This document discusses the evaluation and management of hematological disorders like anemia. It covers taking a thorough history including symptoms, risk factors, medications and lifestyle. The physical exam focuses on signs of anemia. Initial investigations for anemia types include blood counts, iron, B12 and folate levels. Depending on the results, further testing may include endoscopies, biopsy or bone marrow examination to determine the underlying cause such as nutritional deficiencies, infections, cancers or autoimmune disorders. Pernicious anemia specifically requires serology to guide long term treatment.

1. HAEMATOLOGICAL DISORDERS
Station 5
MAMDOUH L DORRAH
MRCP (UK)- LONDON

2. ANAEMIA
History
Examination
Management
Plan

3. ANAEMIA;HISTORY
• History of the Presenting Complain HPC;
 Symptoms of anaemia; Lethargy – Tiredness – Breathlessness – Decreased exercise tolerance.
 Alarm Symptoms; Loss of weight – Loss of appetite – Low grade fever – Lymphadenopathy.
 Review Of Systems; GIT – Respiratory – Urinary – CVS.
• Past Medical History
 H/O Recent Blood loss.
 H/O Recent blood donation.
 H/O Chronic Disease
• Menstrual History
 Days? Number of Pads? Clotting? Flooding?.
 Pregnancy? Delivery? Breastfeeding?
• Family History
• Drug History
• Dietary History; Type of food – Vegetarian?
• Social History ; Smoking? – Alcohol ? – Occupation ? – Residence? – Activities?
• Travel History
• Concerns

4. ANAEMIA;EXAMINATION
CARDIOVASCULAR EXAMINATION
Pulse - Heart
ABDOMINAL EXAMINATION
For Organomegaly
SIGNS OF ANAEMIA
Examine hands & eyes for Pallor
Tell the examiner that you would like to complete your examination by performing
Direct Rectal Examination DRE.
Examination should be guided by the history.

5. ANAEMIA;MANAGEMENTPLAN
Investigations include;
• Haematinics.
• Inflammatory markers; ESR – CRP.
• Coeliac serology.
• Iron profile.
• Thyroid profile.

6. ANAEMIA;REVIEW-CAUSES
• MICROCYTIC ANAEMIA (Low MCV)
 Iron deficiency anaemia  PUD – GI cancer – Coeliac disease – IBD – Hookworm
infestation – Angiodysplasia - HHT
 Thalassaemia
 Sideroblastic anaemia
• MACROCYTIC ANAEMIA (High MCV)
 Megaloblastic  Vitamin B12 deficiency – Folate Deficiency – Cytotoxic drugs.
 Non-megaloblastic  Alcohol – Liver disease – Hypothyroidism – Pregnancy.
 Other haematological disorders  Myelodysplasia – Myeloma – Myeloproliferative
disorders – Aplastic anaemia.
• NORMOCYTIC ANAEMIA (Normal MCV)
 Uraemia.
 Malignancy.
 Chemotherapy
 Aplastic anaemia.

7. ANAEMIA;REVIEW-CAUSES
• Causes of Vitamin B12 deficiency
 Pernicious anaemia.
 Vegans.
 Alcoholics.
 Coeliac disease
• Causes of Folate deficiency
 Pregnancy
 Phenytoin
 Tropical Sprue.
 Coeliac disease.
 Malignancy.
 Haemolysis.

8. ANAEMIA;WORK-UP
• For Microcytic anaemia
 FBC
 Serum Ferritin.
 Faecal occult blood.
 OGD – Barium enema – Colonoscopy.
 INR – PT – Platelet count.
 Haemoglobin electrophoresis.
• For Macrocytic anaemia
 Peripheral smear
 Serum B12 level – Serum Folate level – Red cell folate level/
 Iron profile.
 Gastric Parietal cell Abs – Intrinsic Factor Abs.
 OGD
 Reticulocyte count.
 Bone marrow examination

9. IMPORTANTREMARKS
• For Vitamin B12 deficiency
Pernicious anaemia should be excluded by means of
serology as the presence of pernicious anaemia as a
cause of macrocytosis greatly alters the course of
therapy.
• For Folate Deficiency
Drug induced Folate deficiency should be excluded.