Anaemia

• Define anaemia.

  Low concentration of Hb in blood
• What are the normal ranges of Hb?

  Men = 130-180 g/L

  Women = 120-165 g/L
• How is anaemia classified?

  By MCV of RBCs (normally 80-100 fL)
• What are the symptoms of anaemia?

  Fatigue

  SOB

  Headaches

  Dizziness

  Palpitation

  Worsening comorbidities (angina, HF, PAD)

  Specific to iron-deficiency anaemia

  • Pica
  • Hair loss
• What are the signs of anaemia?

  Pale skin

  Conjunctival pallor

  Tachycardia

  Tachypnoea

  Koilonychia (iron-deficiency anaemia)

  Angular cheilitis (iron)

  Atrophic gastritis (iron)

  Brittle hair & nails (iron)

  Jaundice (haemolytic)

  Bone deformities (thalassaemia)

  Oedema, HTN (CKD)
• What are the different types of anaemia?

  Microcytic

  Normocytic

  Macrocytic
• What are the potential causes of microcytic anaemia?

  TAILS

  Thalassaemia

  Anaemia of chronic disease

  Iron-deficiency anaemia

  Lead poisoning

  Sideroblastic anaemia
• What is sideroblastic anaemia?

  Occurs when bone marrow cannot incorporate iron into Hb molecules

  Due to either genetic defect or myelodysplastic syndrome
• What are the potential causes of iron-deficiency anaemia?

  Insufficient dietary iron intake (e.g. restrictive diets)

  Reduced iron absorption (e.g. coeliac disease)

  Increased body iron requirements (e.g. pregnancy)

  Blood loss (e.g. peptic ulcer, bowel cancer, menstruation)
• What are the Inx for iron-deficiency anaemia?

  Serum ferritin

  Total iron-binding capacity

  Transferrin saturation

  NOTE: New iron-deficiency anaemia in adult (w/o obvious cause) should prompt FIT test ± colonoscopy & OGD)
• Fill in the blanks

  A) low or normal

  B) raised

  C) low

  D) high

  E) same

  F) high

  
• What is the management of iron deficiency anaemia?

  Iron supplementation

  • oral iron (rise in Hb around 20 g/L in 1st month)
  • iron infusions (rapid boost in iron)
• What are the potential causes of normocytic anaemia?

  3 As & 2 Hs

  Acute blood loss

  Anaemia of chronic disease

  Aplastic disease

  Haemolytic anaemia

  Hypothyroidism
• What is haemolytic anaemia?

  Destruction of RBCs (haemolysis) results in low Hb (anaemia)
• What inherited conditions can cause haemolytic anaemia?

  Hereditary spherocytosis

  Hereditary elliptocytosis

  Thalassaemia

  Sickle cell anaemia

  G6PD deficiency
• What acquired conditions may cause haemolytic anaemia?

  Autoimmune haemolytic anaemia

  Alloimmune haemolytic anaemia

  Paroxysmal nocturnal haemoglobinuria

  Microangiopathic haemolytic anaemia

  Prosthetic valve-related haemolysis
• What are the 2 types of macrocytic anaemia?

  Normoblastic

  Megaloblastic
• What are the causes of normoblastic macrocytic anaemia?

  Alcohol

  Reticulocytosis (haemolytic anaemia or blood loss)

  Hypothyroidism

  Liver disease

  Drugs (e.g. azathioprine)
• What are the causes of megaloblastic macrocytic anaemia?

  Vitamin B12 deficiency

  Folate deficiency

  Impaired DNA synthesis prevents cell from dividing normally
• What are reticulocytes?

  Immature RBCs

  Often produced during rapid turnover
• What are the potential causes of B12 deficiency?

  Autoimmune (pernicious anaemia)

  Malabsorption (Crohn's, coeliac, gastric surgery, atrophic gastritis)

  Toxins (e.g. NO)

  Inadequate dietary intake
• What are the potential causes of folate deficiency?

  Inadequate dietary intake

  Alcoholism

  Any GI disorder affecting small bowel

  Pregnancy

  Increased RBC destruction

  Exfoliative skin disorders (psoriasis)

  Medications (anti-epileptics)