Anaemia

Question 1

What would you want to ask about if a patient has a low Hb?

Answer 1

• Fever, night sweats, itch and bone pain - infections and cancer can cause abnormal blood count
• Medications including OTC, from the internet and illicit e.g. NSAIDs can cause stomach ulceration and inflammation of the upper GI tract
• Diet - patient may have changed their diet and is not receiving enough iron
• Indigestion or vomiting: upper GI cancer can present with anaemia
• Change in bowels, either looser or constipated
• Blood loss from anywhere - urine, wiping penis/front/back passage, within the motions/faeces, in sperm or vaginal bleeding, blood in vomit, coughing up blood

Question 2

What would you want to consider in a patient with low Hb?

Answer 2

• Age and sex of patient (anaemia is more concerning if >40, and male. Menorrhagia is a common cause of anaemia in women under 40, though can occur in women who are over 40 as well, nevertheless serious causes must always be considered, even if unlikely))
• Medications (is the person taking medications which could be associated with anaemia, such as in this case where NSAIDs were prescribed which can cause gastric irritation)
• Summary of medical conditions (are they already known to have a condition which might lead to anaemia e.g. menorrhagia)
• Previous results (these may guide you to your next actions and sometimes looking at trends in blood results can be very useful e.g. is it a gradual decline or sudden drop in the haemoglobin)
• Previous investigations (has the person already had investigations into anaemia?)
• Recent consultations (has the person presented recently with any ‘red flags’ for anaemia)