Anaemia is present when there is a decrease in haemoglobin in the blood below the reference level for the age and sex of the individual - Hb <130g/L in adult males (Hct <0.38) and Hb <120g/L in adult females (Hct <0.37)
Pathophysiology
Normal response to anaemia is to make more red cells (reticulocytosis)
Upregulation takes a few days
Reticulocytes: cells that have just left the bone marrow
Larger than average red cells
Still have remnants of RNA - stain purple/deeper red, blood film appears ‘polychromatic’
Pathophysiological classification of anaemia
Decreased production - low reticulocyte count
Hypoproliferative - reduced amount of erythropoiesis
Maturation abnormality - erythropoiesis present but ineffective
Cytoplasmic defects - impaired haemoglobinisation
Nuclear defects - impaired cell division
Increased loss or destruction of red cells - high reticulocyte count
Bleeding
Haemolysis
Clinical presentation
Symptoms
The symptoms of anaemia are non-specific and include breathlessness, fatigue, headaches, palpitations and faintness
Signs
Pallor
Tachycardia
Systolic flow murmur
Cardiac failure
Investigations
Bloods - FBC
Hb concentraton, MCV, haematocrit, mean cell haemoglobin, mean cell haemaglobin concentration
Blood film - look at cellular morphology
Reticulocyte count - assess marrow response
Additional tests - depending on clinical details and lab findings
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