A 45-year-old Singaporean man presents to the GP with lethargy for the last few months. The GP did a full blood count which shows that the patient is anaemic
unexplained.
Microcytic
Iron deficiency
Thalassemia
Normocytic
Blood loss
Haemolysis
Chronic disease
Marrow infiltration
Macrocytic
Megaloblastic
Failure of production of RBC
Nutritional
Reduced BM erythroid cells
Ineffective RBC formation
Chronic inflammation
thalassaemia
renal disease
b12
iron
folate
aplastic anemia
marrow infiltration by leukaemia / neoplasm
GI bleed, ulcer, malignancy
memorrhagia
pregnancy
malabsorption (coeliac disease, atrophic gastritis)
malnutrition
GU bleed
pulmonary haemosiderosis
nail flattening, koilonychia (concave nails), sore tonges, angular stomatitis, dysphagia, gastritis
serum ferratin
B12
Folate
deficiency of gastric IF - pernicious, gastrectomy
AI - IgG against gastric parietal cells
blood count and film, BM aspirate, b12/folate levels, Auto antibodies, test for B12 absorption (radioactive labelled b12, shilling test)
risk of thrombosis, hyperhomocysteinaemia
absorptive - crohn's disease, stagnant loop syndrome, tropical sprue, fish tapeworm, congenital malabsoption
malabsorptive - coeliac disease, tropical sprue, small bower disease / resection
pregnancy, haemolytic anaemia, myeloproliferative disorders
drug induced - folate antagonists, metabolic inhibitors, NO (prolonged use)
hereditary orotic aciduria
inherited
disorders of RBC cell membrane
hereditary spherocytosis
hereditary elliptocytosis
RBC cell metabolism
G6PD deficiency
PK deficiency
oxidative stress trigger
fava beans, drugs, infections.
jaundive in neonate.
rbc cannot generate ATP and become regid
Acquired
AI haemolytic anaemia
warm
cold
microangiopathic haemolytic anaemia
haemolytic uraemic syndrome
thrombotic thrombocytopenic purpura
Thalassemia
alpha
beta
Hb-barts - deletion of all 4 genes, death in utero
HbH - deletion of 3. splenomegaly, hepatomegaly, bone and growth changes, hypochromic microcytic RBC with poikolicytosis, polychromasia and target cells.
trait - deletion of 1. lower MCV, MCH.
excess a-chain - toxic. skull bossing an maxillary enlargement. hair on end radiological appearance of the skull.
electrophoresis
Sickle cell
complications - GU (loss of ability to concentrate urine), Skin (lower limb ulceration), Eyes (proliferative retinopathy, glaucoma), Hepatobiliary (liver damage, pigment gallstones)
sickle cell trait
no clinical problems, since there is enough HbA in red cells. 60%.
Anaemia of chronic disease
malignancy
RA
Connective tissue disorder
chronic infection
extensive trauma