malabsorption (celiac dz) Hypochromic RBC on PBF + sideroblasts in marrow. Rx: Oral iron (eg Fe sulfate 200mg/12-8h PO) – should increase Hb by 1 g/dl/week. SE: constipation, black stoolsHaemolytic Anaemias Causes: Membrane problems Hereditary spherocytosis Elliptocytosis Enzyme problems G6PD deficiency Pyruvate kinase deficiency Hb problems Thalassaemia Sickle cell disease Others Infection: Malaria, HUS Hypersplenism Mechanical heart valves Autoimmune Ab (AIHAs) Snake venom Investigations ↓ Hb ↑ Unconjugated Bilirubin ↑ LDH ↑ Reticulocyte count ↓ haptoglobulin DCT: + in AIHAAnaemia of Chronic Disease Causes: Infection, collagen vascular dz, rheumatoid arthritis, malignancy, renal failure Rx: treat underlying cause. Recombinant erythropoietin for renal Digitally signed by DR WANA HLA SHWE failure DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI University, School of Medicine, KT-Campus, Terengganu, ou=Internal Medicine Group, Reason: This document is for UCSI University, School of Medicine students. Date: 2009.03.08 09:31:58 +0800