How will you tackle a case of anaemia?
Important history from the patient:
– H/o chronic blood loss (bleeding peptic ulcer, haemorrhoids, menorrhagia),
bleeding tendencies.
– Malabsorption (diarrhoea/steatorrhoea), intake of nutritious foods, worm infestations,
exposure to drugs/chemicals/radiation.
– Anorexia, significant weight loss, bowel habits.
Common symptoms/signs attributable to anaemia:
– Symptoms: Fatigue, weakness, giddiness, fainting, anorexia, weakness, tinnitus,
ankle oedema, palpitation, angina pain, breathlessness, insomnia, paraesthesia,
intermittent claudication, lack of concentration.
– Signs: Pallor, bipedal oedema, tachycardia and cardiac dilatation.
Meticulous clinical examination with a target to hit the aetiology.
Corroborated by investigations:
– Peripheral blood film (RBC morphology, reticulocytes), Hb concentration, RBC
count.
– Blood indices: MCV, MCH, MCHC.
– Serum values: serum iron, TIBC, serum ferritin.
– Stool examination for occult blood test and detection of hookworm ova.
– Upper GI endoscopy, proctoscopy.
– Radiology: USG abdomen, chest X-ray, X-ray skull (e.g., multiple myeloma), CT
scan of chest or abdomen in search of malignancy.
– Bone marrow examination.
– Specific test depending on type of anaemia (e.g., ferrokinetics in iron deficiency
anaemia, serum level of vitamin B12 and folate in megaloblastic anaemia; special
haematological tests like Coombs’ test, osmotic fragility, Hb-electrophoresis).
Important history from the patient:
– H/o chronic blood loss (bleeding peptic ulcer, haemorrhoids, menorrhagia),
bleeding tendencies.
– Malabsorption (diarrhoea/steatorrhoea), intake of nutritious foods, worm infestations,
exposure to drugs/chemicals/radiation.
– Anorexia, significant weight loss, bowel habits.
Common symptoms/signs attributable to anaemia:
– Symptoms: Fatigue, weakness, giddiness, fainting, anorexia, weakness, tinnitus,
ankle oedema, palpitation, angina pain, breathlessness, insomnia, paraesthesia,
intermittent claudication, lack of concentration.
– Signs: Pallor, bipedal oedema, tachycardia and cardiac dilatation.
Meticulous clinical examination with a target to hit the aetiology.
Corroborated by investigations:
– Peripheral blood film (RBC morphology, reticulocytes), Hb concentration, RBC
count.
– Blood indices: MCV, MCH, MCHC.
– Serum values: serum iron, TIBC, serum ferritin.
– Stool examination for occult blood test and detection of hookworm ova.
– Upper GI endoscopy, proctoscopy.
– Radiology: USG abdomen, chest X-ray, X-ray skull (e.g., multiple myeloma), CT
scan of chest or abdomen in search of malignancy.
– Bone marrow examination.
– Specific test depending on type of anaemia (e.g., ferrokinetics in iron deficiency
anaemia, serum level of vitamin B12 and folate in megaloblastic anaemia; special
haematological tests like Coombs’ test, osmotic fragility, Hb-electrophoresis).