Anaemia

A low haemoglobin (Hb) concentration <135 g/L for men <115 g/L women.

Can be caused by low red cell mass or increased plasma volume

Causes/Factors

Types of anaemia - first need to determine the mean cell volume of the RBCs (normal MCV 76-96)

Low MCV - microcytic anaemia

1. Iron deficiency anaemia is the most common cause
2. Thalassaemia (if MCV is too low for the Hb level and the RBC count is raised). Iron accumulation so increase serum iron and ferritin

Normal MCV - normocytic anaemia

1. Acute blood loss
2. Anaemia of chronic disease (or $\downarrow$ MCV)
3. Bone marrow failure (not producing enough)
4. Chronic Kidney Disease (not enough EPO)
5. Hypothyroidism
6. Haemolysis (or $\uparrow$ MCV)
7. Pregnancy

Note

If $\downarrow$ WCC or $\downarrow$ platelet in normocytic anaemia suspect bone marrow failure

High MCV - macrocytic anaemia

1. Nutritional disorders - B12 or folate deficiency
2. Alcohol-related Liver Disease
3. Reticulocytosis
4. Cytotoxics (hydroxycarbamide)
5. Myelodysplastic syndromes
6. Marrow infiltration
7. Hypothyroidism
8. Anti-folate drugs (phenytoin)

Haemolytic anaemias

These do not fit into the above classification as it may be normo- or macrocytic (if there are reticulocytes)

• $\downarrow$ haptoglobin
• $\uparrow$ bilirubin - so patients often slightly jaundice

Symptoms

• Fatigue: Feeling tired or weak.
• Pale Skin: Especially noticeable in the face, nails, and mucous membranes.
• Shortness of Breath: Especially with exertion.
• Dizziness or Lightheadedness: Especially when standing up.
• Cold Hands and Feet: Due to poor circulation.
• Headache: Especially with severe anemia.

Signs

• Pale Conjunctiva and Palms: Visible paleness of the conjunctiva (the white part of the eyes) and palms.
• Rapid Heart Rate: Tachycardia may occur to compensate for reduced oxygen-carrying capacity.
• Angular cheilitis: Ulceration at the side of the mouth - iron deficiency anaemia. Also a feature of B12 and B2 deficiency

Diagnostic Tests

• FBC
• B12 and folate
• Ferritin
• Total iron binding capacity

Disease	Iron	TIBC	Ferritin
Iron deficiency	$\downarrow$	$\uparrow$	$\downarrow$
Anaemia of chronic disease	$\downarrow$	$\downarrow$	$\uparrow$
Chronic haemolysis	$\uparrow$	$\downarrow$	$\uparrow$
Haemochromatosis	$\uparrow$	$\downarrow$ or $\leftrightarrow$	$\uparrow$
Pregnancy	$\uparrow$	$\uparrow$	$\leftrightarrow$
Sideroblastic anaemia	$\uparrow$	$\leftrightarrow$	$\uparrow$

Management

• Treat the underlying cause

• Consider transfusion of Hb <70

• 1 unit raises Hb by 10g/L and contains 200-250 mg of iron

• 10-20ml/kg recipient

• Stored at 4$°$C for up to 35 days