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Overview of Anaemia

 
 
 
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Overview

Anaemia is a very common condition that may occur in the context of reduced red blood cell production, increased red blood cell production, or red blood cell loss.
  • Look For

  • Reduced serum haemoglobin (Hb) concentration
  • Reduced haematocrit (HCT) / packed cell volume (PCV)
  • Reduced red cell count (RCC)
  • Causes of Anaemia

  • Reduced RBC Production

  • Haematinic deficiency - B12, folate, iron
  • Bone marrow pathology - pure red cell aplasia, myelodysplastic syndrome, myelofibrosis, bone marrow metastasis
  • Endocrine - EPO deficiency, hypothyroidism
  • Anaemia of chronic disease (infection / inflammation / malignancy)
  • Sideroblastic anaemia
  • Thalassaemias
  • Increased RBC Destruction (Haemolysis)

  • Immune haemolysis - autoimmune, alloimmune, drug-induced
  • Red cell fragmentation - thrombotic microangiopathies, mechanical haemolysis
  • Intrinsic RBC disorders - enzymopathies, membranopathies, haemoglobinopathies
  • Hypersplenism
  • Other - infection, copper, lead, hypophosphataemia
  • RBC Loss

  • Trauma
  • Gastrointestinal bleed
  • Bleeding from another source e.g. urinary tract
  • Factitious

  • Dilutional - excess fluid administration, pregnancy

Microcytic Hypochromic Anaemia

  • Look For

  • Reduced serum haemoglobin, haematocrit and red cell count
  • Reduced MCV (<80fL)
  • Reduced MCH / MCHC
  • Causes of Microcytic Hypochromic Anaemia

  • Iron deficiency anaemia
  • Thalassaemia
  • Congenital sideroblastic anaemia
  • Anaemia of chronic disease
  • Lead poisoning
  • Hyperthyroidism

Normocytic Normochromic Anaemia

  • Look For

  • Reduced serum haemoglobin, haematocrit and red cell count
  • Normal MCV (80 - 100fL)
  • Normal MCH / MCHC
  • Causes of Normocytic Normochromic Anaemia

  • Dilutional - excess fluid administration, pregnancy
  • Acute haemorrhage
  • Chronic kidney disease
  • Anaemia of chronic disease (infection / inflammation / malignancy)
  • Pure red cell aplasia - Diamond-Blackfan syndrome, drugs, lymphoma, CLL, parvovirus B19
  • Bone marrow infiltration - myelofibrosis, bone marrow metastases
  • Early megaloblastic anaemia
  • Early iron deficiency anaemia
  • Haemolytic anaemia
  • Congenital sideroblastic anaemia

Macrocytic Hyperchromic Anaemia

  • Look For

  • Reduced serum haemoglobin, haematocrit and red cell count
  • Elevated MCV (>100fL)
  • Elevated MCH / MCHC
  • Causes of Macrocytic Hyperchromic Anaemia

  • Megaloblastic anaemia - B12 / folate deficiency, drugs
  • Myelodysplastic syndrome
  • Post splenectomy
  • Hypothyroidism
  • Chronic liver disease
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