Anaemia
Definition
Low haemoglobin concentration (levels lower in females)
Aetiology
Refer to flowchart above
*TIBC = total iron binding capacity
Risk Factors
Clinical Features
Symptoms
Signs
Investigations
Bedside: Urinalysis (haematouria)
Bloods: FBC, Blood film, Coags, Fe studies (-- ferritin, -- sat, ++TIBC), haptoglobin (-- in haemolytic anaemia), LDH (++ = destruction of cells), LFT (bilirubin ++ if haemolytic), Coombs test (+ve), UEC (-- = -- EPO)
Others: BM biopsy (if suspect refractory anaemia)
Management
Source
BMJ Best Practice 2014
OHCM 9th Ed 2014
Low haemoglobin concentration (levels lower in females)
Aetiology
Refer to flowchart above
*TIBC = total iron binding capacity
Risk Factors
- Extremes of age
- Female
- Pregnancy
- Lactation
Clinical Features
Symptoms
- Fatigue
- Dyspnoea
- Faintness
- Palpitations
- Headache
- Concentration loss
- Tinnitus
- Anorexia
- Angina (if there is pre-existing coronary artery disease.)
Signs
- May be absent even in severe anaemia
- Koilonychia (spoon nails)
- Pallor (eg conjunctivae - not a reliable sign)
- Tachycardia, flow murmurs (if severe)
- PR exam not indicated unless tenesmus. Delay until colonoscopy.
Investigations
Bedside: Urinalysis (haematouria)
Bloods: FBC, Blood film, Coags, Fe studies (-- ferritin, -- sat, ++TIBC), haptoglobin (-- in haemolytic anaemia), LDH (++ = destruction of cells), LFT (bilirubin ++ if haemolytic), Coombs test (+ve), UEC (-- = -- EPO)
Others: BM biopsy (if suspect refractory anaemia)
Management
- Treat the cause
- Transfusion rarely needed unless severe (<70g/L) thalassaemia
- If CCF, be extremely cautious - give packed cells slowly with frusemide, stop if signs of CCF worsens
- If taking Fe tablets, take it with 1 glass of orange juice. Vit C aids Fe absorption.
Source
BMJ Best Practice 2014
OHCM 9th Ed 2014