Anaemia

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Definition

-  Decrease in RBCs or Hb on FBE

 

Features

-  Always needs further Ix to determine cause

 

Hx & Exam

-  General S/S

-  Dyspnoea, pallor, fatigue

-  Pale palmar creases, conjunctival pallor (Hb < 80)

-  Decreased capillary refill

-  Tachycardia

-  Systolic flow murmur, strong peripheral pulses

-  Blood loss: bleeding diathesis, surgery, haemorrhage, haemorrhoids, intestinal parasite, thrombocytopaenia..

-  Jaundice: haemolytic aneamia

 

PMH

-  Liver disease: anaemia of chronic disease, bleeding diathesis

-  CRF: anaemia of chronic disease, normocytic anaemia

-  Anticogulation: AF, mechanical heart valve, post-op

-  Haemophillia

-  Menstrual Hx

-  Vegetarian: Megaloblastic anaemia, IDA

 

Medications

-  Anti-coagulation: Warfarin, Heparin, Aspirin

 

Family

-  Hemohphillia (A,B), vWD

-  African, Middle Eastern: G6PD, haemoglobinopathies

 

Classfication by Type

-  Hypoproliferatiive (marrow)

-  Iron Deficiency Anaemia (IDA)

-  Marrow damage

-  Hypothyroidism

-  Decreased EPO: CRF, inflammation

-  Ineffective erythropoiesis (RBC mat.)

-  Megaloblastic anaemia

-  Pernicious anaemia

-  Blood loss/Haemolysis

-  Thalassaemia

-  Sickle cell anaemia

 

Ix

-  FBE

-  RBC, Hb: anaemia

-  MCV: microcytic, normocytic, macrocytic

-  MCHC: hypochromic, normochromic, hyperchromic

-  Reticulocytes (see below)

-  Platelets: thrombocytopaenia

-  Blood film

-  Iron studies: IDA

-  Coags

-  APTT, INR

-  Mixed test

-  Inhiitor assays (lupus anticoagulatnt)

-  Clotting factor assays (Factor VIII, IX)

-  vWF (Risocetin)

 

Classfication by MCV

-  Microcytic anaemia

-  Iron Deficiency Anaema (IDA)

-  Thalassaemia

-  Normocytic anaemia

-  Anaemia of chronic disease

-  Macrocytic/Megaloblastic anaemia

 

Dx by Retics

-  Reticulcytes

-  < 2

-  Normocytic: Hypoproliferative (75% all aneamias)

-   Iron studies: IDA

-   Decreased T3/T4: Hypothyroid

-   U&E, GFR: CRF

-  Ineffective Erythropoeisis

-   Microcytic Severe IDA

-  Haemoglobinopathy

-   Macrocytic

-  B12, Folate, Drug, Myelodysplasia, EtOH

-  => 2.5

-  Haemolysis/Blood Loss