Anaemia

Sadly, the anaemic monkey on the left is suffering from pallor.

Definition

A decrease in the quantity of haemoglobin. In practice, this means a low haemoglobin on an FBC.

Epidemiology

I think the red box says it all, really.

Pathophysiology

Go to causes of anaemia. There are loads and mostly worth learning.

Clinical Features

This is Lucifer. He has unfortunately got every symptom of anaemia. (Helpfully translated from American into a real language)

It's worth mentioning the majority of anaemia is asymptomatic. The most common symptoms are:

• Pallor
• Fatigue
• Dizziness
• Palpitations
• Chest pain
• Itching

Learn those. There are others in the box on the right-hand side but mostly that's just to show that there are loads of symptoms for anaemia.

Investigations

• FBC - I hope you've already done one of these - otherwise your diagnosis is inaccurate. If you've been looked at causes of anaemia, you'll know that after the haemoglobin, the next thing to look at is the MCV.

Microcytic anaemia (MCV<70)

• Ferritin, serum iron and total iron binding capacity (TIBC) - for iron deficiency anaemia

Normocytic anaemia (MCV 70-96)

With this, the next thing to look at is reticulocyte count. Reticulocytes are immature red blood cells and as the level of red blood cells goes down, reticulocyte production sometimes goes up but usually in acute blood loss. Thus:

• Elevated reticulocyte count suggests haemolytic anaemia or haemorrhage
• Normal/reduced reticulocyte count suggest anaemia of chronic disease. So you should do:
  • U+Es - abnormal kidney function
  • LFTs - abnormal liver function
  • TFTs - thryroid dysfunction
  • Serum iron - iron deficiency anaemia

Macrocytic anaemia (MCV>96)

• ESR - malignancy
• serum B12 - B12 deficiency
• red cell folate (not serum folate, it's less accurate) - folate deficiency
• LFTs - including gamma GT

When all those have been exhausted you can do a:

• bone marrow biopsy

If you B12 come back positive, you need to do a Schilling test. This is a test using differently labelled types of B12 (using different types of cobalt) to determine what the B12 deficiency is due to.