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Anaemia

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)

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Anaemia

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  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

  7. Hypoproliferative Anaemias Failure of cell maturation Nuclear breakdown Cytoplasmic breakdown Folate or B12 deficiency Globin defect Haem defect Defective DNA synthesis Thalassemia Fe deficiency Megaloblastic Anaemia Sickle cell A Macrocytic Anaemia Decreased reticulocytes Microcytic anaemia

  8. Anaemia Workup - MCV MCV Microcytic Normocytic Macrocytic Iron Deficiency IDA Chronic Infections Thalassemias Hemoglobinopathies Sideroblastic Anemia (very rare) Chronic disease Early IDA Hemoglobinopathies Primary marrow disorders Renal failure Combined deficiencies Haemolysis (not always) Aplastic anaemia Megaloblastic anemias (Fe Liver disease/alcohol Hemoglobinopathies Metabolic disorders Increased destruction Reticulocytosis (eg haemolysis) Myelodysplastic syndromes

  9. 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.

  10. Investigations • Haematinics • 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

  15. Sickle cells • A genetic haemoglobinopathy

  16. Spherocytes • Present in hereditary spherocytosis and autoimmune haemolytic anaemias.

  17. 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.

  18. Elliptocytosis • Hereditory elliptocytosis and B12/folate deficiency

  19. Target Cells • Thalassemias • Liver disease • Sickle cell • Postsplenectomy

  20. Hypochromic microcytic anaemia due to iron deficiency

  21. Iron deficiency again!

  22. Treatments

  23. Quiz • What are some symptoms of anaemia?

  24. References • Oxford handbook • Med note share • http://www.drsarma.in/files/medicine/Anaemia/Anaemia%20Comprehensive%20by%20Dr%20Sarma.ppt

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