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Anaemia (Aetiology (Metabolic (Fe deficiency Chronic blood loss (GI,…
Anaemia
Aetiology
Metabolic
Fe deficiency
Chronic blood loss (GI, menses)
Poor diet intake
Malabsorption (Coeliac, Crohn's)
Renal failure
Low EPO
B12/folate deficiency
Metabolic - alcohol/liver disease
Autoimmune - Coeliac, Crohn's
Drugs - cholestyramine, DFR inhibs
Iatrogenic - dialysis
Liver disease
Genetic
Enzyme disorders
G6PD deficiency
PK deficiency
Hb disorders
Thalassemias
Sickle cell
Membrane defects
Spherocytosis
Elliptocytosis
Neoplastic
MDS
Leukaemias
Myeloma
Endocrine
Hypothyroidism
Pregnancy
Haematological
Reticulocytosis
Sideroblastic anaemia
Older adults
Haemolysis
Immune or non immune
Aplastic anaemia
Drugs
Cytotoxics
Antifolates
Alcohol
Infection/inflamm
Chronic disease
Infection, systemic autoimmune disease,
malignancy, renal failure, liver failure etc.
Vascular
Bleeding
Acute rapid loss, Hb conc initially the same
Vol resus dilutes RBCs, low Hb MCV normal
Chronically, Fe stores depleted (Fe deficient anaemia)
Clinical
presentation
Fatigue
SOB
(exertional)
Palpitations
Syncope
Headache
Anorexia
Chest pain
(angina)
Jaundice
Pathophysiology
Mechanisms
Whole blood loss
Trauma, GI bleeds etc.
Increased RBC loss
Vascular - bleeding
Haematological - haemolytic anaemias
Reduced RBC production
Metabolic - Fe, folate, B12, EPO (renal failure)
Infection/inflamm - chronic disease
Iatrogenic - chemo, RT
Idiopathic - anemia chronic disease
Neoplastic - MDS, myeloma, leukaemia
Haematological - aplastic anaemia
Outcome
Issues
Reduced RBC conc in serum (relative to plasma vol)
Impaired O2 carrying capacity so reduced supply to organs
May also have hypovolemia and thus shock
Compensation
Increased O2 extraction by tissues (2,3 DPG)
Increased SV and HR to inc CO
Types
Microcytic
Metabolic - Fe deficiency
Idiopathic - sideroblastic anaemia, anaemia of chronic disease
Genetic - thalassemias
Normocytic
Vascular - acute blood loss, haemolysis
Metabolic - renal failure
Idiopathic - anaemia of chronic disease
Endocrine - hypothyroidism, pregnancy
Haematological - BM failure (aplastic anaemia)
Macrocytic
Metabolic - B12/folate deficiency, alcohol/liver disease
Neoplastic - MDS/marrow infiltration
Drugs - cytotoxics, antifolates, AEDs
Endocrine - hypothyroidism
Haematological - reticulocytosis
Diagnosis
Examination
Kolinykia, pallor, pale conjunctiva
high HR, flow murmurs
Investigations
Bedside
Obs - high HR
ECG - sinus tachy
Bloods
FBC - low Hb, MCV (high/norm/low)
Fe studies (ferritin, TIBC), B12/folate (may be low)
LFTs (liver disease), U+Es (renal disease)
TFTs (thyroid function)
Blood film
Microcytic, hypochromic, target cells - Fe deficiency
Macrocytic, megaloblastic - B12/folate deficiency
Imaging
OGD/colonoscopy if GIT bleed
History
PC - symptoms
HPC - genetic disease, chronic disease
DH - cytotoxic, antifolates, allergies
FH - thalassemia, sickle cell, haemolytic
SH - smoking, alcohol, diet
Epidemiology
Common
Fe deficiency
commonest cause
Management
Conservative
Education
Find and treat cause
Medical
Fe replacement
Indication: Fe deficiency anaemia
E.g. ferrous sulphate tablets, IV Fe
Blood transfusion
Indication: severe acute anaemia Hb<70
MOA: replace loss with matched blood
B12/folate replacement
Indication: B12/folate deficiency
EPO
Indication: anaemia chronic disease e.g. RF
MOA: inc RBC production
SEs: flu-like symptoms, HTN, VTE
Pyridoxine replacement
Indication: sideroblastic anaemia
Definition
Low Hb conc for age and sex
(<115g/L F, <135g/L M)