Anaemia

Anaemia is a condition characterized by a decrease in the number of red blood cells (RBCs) or the amount of hemoglobin in the blood, leading to reduced oxygen transport capacity. The diagnosis, differential diagnosis, and management of anaemia involve several steps and considerations:

Diagnosis:

  • Risk Factors: Dietary deficiencies, family history of hematologic diseases, chronic diseases, recent bleeding
  • General Symptoms
    • Fatigue: A common and early symptom, often due to decreased oxygen delivery to tissues.
    • Weakness: Feeling of generalized lack of energy and strength.
    • Dizziness or Lightheadedness: Especially upon standing or with exertion.
    • Shortness of Breath: Particularly during exercise or exertion, as the body tries to compensate for decreased oxygen carrying capacity.
    • Palpitations: Awareness of the heart beating, often fast or irregularly, as the heart attempts to deliver more oxygen-rich blood.
  • Examination Signs
    • Pallor: Pale skin, especially noticeable on the face, inner lower eyelids, and nails.
    • Tachycardia: Rapid heart rate, especially upon exertion.
    • Systolic Heart Murmur: Due to increased flow of blood in the arteries.
    • Angular Cheilitis: Inflammation of the corners of the mouth.
    • Koilonychia: Spoon-shaped nails, commonly seen in iron deficiency anemia.
  • Other Symptoms
    • Headache: Can occur due to decreased oxygen delivery to the brain.
    • Coldness in Hands and Feet: Poor circulation due to reduced hemoglobin.
    • Chest Pain: Especially in people with underlying heart disease, as anemia can exacerbate angina.
    • Irritability and Mood Changes: Due to decreased oxygenation.
    • Difficulty Concentrating: Reduced oxygen to the brain can affect cognitive functions.
  • Laboratory Tests:
    • Full Blood Count (FBC): To check hemoglobin levels, RBC count, and indices like mean corpuscular volume (MCV), which can indicate the type of anaemia.
    • Peripheral Smear: To examine the shape, size, and color of blood cells.
    • Reticulocyte Count: To assess bone marrow function.
    • Iron Studies: Including serum iron, ferritin, total iron-binding capacity (TIBC), and transferrin saturation.
    • Vitamin B12 and Folate Levels: To rule out deficiency.
    • Other Tests: May include renal function, liver enzymes, thyroid function tests, and hemolysis markers like lactate dehydrogenase (LDH), haptoglobin, and bilirubin depending on the suspected cause.

Differential Diagnosis:

The differential diagnosis of anaemia is typically based on the MCV:

  • Microcytic Anaemia (MCV <80 fL):
    • Iron deficiency anaemia (most common).
    • Anaemia of chronic disease (ACD) with concurrent iron deficiency.
    • Thalassemia.
    • Lead poisoning.
  • Normocytic Anaemia (MCV 80-100 fL):
    • ACD without iron deficiency.
    • Acute blood loss.
    • Aplastic anaemia.
    • Renal failure.
    • Hemolysis.
  • Macrocytic Anaemia (MCV >100 fL):
    • Vitamin B12 or folate deficiency.
    • Myelodysplastic syndromes.
    • Alcoholism.
    • Liver disease.
    • Hypothyroidism.

Management:

  • Iron Deficiency Anaemia:
    • Oral iron supplements (ferrous sulfate or ferrous gluconate).
    • Treat underlying causes such as bleeding.
    • Intravenous iron for those who cannot tolerate oral iron or with malabsorption.
  • Vitamin B12 or Folate Deficiency:
    • Vitamin B12 injections or high-dose oral supplementation.
    • Oral folate supplementation.
    • Addressing dietary deficiencies.
  • Anaemia of Chronic Disease:
    • Treatment of underlying inflammatory or chronic disease.
    • Erythropoiesis-stimulating agents (ESAs) for certain conditions like renal anaemia.
    • Consideration of IV iron if iron stores are low.
  • Hemolytic Anaemia:
    • Identifying and treating the underlying cause (e.g., stopping a causative medication).
    • Corticosteroids or immunosuppressive agents for immune-mediated hemolysis.
    • Transfusions may be necessary for acute or severe anaemia.
  • Aplastic Anaemia:
    • Bone marrow stimulants.
    • Immunosuppressive therapy.
    • Bone marrow transplantation for severe cases.
  • Thalassemia:
    • Regular blood transfusions in severe cases.
    • Chelation therapy to manage iron overload.
    • Folic acid supplementation.
  • General Measures:
    • Diet counseling for sources of iron, vitamin B12, and folate.
    • Monitoring response to treatment with repeat FBC and reticulocyte count.
    • Referral to a hematologist for complex cases or if a primary bone marrow disorder is suspected.

It’s essential for the management plan to be tailored to the specific type and cause of anaemia. This often involves both treatment of the anaemia itself and the underlying condition that led to it. Regular monitoring and follow-up are crucial to ensure the effectiveness of the treatment and to adjust it as necessary.