Transcript Anaemia - ASHWINI

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
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Fatigue
Headaches
Faintness
SOB
Palpitations
Angina
Intermittent Claudication
Pica
Recurrent minor infections…….
Signs
• Pallor – face, lips, tongue, conjunctivae
etc.
• Glossitis, Angular stomatitis, Oesophageal
webs
• Koilonychia
• Hypersplenism
• Bleeding………
Primary Investigations
• FBC
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Hb
RBCs
HTC/PCV
MCV (79-96fl)
MCHb
MCHbC (27-32pg)
Reticulocyte count
White cells + plts
Classification
Microcytic
Normocytic
Macrocytic
Fe deficiency
Acute Blood
B12 deficiency
Thalassaemias
Haemolysis
Folate deficiency
Chronic disease
Pregnancy
Liver Disease
Renal failure
Alcohol
Chronic disease
Myelodysplasia
Bone marrow
failure
Hypothyroidism
Causes of Anaemia
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
Haemolysis
• Reduced rbc lifespan and increased rbc
destruction
• Assoc. w/ Reticulocytosis, Splenomegaly,
Jaundice, Haemoglobinuria
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
Micronutrient deficiencies:
Macrocytic anaemias
1. 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)
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
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
Folic acid def. Rx:
• 1mg/d orally
• Rapid improvement
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
Rx Fe deficiency:
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Oral: FeSO4 200mg 12-8hrly
Continue until Hb is normal
3 months to replenish stores
Dietary advice
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
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
Aplastic anaemia
• Severe life threatening, bone marrow
failure
• Etiology idiopathic or autoimmunity,
radiation, drugs, toxins, viruses.
• Peripheral blood smear pancytopenia
Marrow infiltration
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Leukaemias
Myelofibrosis
Disseminated carcinoma
Disseminated lymphomas
Summary