16: HAEMATOLOGY

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CHAPTER 16 HAEMATOLOGY

Haemoglobinopathies

ANAEMIA

Patients with anaemia are diagnosed because they look anaemic, have the symptoms of anaemia or are found incidentally to be anaemic.

Diagnosis

History.

• Bleeding: heavy periods are a common cause of iron-deficiency anaemia. Rectal bleeding is the other common cause.

• Diet: the elderly often take a diet low in iron. Vegetarians are also at risk.

• A past history of iron-deficiency anaemia, which raises the chance of another episode of the same.

• Symptoms of anaemia: tiredness, breathlessness, exhaustion and palpitations can all be caused by anaemia. Angina can be unmasked or exacerbated by becoming anaemic.

• Symptoms occasionally accompanying anaemias: bruising and infections suggest aplastic anaemia. Paraesthesia of the feet can occur in pernicious anaemia. Chronic disease can cause anaemia, e.g. renal failure, inflammatory bowel disease and rheumatoid arthritis. Cancer often causes anaemia.

Examination.

In general practice there is usually little to add by examining the asymptomatic patient other than to look at the conjunctivae for pallor. The yellowish appearance of the face in pernicious anaemia is characteristic.

Investigations

• Full blood count: the first test is the FBC and film. This alone is sufficient to confirm the presence of anaemia, which is characterised by a Hb less than:

– 12.5 g/dl for men

– 11.5 g/dl for women.

• Iron-deficiency anaemia is characterised by a low mean cell volume (<76 fl) and a low mean cell Hb concentration (<30 g/dl), and should be confirmed by checking for a low serum iron (<15 μmol/l in men; 14 μmol/l in women).

• Transferrin: a high transferrin (>400 mg/dl) supports the diagnosis of iron-deficiency anaemia. A low transferrin (<200 mg/dl) suggests the anaemia of chronic disease.

Where there is no obvious cause for the anaemia (e.g. heavy periods), the patient should be referred, if appropriate, for investigation of the gastrointestinal tract. Occult malignancy occasionally comes to light after presenting with anaemia.

Management

Iron-deficiency anaemia

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