..…..by DR DANIEL, D.N. MBBS

 

DEFINITION  

Anaemia is said to be present when there is a decrease in the level of Haemoglobin in the blood. this is when Haemoglobin is below the normal level for the age and sex of the individual in that environment.

  • Haemoglobin (Hb) Levels in Anaemia:       Adult male <13g/dl   (Adult female <11.5g/dl)

Severe anaemia  – < 7g/dl

Moderate anaemia  – 7-9g/dl

Mild anaemia  – 10-12g/dl

 

Haematocrit (Packed Cell Volume-PCV):  

In Anaemia, the PCV is below the normal value for the age and sex i.e.

<40% in males

<36% in females

Anaemia results in decreased oxygen carrying capacity of blood.

 

PHYSIOLOGY

Severity of anaemia depends not only on the Hb level but also on

-age

-cardiac and respiratory function

-speed of onset of the anaemia

-plasma volume

Hence there are 3 stages of anaemia :

 

3 stages of anaemia

  • Compensated anaemia (Hb >7g/dl) – plasma volume expands to keep the total blood volume normal.
  • Decompensated anaemia (Hb 5-7g/dl) –there is increased cardiac output and heart rate. Vasodilatation and increased peripheral blood flow produce clinical signs of warm hands and collapsing pulse.
  • Life threatening anaemia (Hb <5g/dl) – Severe anaemia with circulatory congestion.

There are symptoms of tissue hypoxia and signs of heart failure.

 

CAUSES OF ANAEMIA

– Blood loss

– Increased red cell destruction

– Decreased red cell production

– Faulty red cell production

CLASSIFICATION

Although there may be many clinical situations in which a combination of abnormalities are present, the categories below serve as a useful diagnostic aid:-

Microcytic Hypochromic  – Iron deficiency anaemia

Thalassaemia

Sideroblastic anaemia

ACD( Anaemia of chronic disease)

Normocytic Normochromic –

Acute blood loss

Haemolytic anaemia

Renal failure

Infection

Inflammation

Neoplasm

Bone marrow infiltration and fibrosis

Endocrine diseases

Macrocytic Normochromic –

B12 deficiency anaemia

Folate deficiency anaemia

Aplastic anaemia

Hypothyroidism

Chronic Liver Disease

Alcohol

 

CLINICAL PRESENTATION

Symptoms                           

Fatique

Headache

Faintness

Breathlessness

Angina

Intemittent claudication

Palpitation

Tinnitus

            Signs

Pallor

Tachycardia

Systolic flow mummur

Cardiac failure

Retinal haemorrhage

Papilloedema

 

OTHER CLINICAL FINDINGS

Other signs and symptoms specific to the cause of the anaemia may be present :-

Weakness in the lower limbs

Leg ulceration

Jaundice

Lymphadenopathy

Splenomegaly

Body swelling

 

MANAGEMENT

  • History – Onset of features of anaemia

Constitutional symptoms

Family history

Drug history

History may be suggestive of type of    anaemia

  • Examination – Wasting, body swellings, pallor, jaundice, leuconychia, koilonychia, lymphadenopathy, splenomegaly, enlarged liver etc.
  • Investigations

FBC with blood film

Hb electrophoresis

Serum protein electrophoresis

Serum iron, ferritin and TIBC( Total iron binding capacity)

Serum folate and B12 levels

LFT

Urinalysis, E,U.& Creatinine

Abdominal USS & CXR

Treatment –

– Decompensated and life threatening anaemia need urgent intervention in the form of blood transfusion (packed cells)

– Replacement of deficient nutrients eg Fe, vit B12, folate

– Treatment of underlying cause

– Chemotherapy in neoplasms

– Erythropoietin in Chronic Kidney Disease and Sickle Cell Anaemia

 

COMPLICATIONS

NOTE : If the anaemia is not treated, it may cause many health problems such as;

i. Severe tiredness

ii. Pregnancy complications/loss

iii. Heart problem

iv.  Death

 

PREVENTION

  • Many types of anaemia cannot be prevented, but eating healthy diet might prevent iron and vitamin deficiency anaemia.
  • A healthy diet includes: Iron rich food e.g. beef and other meat etc.

PROGNOSIS

  • Generally speaking young people recover from anaemia more quickly than the older people because elderly can develop heart condition, including angina, arrhythmias, and myocarial infarction.
  • People that are undiagnosed or untreated for anaemia may have life threatening organ failure.

 

 

 

REFERENCES

  • Hoffbrand’s essential haematology, 8th edition
  • Power point presentation on anaemia