Diagnostic Approach to Anaemia (1)

Question 1

How’s it diagnosed?

How is it classified ?

How does it present?

Answer 1

➊ < 120g/L in women, < 130g/L in men

➋ • Microcytic - MCV < 80FI
• Normocytic - MCV 80-100FI
• Macrocytic - MCV > 100FI

➌ • Symptoms - Fatigue, SOB, Dizziness, Headache, Palpitations
• Signs - Pale skin, Conjunctival pallor, Tachycardia, Tachypnoea

Question 2

What are the causes of Microcytic anaemia?

Answer 2

• Iron-deficiency - Most common
• Thalassaemia
• Anaemia of chronic disease
• Lead poisoning
• Sideroblastic anaemia (very rare)

N.B. Sideroblastic anaemia presents very similarly to IDA, but is refractory to intensive iron therapy, and has an atypically high serum ferritin and iron

Question 3

What are the causes of Normocytic anaemia?

(There’s a pneumonic)

Answer 3

3 A’s and 2 H’s:
• Acute blood loss
• Aplastic anaemia (Bone Marrow Failure) - Suspect if pancytopenic
• Anaemia of chronic disease
• Haemolytic anaemia
• Hypothyroidism

Question 4

What are the causes of Macrocytic anaemia?

What’s a common cause of B12 deficiency?
→ What occurs here?
→ How is it managed?

Answer 4

➊ • Megaloblastic - B12 or Folate deficiency
• Non-megaloblastic - Alcohol, Hypothyroidism, Liver disease, Reticulocytosis, Drugs like Azathioprine

➋ Percinious anaemia
→ Autoimmune attack of gastric parietal cells by autoantibodies against IF, which is needed for B12 absorption in the terminal ileum
→ Life-long replacement with Cobalamin