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Anaemia

Anaemia. A comprehensive review. Definition. Blood haemoglobin concentration below the normal range for sex and age. Adult male <13.5 g/dl Adult female <11.5 g/dl. Symptoms. Fatigue Headaches Faintness SOB Palpitations Angina Intermittent Claudication Pica

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Anaemia

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  1. Anaemia A comprehensive review

  2. Definition • Blood haemoglobin concentration below the normal range for sex and age. • Adult male <13.5 g/dl • Adult female <11.5 g/dl

  3. Symptoms • Fatigue • Headaches • Faintness • SOB • Palpitations • Angina • Intermittent Claudication • Pica • Recurrent minor infections…….

  4. Signs • Pallor – face, lips, tongue, conjunctivae etc. • Glossitis, Angular stomatitis, Oesophageal webs • Koilonychia • Hypersplenism • Bleeding………

  5. Primary Investigations • FBC • Hb • RBCs • HTC/PCV • MCV (79-96fl) • MCHb • MCHbC (27-32pg) • Reticulocyte count • White cells + plts

  6. Classification Normocytic Acute Blood Haemolysis Pregnancy Renal failure Chronic disease Bone marrow failure Macrocytic B12 deficiency Folate deficiency Liver Disease Alcohol Myelodysplasia Hypothyroidism Microcytic Fe deficiency Thalassaemias Chronic disease

  7. Causes of Anaemia

  8. Blood Loss • Acute • Following initial hypovolaemia, fluid shift produces a normochromic normocytic anaemia • Full rbc restoration may take up to 6 weeks • Chronic • Commonest cause of Fe deficiency anaemia • Common Sites – GI&GU tracts • Menorrhagia

  9. Haemolysis • Reduced rbc lifespan and increased rbc destruction • Assoc. w/ Reticulocytosis, Splenomegaly, Jaundice, Haemoglobinuria

  10. Haemolysis • Hereditary • Haemoglobinopathies eg. Sickle cell, Thalassaemia • Cell membrane defects eg. Spherocytosis • Enzyme deficiencies eg. G6PD & PK deficiency • Acquired • Incompatible Blood product transfusion/Haemorrhagic disease of the newborn • Auto Immune (Cold IgM & Warm IgG) • Mechanical (Heart valves, DIC, HUS) • Infectious eg. Malaria

  11. Micronutrient deficiencies: Macrocytic anaemias • Vit B12: serum level < 100pg/ml • Dietary deficiency (rare) • ↓production of IF: pernicious anaemia, gastrectomy, HP infection, congenital • Competition for vit B12 binding sites in gut: blind loop syndrome, fish tapeworm, • Pancreatic insufficiency • Decreased absorption: ileal resection, Crohn’s • Transcobalamin def (rare)

  12. Treatment B12 def: • IM B12 100ug • Daily for 1 week, Weekly for 1st month OR Alt days for 2 weeks • Monthly for life • Respond immediate sense of well being • CNS signs reversible if short duration • cont

  13. 2. Folic acid: normal serum B12 levels • Dietary def: fruit and veg • Decreased absorption: Tropical sprue, Drugs: phenytoin, sulfasalazine, trimethoprim- sulfa methoxazole • Increased requirements: Chronic haemolytic anaemia, preg, exfoliative skin disease • Loss: dialysis

  14. Folic acid def. Rx: • 1mg/d orally • Rapid improvement

  15. Fe def anaemia: < 12micrograms or absent bone marrow stores • microcytic • Deficiency in diet: sources • Decreased absorption: tannins, phosphates • Increased requirements: preg, lactation • Blood loss: GI, menstrual, blood donation • Haemoglobinuria

  16. Rx Fe deficiency: • Oral: FeSO4 200mg 12-8hrly • Continue until Hb is normal • 3 months to replenish stores • Dietary advice

  17. Dyserythropoiesis • Defective RBC formation • Anaemia of chronic disorders: • TB, RA, Cancer, renal/liver failure • Normocytic + normochromic • Failure of macrophages to transfer iron to bone marrow • ↓marrow response to epo

  18. Dyserythropoiesis • Myelodysplastic/Refractory • Increasing marrow failure • Similar etiology to leukaemias (can be 2° to chemo) • Sideroblastic • Defective haem synth → accumulation of iron in reticulocyte cytoplasm transforming to • ring sideroblasts + hypochromic

  19. Aplastic anaemia • Severe life threatening, bone marrow failure • Etiology idiopathic or autoimmunity, radiation, drugs, toxins, viruses. • Peripheral blood smear pancytopenia

  20. Marrow infiltration • Leukaemias • Myelofibrosis • Disseminated carcinoma • Disseminated lymphomas

  21. Summary

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