anaemia 1

Nota:

• anaemia is present when the haemoglobin is more than two standard deviations below the mean haemoglobin for that individual. it varies with sex and age

1. symptoms

   Nota:

   • symptoms depends on the underlying pathology as well as the severity and speed of onset of anaemia. mild anaemia often no symptoms. insidious-onset anaemia, even if profound, likewise may cause few symptoms
   1. in rapid-onset/severe anaemia*: 1)fatigue 2)peripheral oedema e.g.swollen feet 3)breathlessness 4)angina

      Nota:

      • 3)breathlessness particularly if heart or lung disease is present. anemia is one cause of decompensation of chronic heart failure 4)angina if there is underlying coronary disease which may have been undetected before the anaemia
2. signs
   1. usually unremarkable*; 1)pallor(palms of the hand, conjunctiva) may occur 2) a systolic 'flow' murmur is common 3)evidence of pathology 4)long-standing iron deficiency anaemia, koilonychia(spoon- shaped nails) may occur

      Nota:

      • pallor may also occur in people that are not anaemic vice versa
3. classifications

   Nota:

   • anaemia is a physiological abnormality, not a diagnosi. a final, pathological diagnosis must always be made
   1. 1)microcytic/hypochromic anaemia: the red cells are smaller than normal and contain less haemoglobin than normal. common cause are iron deficiency anaemia and thalassaemia, MCV<80 fl
   2. 2)Normochromic and normocytic anaemia: AKA anaemia of chronic disease. red cells are normal or just slightly reduce in size and have a normal Hb conc. common cause include: 1) chronic infections, 2)inflammatory diseases 3)malignant disease 4)renal failure. MCV 80-95 fl

      Nota:

      • 1) C.I such as tuberculosis and osteomyelitis  2)I. D such as rheumatoid arthritis and connective tissue disorder the anaemia of chronic desease is in part caused by the inhibitory effect of interleukin 1 on erythropoiesis, and by erythropoietin deficiency*(especially in renal failure), iron deficiency often complicates chronic disease and may explain a lower than expected haemoglobin
   3. 3) Macrocytic anaemia: red cells are larger than normal. common cause 1)vitamin B12 or folate deficiency 2)cytotoxic drug treatment e.g azathioprine or cyclophosphamide 3)Myelodysplasia 4)Haemolytic anaemias 5)hypothyroidism 6)liver disease and alcohol abuse MCV >100 fl

      Nota:

      • 6)liver and alcohol abuse result in a macrocytosis but not anaemia!, unless there is a coincidental bleeding or haematinic deficiency