Anaemia
Corrina Mc Mahon
Normal Haematopoiesis

Foetus – 0-2 mo; Yolk sac
2-7mo; liver/spleen
5-9mo; bone marrow

Infants – Bone marrow of all bones

Adults – Vertebrae, ribs, sternum, skull,
sacrum, proximal ends of femur
Haematopoiesis II
Normal Values

Haemoglobin
 15-21g/dl;
Neonate
 9.5-12.5g/dl; 1-3mo
 >11g/dl; >3mo
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Platelets
 150-450
x10^9/l
Signs and Symptoms of anaemia

Symptoms
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Pallor
Poor feeding
Tachypnoea
Lethargy
Signs
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Oedema
Tachypnoea
Tachycardia/systolic flow murmur/cardiomegaly
Hepatosplenomegaly
Hypotension
Types of Anaemia
Hypochromic/ microcytic
MCV<80fl
MCH<27
Iron deficiency
Thalassaemia
Chronic disease
Lead poisoning
Sideroblastic
Macrocytic
MCV>95fl
Megaloblastic
Alcohol
Liver disease
Myelodysplasia
Aplastic
Pregnancy
Reticulocytosis
Iron Deficiency Anaemia
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Commonest Anaemia
Normally 5-10% of iron in food is absorbed
C/F: Glossitis, Angular stomatitis, Brittle nails
Generalised epithelial changes
Causes of Iron Deficiency

Blood Loss
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Increased Demands
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GIT
Uterine
Renal
Prematurity
Growth
Pregnancy
Malabsorption
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Coeliac disease
Colitis
Cows Milk
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Diet
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Intrauterine blood loss
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Twin/twin
Foetal-Maternal
Iatrogenic Blood Loss
Investigations
FBC and Blood Film
 Serum Iron and TIBC
 Ferritin

Then find the cause!
Failure to Respond
Continued Haemorrhage
 Failure to comply
 Wrong diagnosis
 Mixed deficiency
 Malabsorption
 Slow release preparation
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Megaloblastic Anaemia
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Vitamin B12 deficiency
Folate deficiency
Abnormalities of B12 or folate metabolism, Anti-folate drugs, nitrous
oxide, transcobalamin deficiency
Defects of DNA synthesis, alcohol, hydroxyurea, chemotherapy
Causes of B12 deficiency

Nutritional
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3 year supply
Malabsorption
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Gastric causes
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Pernicious anaemia
Abnormality of intrinsic factor
Total or partial gastrectomy
Intestinal Causes
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Ileal resection
Crohns disease
Stagnant loop syndrome
Congenital malabsorption with preteinuria
Tropical sprue
Folate deficiency
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Nutritional
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Malabsorption
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Excess Utilisation
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Pregnancy and lactation
Prematurity
Haemolytic anaemia
Inflammatory disease
Malignancy
Drugs
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Coeliac Disease
Crohns disease
Extensive jejunal resection
Anticonvulsants
Sulphasalazine
Mixed
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Liver disease
Alcoholism
Haemolytic Anaemia
Hereditary
Membrane
H. Spherocytosis
H. Eliptocytosis
Metabolism
G6PD deficiency
Pyruvate Kinase deficiency
Haemoglobin
Abnormal, HbS, HbC etc
Acquired
Immune
Autoimmune
Alloimmune
Red cell Fragmenation
TTP
HUS
DIC
Infections
Chemical and Physical agents
PNH
Signs and symptoms of HA

s/s of Anaemia
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Jaundice
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Splenomegaly
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Abdominal pain
Investigation of HA
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FBC & film
Reticulocyte count
Direct Coombes test
Bilirubin & LDH
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Haptoglobins
Urinary Hb/Haemosiderin
Free serum Hb
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Specific tests
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Case 1
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Newborn infant
Pale,tachycardia
Hepatosplenomegaly
Jaundice
FBC
Hb 6g/dl
WCC 15 x 109/l
Platelets 200 x 109/l
Reticulocytes 10%
DCT positive
Haemolytic disease of the newborn
Passage of IgG antibodies
 Rhesus/ABO/Kell/Duffy/Kidd
 Mild, moderate, severe (Hydrops)
 May get worse with each pregnancy
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Case 2
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2 week old boy
Pale
Tachycardia
Prolonged Jaundice
Splenomegaly
Older brother jaundiced
Father – cholecystectomy
at 15 yrs
FBC
Hb 9g/dl
WCC 9 x 109/l
Platelets 210 x 109/l
Retics 15%
DCT negative
LFTS
Bilirubin 40 iu/l
LDH 500 iu/l
Case 2 Blood Film
Other investigations
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Virology
Cultures
Heinz body prep
Haemoglobin
electrophoresis
Red cell enzymes
Red cell membrane
studies
Hereditary Spherocytosis
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Most common HHA in
Northern Europeans
Membrane defect
Autosomal dominant
(75%)
Most severe cases –
hydrops in utero
Treatment;
 Blood transfusion
 Splenectomy
Case 3
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5yr old Nigerian boy
Pyrexial
URTI
Treated Co-trimoxazole
 lethargy/jaundice
FBC:
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Hb 8g/dl
WCC 15 x 109/l
Platelets 350 x 109/l
Reticulocytes 15%
Examination of Urine
G6PD Deficiency
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Sex – linked
West African,
Mediterranean, middle
East, SE Asia
Neonatal jaundice
Episodes of IV
haemolysis
Heinz Bodies
NADPH regenerates
glucathione which
protects Hb against
oxidative damage
Haemoglobinopathy

Thalassaemia
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Failure to produce adequate globin chains
Sickle cell Disease
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Production of an abnormal Hb
B-Thalassaemia Major
B-Thalassaemia Major
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Failure of B-Chain
production
Anaemia in 1st year
Chronic transfusion
Iron overload
Growth failure
Sickle Cell Anaemia
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Valine for glutamine
substitution at position 6 globin chain
Sickling; Abnormal
adherence of RBC to
endothelium  Hb
polymerisationelongated
filaments  semi-solid gel
Reversible
sickling/irreversible
changes
HbS - Sickling
HbF/HbA - sickling
Factors precipitating RBC sickling
Deoxygenation
Dehydration
Infection
Acidosis
Cold
Vigorous exercise
Menstruation
Problems associated with SCD
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Hyposplenism
Anaemia
Vasoocclusion
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Bone
Chest
Abdominal
Splenic sequestration
Cerebrovascular events
Renal Disease
Life expectancy 45yrs
Bony Abnormalities in SCD
Diagnosis

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FBC/Film/Reticulocytes
Sickledex (not in under 6
mo)
Hb Electrophoresis
Also
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G6PD Analysis
Presence of another
haemoglobinopathy