Anaemia

Question 1

Introduction

Answer 1

• Abnormal reduction in normal number of circulatory RBC, HB or hematocrit .
• Reduction of oxygen carrying capacity.
  Reduce number of RBC transporting oxygen gas and carbondioxide gas
• Not a diagnosis.
  It is a manifestation of other disorders.
  Need to identify the cause.
  Therefore it must be secondary to somethinge.g Anemia due to sickle cell disease
• It could be a acute or chronic

Question 2

Classification

Answer 2

Classifications
A. Based on morphological appearance of RBC and MCV
Hypochromic microcytic
Normochromatic normocytic
Macrocytic anemia

B. Lower limit of MCV
70ft + x (age in years)
70 + x (age) of child

C. Upper limit of MCV
Add 0.6 FL per year to 84 until 96 FL
therefore, (0.6 * 8 of child) + 84
Note; in exam you can be given MCV of 100 mm of a child, know that it is abnormal that is there is macrocytic anemia

Question 4

Causes of hypochromic macrocytic anemia

Answer 4

1. Iron deficiency (common source in our area)
2. Lead poisoning
3. Copper deficiency

Question 5

Causes of normocytic normochromic Anemia

Answer 5

1. Hemolytic state e.g sickle cell anemia, G6PD deficiency.
2. Aplastic bone marrow.
3. Blood loss e.g menstruation, trauma.
4. Malignancy
5. Sequestration
6. chronic disease condition e.g CKD

HABMS

Question 6

Causes of microcytic anemia

Answer 6

1. B12 deficiency
2. Folic acid
3. Pernicious anemia;
   absence of intrinsic factor for B12 by vitamin

Question 7

Other classifications

Answer 7

1. Genetic and non genetic cause
   A. Genetic
   Sickle cell anemia
   G6PD deficiency
   Hereditary spherocytosis
   Fanconi’s anaemia
   Abetalipoprotenamia

B. Nutritional (non genetic)
iron deficiency
folic acid and B12 deficiency
starvation/malnutrition

Note; nutritional diagnosis are sometimes called “hidden hunger “ . It can be seen in exam. It is just a way to describe deficiency. They hunger does not show. The person may look good on the outside, it is not still until you do an investigation.

C. physical injury
I. trauma
II. burns
III. frostbite EG in cold regions like Canada

Question 8

General Classification of anemia

Answer 8

1. Anemia due to increase red blood cell destruction EG hemolysis, hemolytic uremic syndrome.
2. Anemia due to decrease red blood cell production.
3. Anemia due to blood loss.

Question 9

1. Anemia due to increase red blood cell destruction EG hemolysis, hemolytic uremic syndrome.

Answer 9

1. Anemia due to increase RBC destruction EG HUS, hemolysis
   HUS, is a cause of acute kidney injury and present with diarrhea and blood stool.
   MAT is characteristics of HUS.
   M; microangiopathic hemolytic anemia (MAHA)
   A; acute kidney failure
   T. thrombocytopenia

Question 11

B. Anemia due to decrease red blood cell production

Answer 11

I. Aplastic anemia
II. Malignancy like leukemia

Question 12

C. Blood loss (anemia due to blood loss)

Answer 12

I. Trauma
II. Menorrhagia
III. Bleeding disorders such as Factor IX, X deficiency

Question 13

D. Anaemia due to chronic disorder

Answer 13

I. Systemic lupus erythromatosis
II. Chronic kidney disease
III. Malignancies

Question 14

Features of anaemia

Answer 14

Features of anemia
a. Anemia has a wide range of presentation and can affect both organs and systems
b. Multi systemic; it can affect any system
c. May range from Mild to severe.
d. Occasionally a pediatrics emergency.
e. Spoon shaped nails (koilonychia)

Question 15

Symptoms

Answer 15

Symptoms of Anemia
1. CNS
Dizziness
fatigue
fanty spell

2. Blood vessels; low blood pressure
3. Heart;
   palpitation
   rapid heart rate
   angina
   chest pain
   heart attack
4. Spleen enlargement
5. Intestinal: changed stool colour
6. Muscular; weakness
7. Eyes: yellowing
8. Skin: paleness, coldness and yellowing
9. Respiratory; shortness of breath

Question 16

Complications of anemia

Answer 16

a. Tissue hypoxia: there is reduced oxygen to the tissue
b. Shock
c. Coronary insufficiency
d. pulmonary insufficiency
e. convulsion
f. heart failure

TSCPCH

Question 17

Management

Answer 17

1. History taking
2. Physical examination
3. Investigations
4. Treatment

Example: how do you manage a 5-years-old child who presented with symptoms of heart failure due to anemia

1. History
   Look at the telltale signs
2. Physical examination
   Tachypnea
   pale (conjunctiva and Palmar)
   Cardiomegaly
   Hepatosplenomegaly

Investigations
1. HB: low, RBC: low, PVC: low
b. Investigate the cause by doing FBC
c. Peripheral blood film
d. Urinalysis; urobilinogen

Treatment
1. Mild to moderate
A. give hematinics
B. balance diet
C. treat underlying cause

2. For severe, it is now causing heart failure the only substitute is blood transfusion.
   Therefore give packed cell Volume ; you can give fresh whole blood in blood loss anemia. If there is no packed cell volume; you can give sedimented RBC.

You give laxis (frusemide or any diuretics)
Note: anemia is a hyper dynamic state because there is increase in heart rate, respiratory rate.

You give frusemide as a preload, it is a preload reducing agent. To reduce the amount of blood returning to the heart because they heart is weak. It will clear the system for fresh blood to flow in