Anemia
Anemia
Definition : Anemia refers to a state in which the level of haemoglobin in the blood is below appropriate for age and sex.
We have described in article :
Classification of Anemia
Common Causes of Anemia
Clinical features of Anemia
Investigation of Anemia
Treatment of Anemia
Symptoms of anemia :
- Fatigue, tiredness, effort intolerance.
- Effort dyspnoea.
- Palpitations.
- Effort angina.
- Headaches.
- Faintness, giddiness.
- Pounding in the ear.
- Symptoms of the cause.
Signs of anemia :
- Pallor.
- Tachycardia.
- Koilonychia: Iron deficiency anemia.
- Jaundice: Haemolytic anemia.
- Haemolytic facies: Haemolytic anemia,
- Bleeding manifestation: Aplastic anemia, anemia due to bone marrow infiltration such as leukaemia.
- Temperature: Aplastic anemia, anemia due to bone marrow infiltration such as leukaemia.
- Lymphadenopathy: Anemia due to leukaemia, lymphoma etc.
- Systolic flow murmur
- High cardiac output state.
- Features of congestive cardiac failure.
- Leg ulcer: Sickle cell anemia.
- Rarely papilioedema.
- Hypertension: CKD.
- Abdomen: Hepatomegaly, splenomegaly, any lump (stomach, colon).
Classification of anemia:
Morphological classification:
(On the basis of absolute values-MCV, MCH, MCHC)
1) Microcytic hypochromic anemia: ( MCV, MCH & MCHC)
- Iron deficiency anemia. Thalassaemias
- Sideroblastic anemia.
- Anemia of chronic disease.
2) Normocytic normochromic anemia: (MCV, MCH & MCHC normal, but RBC & Hb).
- Aplastic anemia.
- Haemolytic anemia.
- Acute haemorrhagic
- anemia.
3) Macrocytic anaemia: ( MCV, MCHC normal).
- Megaloblasic anemia vtamin B12 deficiency.
- Megaloblastic anaemis due to folic acid deficiency.
Common causes of anemia :
1). Blood loss anaemia: Haemorrhoids.
- Anal fissure.
- Bleeding peptic ulcer disease.
- Carcinoma of stomach, colon etc.
- Menorrhagia
- Hook worm infestation.
2) Nutritional deficiency: Lack of iron and folate in diet, malabsorption.
3) Frequent pregnancy. 4) Chronic kidney disease (CKD).
5) Haematological malignancy.
6) Aplastic anaemia.
7) Congenital haemolytic anaemia.
8) Anaemia of chronic disease.
Causes of anemia in chronic diseases: [Mechanism- IL6 suppresses bone marrow
2) Chronic inflammation e.g. connective tissue disorders.
3) Malignancy.
History to find out cause of Anemia:
- Any chronic bleeding e.g. per-rectal bleeding, hematemesis, melaena, haemoptysis, menorrhagia (in female).
- Dietary history- Megaloblastic anemia is common in strict vegans.
- Gastric or intestinal surgery.
- Abdominal lump.
- Fever, bleeding manifestation- Haematological malignancy, bone marrow failure.
- Drug history-Immunosuppressive drugs.
- Any chronic disease.
- History of repeated blood transfusion- Hereditary haemolytic anemia.
Clinical features of anemia:
Depends on the degree of anemia and severity of the causative disorder.
Investigation plan for anemia :
- Hb%, CBC with ESR
- PBF.
- Bone marrow examination- In suspected aplastic anemia, leukaemia etc.
- Other tests: (Done in particular situations)
- Serum iron profile.
- Haemoglobin electrophoresis.
- Serum vitamin B12 and folic acid assay.
Treatment plan for anemia :
1) Correction of anaemia by:
- Oral iron therapy
- Parenteral iron therapy
- Blood transfusion
- Folic acid and vitamin B12 therapy etc.
2) Treatment of underlying disease.
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