Anaemia

Dr.Ahlam AL-Buhairan

Anaemia
Definition:
Reduction in the haemoglobin concenration. Accompanied by a reduction in the RBC count and PCV (with some few exceptions). Values are below the lower limit of the normal range.

Anaemia
The haemoglobin concentration is determined by alterations in both total circulating plasma volume as well as of total circulating haemoglobin mass.

Thus a reduction in plasma volume in some cases (dehydration) may mask the anaemia.

Anaemia
On the other hand, an increase in plasma volume due to splenomegaly e.g. may cause anaemia even with normal values. fals positive Anaemia does not appear immediately when acute major blood loss occurs because the total blood volume has been reduced.

Clinical features of anaemia

Factors affecting the clinical features associated with anaemia: 1. Speed of onset: Fast progressive anaemia causes more symptoms than the slow one. 2. Severity: Mild anaemia has no symptoms but are present when Hb is < 9-10g/dl. 3. Age: Anaemia is worst with elderly.

Signs&Symptoms
Symptoms:
Shortness of breath, weakness, lethargy, palpitation and headaches. In elderly, symptoms of cardiac failure, angina pectoris, confusionetc. Also, visual disturbances may occur because of retinal haemorrhages (very severe anaemia).

Signs
General:
Pallor of mucous membranes (Hb<9-10g/dl). Tachychardia, cardiomegaly, features of congestive heart failure.

Specific:
Associated with particular types of anaemia e.g koilonychia (spoon nails) with I.D.A., jaundice with H.A, leg ulcers with S.C.A

Classification of anaemia
Based on red cell indices divides the anaemia into:
1. Microcytic anaemia 2. Normocytic anaemia 3. Macrocytic anaemia

Microcytic anaemia
Microcytic,& hypochromic:
Red cell indices are below the normal range MCV <80 fl (80-95 fl) MCH <27 pg (27-34 pg) Iron deficiency anaemia, thalassaemia

Macrocytic anaemia
Macrocytic:
MCV >95 fl Megaloblastic anaemia; (deficiency of folate or vit B12) Liver disease, alcohol intake

Normocytic Anaemia
Normocytic& normochromic:
Red cell indices are within the normal range MCV 80-95 fl MCH 27-34 pg Haemolytic anaemia, B.M failure, after acute blood loss

Other lab findings

1. W.B.C&Plt counts: To exclude pancytopenia (reduction in all blood cells). Neutrophil&plt counts are increased in anaemia cases due to haemolysis or haemorrhage. W.B.C count is usually high in leukaemias and infections

Other lab findings

Reticulocyte count.
High count in anaemias associated with: 1. Erythroid hyperplasia as in chronic haemolysis. 2. Acute major haemorrhage (until the Hb returns to normal).

Other lab findings

Blood film:
Abnormal cell morphology or red cell inclusions may be associated with certain conditions. Assessment of W.B.C differential count, plt number and shape, presence of abnormal cells e.g normoblast, granulocyte precursors.

Other lab findings

B.M examination: By B.M aspiration. Detailed morphological information can be obtained e.g: 1. Details of developing cells (normoblastic or megaloblastic) 2. The proportion of the different cell lines can be assessed (myeloid:erythroid ratio).