Overview 

The World Health Organization defines anaemia as a haemoglobin (Hb) concentration below 13 g/dl (130 g/L) in men over 15 years of age, below 12 g/dl (120g/L) in non-pregnant women over 15 years of age, and below 11 g/dl (110g/L) in pregnant women. There are many causes of anaemia. It is important to take a comprehensive history, examination and inspect FBC and blood films.

Physiology of RBCs

Approach

• History
  • Symptoms of Anaemia (fatigue, shortness of breath)
  • Sleeping – Obstructive sleep Apnoea
  • Pancytopaenia (easy bruising, bleeding, infections)
  • Family History of haemolytic disease
  • Menstrual history: menorrhagia, menometrorrhagia
  • Connective Tissue disorder
  • Neurological symptoms
  • Medication history
  • Ethnic background
  • Medical condition
  • Surgical history – heart valve surgery associated with haemolysis
• Examination
  • Jaundice
  • Pallor
  • Splenomegaly
  • Hepatomegaly
  • Signs of connective tissue disease

Investigations 

If anaemia is suspected begin with:

• Full blood examination
• Iron studies
• Serum vitamin B12/folate
• Peripheral Blood film
• Reticulocyte count

1. The first step in diagnosing the cause of anaemia is to find out the mean cell volume (MCV). The initial classification is based on the MCV:
   • Microcytic Anaemia
   • Normocytic Anaemia
   • Macrocytic Anaemia
2.  Any further investigations will be determined by the blood film appearance and clinical suspicion