ANEMIA

WHAT IS ANEMIA

● Anemia is defined as blood Hb concentration <13g/dl or hematocrit <39% in males and

1<12g/dl or Hct <37% in females.
● Grading of anemia (according to WHO)
○ Mild: 9-11g/dl
○ Moderate: 7-9g/dl
○ Severe <7g/dl
TYPES OF ANEMIAS

● Iron deficiency anemia

● Megaloblastic anemia
○ Vit B12 deficiency
○ Folate deficiency
● Hemolytic anemia
● Sickle cell anemia
● Thalassaemia
○ Alpha
○ beta
CLINICAL FEATURES

NON SPECIFIC SYMPTOMS: NON SPECIFIC SIGNS:

● Tiredness ● Mucosal membrane pallor

● Lightheadedness ● Tachypnoea
● Breathlessness ● Increased JVP
● development/ worsening of ischemic ● Tachycardia
symptoms ● Flow murmur
● Ankle edema
● Postural hypotension
SPECIFIC SIGNS

● Hemolytic anemia:
○ Jaundice
● Vit B12 deficiency:
○ Peripheral neuropathy
○ Dementia
○ Subacute combined degeneration od cord
● Sickle cell anemia:
○ Leg ulcers
○ Srtoke /features of Pulmonary HTN.
DETERMINE THE ETIOLOGY OF
ANEMIA
 INVESTIGATIONS
● CBP
● Peripheral smear
● Blood indices

ANEMIA MCV MCHC RDW SMEAR

Iron deficiency Microcytic Hypochromic raised Elliptocytes

anemia nucleated /
Target RBCs.

Vit B12 and Megaloblastic raised Oval

Folate PMN
deficiency segmented
anemia

Hemolytic Macrocytic Normochromic raised spherocytes

Thalassemia Microcytic Hypochromic Stippled RBC

INVESTIGATIONS

● Iron deficiency anemia:

○ Serum ferritin :
○ Iron:
○ Transferrin saturation :
○ TIBC :
○ Transferrin receptor
● Megaloblastic anemia:
○ Plasma lactate dehydrogenase :
○ Serum folate :
○ Red cell folate level
● Hemolytic anemia: Megaloblastic anemia
○ Unconjugated bilirubin
○ Lactate dehydrogenase
○ Urinary urobilinogen
○ Haptoglobin
○ Coombs test to know if antibody is present or not.
○ Osmotic fragility

Hemolytic anemia
● Sickle cell anemia:
○ Hemoglobin electrophoresis to demonstrate absence of HbA, 2-20% of HbF and predominance of HbS

Sickle cell anemia

Thalassemia