Anemia evaluation

1. Anemia
Anemia: Anemia refers to a state in which the level of haemoglobin in the blood is below the
reference range appropriate for age and sex.
Normal Hb: M→13-18 g/dl
F→11.5-16.5 g/dl
Sites where seen Causes/ classification History taking
1.Lower conjunctiva
2.upper surface of
the tongue
3.Buccal mucous
membrane
4.Nail bed
5.Palm of the hand
6.sole of the foot.
Morphological classification:
1.Normocytic normochromic
(MCV normal→ 76-98 fl):
 Blood loss
 Anemia of chronic disease
2.Microcytic hypochromic
(MCV→<76fl):
 Thalassasemia (hereditary
hemolytic anemia)
 IDA
 sideroblastic anemia
 Anemia of chronic disease
3.Megaloblstic anemia
(MCV→>98 fl):
 B12/folate deficiency
 Pernicious anemia
 Drugs(cytotoxic drugs)
 Surgery(gastrectomy)
 Myelodysplaia
1.Dietar history:
2.Past Medical History:
-Rheumatoid Arthrits
(ACD)
-chronic diseases(CKD)
-Surgery(Gastrectomy)
3.Family History:
-Haemoglobinopathy
-Spherocytosis
-Pernicious anemia
4.Drug history:
-NSAIDS (PUD)
-Aspirin (PUD)
-Sulphonamide
(hemolysis)
-Chloramphenicol
(Aplasia)
5.Pregnancy/
Heavy menstrual
bleeding/malabsorption
6.Any bleeding history:
-haemorrhoid
-epistaxis
-malena
Aetiological classifications:
1.ineffective marrow production:
 lack of iron/B12/folate
 Myelodysplaia
 Malignancy
 Renal failure
 Anemia of chronic disease
2.Increased removal of cells:
 Blood loss
 Haemolysis
 Hypersplenism
Dr Ruhul Amin
REGISTRAR
Departmentof Medicine,JRRMCH.
BANGLADESH.
EMAIL: ruhul006@gmail.com

2. Physical examinations
General Systemic Symptoms
Oral:Tongue→smooth,shiny,
Atrophy of papilla, Angular stomatits
Anemia→Pallor
Jaundice→hemolysis
Edema →Anemic HF,
Pulse→Tachycardia
JVP→ raised
BP→Postural Hypotension
Clubbing→malignancy
Koilonychia→IDA
Leuconychia→IDA
Sternal tenderness→Leukemia,KA
LN→ malignancy
Abdomen :
 RIF mass→caecal
carcinoma
 Hepatosplenomegaly
→
CVS :FLOW Murmur
Respiratorysystem→PHT
(sickle cell anemia)
Neurology:
→Peripheral neuropathy
→SCD
→Dementia
→stroke (sickle cell anemia)
LEG:
leg ulcer (sickle cell anemia)
-Tiredness
-lightheadedness
-Breathlessness
-Angina/
claudication
-edema
Investigations:
1.Full blood count :
(HB%,TC,DC,ESR,PLT )
-pancytopenia (aplastic
anemia,hypersplenism,aleukemiac
anemia)
2.PBF
3.Reticulocyte count: High in HA
4.MCV & MCHC
5.BM examination
6.USG of abdomen
7.Upper GIT endo/colonoscopy
8.Iron profile
Q.what are the signs point to
specific Cause of anemia ?
-Triad of anemia,jaundice
,splenomegaly→Hemolytic
anemia
-angular stomatits,glossitis→IDA
-Glossitis→B12/folate deficiency
-splenomegaly→CML.lymphoma
-Bony tender→acute leukemia
- leg ulcer (sickle cell anemia)
- Neurology:B12 deficiency
→Peripheral neuropathy
→SCD
→Dementia
→stroke(sickle cell anemia)
Q.causes of
sideroblastic
anemia ?
1.hereditary
2.acquired:
a.primary
b.secondary
-Rheumatoid
arthritis
-Neoplastic
(lymphoma.
leukemia,carcinoma
,myeloma)
-drugs (INH)
-LEAD poisoning
-Megaloblastic
anemia,hemolytic
anemia