Anaemia

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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221 Anaemia

Patient 1

Instruction

Would you like to ask this anaemic patient a few questions?

Salient features

History

• Ask about the following:

• Blood loss such as bleeding per rectum, melaena, haematemesis
• Menstrual blood loss: duration of periods, the occurrence of clots and the number of sanitary towels or tampons used
• Drug history: NSAIDs, phenytoin, chloramphenicol
• Associated symptoms such as weight loss, shortness of breath, chronic diarrhoea
• Diet: in vegans, alcoholics, elderly patients
• Past history of gastrectomy
• Family history.

Diagnosis

This patient’s anaemia is caused by severe melaena, which indicates bleeding in the upper GI tract and is probably the result of peptic ulcer or bleeding varices (aetiology). The patient is currently receiving a blood transfusion, indicating that the anaemia was severe (functional status).

Patient 2

Instruction

Would you like to examine this anaemic patient?

Salient features

Examination

• Examine:

• nails for koilonychia or iron-deficiency anaemia and (rarely) for clubbing of infective endocarditis
• tongue for pallor, atrophic glossitis and angular stomatitis of vitamin B12 deficiency (Fig. 221.1)
• mouth for angular stomatitis of severe malnutrition and ulcers of neutropenia
• lymph nodes in the neck, axillae and groin (secondaries, lymphoproliferative disorders)
• skin for bruising associated with bone marrow depression, seen in leukaemia and aplastic anaemia
• abdomen for hepatomegaly, splenomegaly and other masses
• legs for ulcers seen in haemoglobinopathies.

• Comment on the pallor of the face and conjunctiva, looking for the lemon-yellow hue of pernicious anaemia.

• Comment on the ethnic origin (thalassaemia).

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