An Overview of Anaemia

Dr Abdul Rahim Hussein

Department of Haematology

An overview of anaemia

Introduction
Classification
Red cell indices
Approach to a patient with anaemia

An overview of anaemia
1. Introduction

A. Definition
B. Normal range
C. General principles
D. Theoretical aspects of
underlying diseases in relation to
clinical examination

An overview of anaemia
1. Introduction
A reduction in haemoglobin
A. Definition
concentration of blood with
reference to healthy individuals of
the same age group, sex,
physiological state and
environment (altitude)

An overview of anaemia
1. Introduction
B. Normal range for
haemoglobin

Depends on age-group
and sex
Paediatric and adult
normal range

An overview of anaemia
1. Introduction
C. General
principles

Anaemia is a sign not a

diagnosis/disease
Anaemia is a dynamic process
Although the elderly are more
prone to anaemia, being
elderly is not a cause of
anaemia
The diagnosis of iron
deficiency anaemia mandates
further work-up

An overview of anaemia
1. Introduction
Fundamental knowledge
C. Theoretical aspects of
with regard to the
underlying diseases in
underlying cause of the
relation to clinical
anaemia
e.g. hookworm
examination
infestation, koilonychia
>> IDA
e.g. vegan, subacute
combined degeneration
of the cord >>
Megaloblastic anaemia

An overview of anaemia
2. Classification

1. Pathophysiology/Aetiology
Blood loss
Increased destruction
Decreased production
2. Morphology (based on FBP)
Normocytic normochromic
(MCV & MCH are normal)
Microcytic hypochromic
(MCV & MCH are low)
Macrocytic
(MCV & MCH are high)

An overview of anaemia
3. Red cell indices

Rbc
Hb
HCT/PCV
MCV
MCH
MCHC
RDW

However other blood cells (white cell & platelet)

indices can be affected depending on the underlying
cause

An overview of anaemia
4. Approach to a patient
with anaemia

A. Clinical History
B. Physical examination
C. Investigations

An overview of anaemia
3. Approach to a patient
with anaemia
A. Clinical history

Main complaint
History of presenting
illness
Past medical history
Family history
Dietary history
Drug history
Menstrual history

An overview of anaemia
3. Approach to patients
with anaemia
A. Clinical history
Main complaint

>>

Main symptoms of
anaemia e.g. lethargy,
lassitude, malaise,
fatigue, tiredness

An overview of anaemia
3. Approach to patients
with anaemia
A. Clinical history
History of presenting >> Details about the main
symptom
illness
Associated symptoms
Underlying
pathogenesis

An overview of anaemia
3. Approach to patients
with anaemia
A. Clinical history
Family history

>>

Similar problem in the

family
Draw a family tree

An overview of anaemia
3. Approach to patients
with anaemia
A. Clinical history
Dietary history

>>

Daily dietary intake in

the main meals:
breakfast, lunch,
dinner (food&drink)

An overview of anaemia
3. Approach to a patient
with anaemia
B. Physical examination

General inspection
Vital signs
CVS
RS
Abdomen
LN
CNS

An overview of anaemia

3. Approach to a patient
with anaemia
C. Laboratory
investigations

I. Full blood picture (FBP)

Normocytic normochromic
Microcytic hypochromic
Macrocytic

An overview of anaemia
3. Approach to a patient with anaemia
C. Lab investigation
I. FBP
Normocytic normochromic
anaemia
Chronic inflammatory
diseases
Malignancy
Liver/renal/endocrine
diseases
II. Reticulocyte count
Acute blood loss
III. Biochemical tests
IV. Bone marrow exam
Haemolysis

An overview of anaemia
3. Approach to patient
with anaemia
C. Lab investigation
Microcytic hypochromic anaemia
I. FBP
Iron deficiency
Thalassaemia
Anaemia of chronic diseases
Sideroblastic anaemia
II.
III.
IV.
V.

Serum ferritin
Hb electrophoresis
Marrow iron store
Other investigations

An overview of anaemia
3. Approach to patient with
anaemia
C. Lab investigation
I. FBP

II. Reticulocyte count

III. Serum vit B12 & rbc folate
IV. Bone marrow exam.

Macrocytic anaemia
Megaloblaastic
anaemia
Non megaloblastic
anaemia