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Anaemia

Specialties > Child health

Background knowledge 🧠

Definition

  • Anaemia is defined as a reduction in the haemoglobin concentration below the normal reference range for age, sex, and physiological status.
  • It reflects a decrease in the oxygen-carrying capacity of the blood.

Epidemiology

  • Anaemia affects approximately 30% of the global population.
  • Prevalence is higher in women of childbearing age and the elderly.
  • Iron deficiency is the most common cause globally.

Aetiology and Pathophysiology

  • Reduced RBC production (e.g., iron deficiency, vitamin B12/folate deficiency).
  • Increased RBC destruction (e.g., haemolysis).
  • Blood loss (e.g., gastrointestinal bleeding, menorrhagia).
  • Bone marrow failure (e.g., aplastic anaemia).
  • Chronic disease leading to functional iron deficiency.

Types

  • Microcytic (e.g., iron deficiency anaemia, thalassaemia).
  • Normocytic (e.g., anaemia of chronic disease, acute blood loss).
  • Macrocytic (e.g., vitamin B12/folate deficiency, alcohol-related anaemia).
  • Haemolytic (e.g., hereditary spherocytosis, G6PD deficiency).

Clinical Features 🌡️

Symptoms

  • Fatigue and general weakness.
  • Dyspnoea on exertion.
  • Palpitations.
  • Pallor.
  • Headaches and dizziness.
  • Cold intolerance.

Signs

  • Pallor (conjunctival, palmar).
  • Tachycardia.
  • Systolic flow murmur.
  • Angular cheilitis (iron deficiency).
  • Glossitis (B12 deficiency).
  • Jaundice (haemolytic anaemia).

Investigations 🧪

Tests

  • Full blood count (FBC) with red cell indices (MCV, MCH).
  • Blood film (morphology).
  • Serum ferritin (iron stores), serum iron, TIBC.
  • Vitamin B12 and folate levels.
  • Reticulocyte count.
  • Bone marrow biopsy (if indicated).

Management 🥼

Management

  • Treat underlying cause (e.g., iron supplementation for iron deficiency).
  • Transfusion if haemoglobin is critically low.
  • Vitamin B12 or folate supplementation if deficient.
  • Erythropoiesis-stimulating agents in chronic kidney disease.
  • Manage complications (e.g., heart failure).

Complications

  • Heart failure (due to increased cardiac workload).
  • Angina or myocardial infarction.
  • Cognitive impairment (especially in the elderly).
  • Growth retardation in children.
  • Complications of transfusions (e.g., iron overload).

Prognosis

  • Depends on the underlying cause and the severity.
  • Reversible with appropriate treatment in many cases.
  • Prognosis worse in chronic disease or if left untreated.
  • Chronic anaemia can lead to significant morbidity.
  • Mortality risk increases with complications like heart failure.

Key Points

  • Anaemia is a common condition with multiple causes.
  • Clinical features are non-specific but important to recognise.
  • Investigation and treatment should be tailored to the underlying cause.
  • Untreated anaemia can lead to serious complications.
  • Effective management improves patient outcomes.

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Child health