Flowchart
Case 3
Flowchart content
Large blood loss
Water shift from interstitial → plasma
Haemodilution,
↓ Haematocrit
↓ Oxygenation
Haemorrhagic Anaemia
Billirubin accumulation, jaundice
Juxtoglomerular apparatus in kidney
↑ Erythropoietin
↑ Proliferation and premature release of reticulocytes
Remnants of nucleus and organelles in blood film
Abnormal GI tract bleeding
Heavy menstrual bleeding
↓ Ferritin
↓ Haemosiderin
↓ Iron stores, serum iron, ferritin, transferrin saturation
↑ Erythroid activity in bone marrow
Hypochromic and microcytic RBCs
↓ Hb, MCV, MCHC;
↑ RBCWD
↓ Haemoglobin content in RBC
↓ α-globin production
Deletion mutation of α-globin alleles
Consistent RBCWD
Thalassemia
(α and β variants)
Iron deficiency anaemia
Pallor, fatigue
Haemolytic
Anaemia
Activation of monocytes, T-cells
Inflammatory stimulus
↑ Hepcidin synthesis, consequent
↓ Ferroportin
Normal serum ferritin levels;
↓ Serum iron
↓ Iron availability, despite high storage supply
↓ Normal Hb values until inflammation is resolved
↓ Erythropoietin
↓ Erythropoiesis
Inflammatory mediators
Anaemia of chronic inflammation/
disease
Normocytic, immature cells
Vegetarian diet, insufficient dietary iron
Chronic conditions
Malaena
Haemorrhoid
Fatigue, pallor
Darker urine
Oral iron replacement therapy
Intravenous iron replacement therapy
Iron chelation therapy to avoid haemochromatosis
↓ β-globin production
Deletion mutation of β-globin alleles
Folic acid
supplementation
Treatment of underlying disease
Corticosteroids
Correction of avenue of bleeding
Correction of abnormal RBC breakdown
Abnormal breakdown of RBCs
Microcytic RBCs with chronic bleeding
Inherited conditions causing RBC membrane defects
Autoimmune diseases
Peptic ulcer
Epithelial injury
Diffusion of H+ across gastric mucosa
H. pylori infection attacks gastric mucous
Bloody stool
Tenderness of epigastrum
H. pylori produces urea, detected in urease test
Triple therapy
Diet and lifestyle