Description
This comprehensive academic lecture on the diagnostic approach to anaemia, authored by Dr. CK Mwandama from the Haematology Unit within the Department of Internal Medicine at the University Teaching Hospital (UTH) in Lusaka, provides a systematic and in-depth review of various anaemia subtypes. The presentation outlines a clear algorithmic methodology for evaluating microcytic, macrocytic, and normocytic anaemias, serving as a crucial framework for clinical decision-making. It delves into the detailed pathogenesis, clinical features, and evidence-based management of specific deficiencies, including iron deficiency anaemia, vitamin B12 deficiency (with a focus on pernicious anaemia), and folate deficiency. The lecture also covers the complex pathophysiology of anaemia of chronic disease (AOCD), explaining the role of cytokines and hepcidin in iron sequestration and erythropoiesis suppression, and reviews the classification, mechanisms, and treatment of autoimmune haemolytic anaemias (AIHA). For each condition, the material discusses key investigations, such as iron studies, serum B12 and folate levels, direct antiglobulin tests, and bone marrow findings, alongside therapeutic strategies ranging from oral iron supplementation and intramuscular hydroxocobalamin to corticosteroids and immunosuppressive agents. This resource is essential for medical students, postgraduate trainees in internal medicine and haematology, and practicing clinicians seeking to refine their diagnostic skills and therapeutic approach to this common clinical presentation. It serves as a valuable study and reference guide for both exam preparation and clinical practice. Review this detailed presentation to strengthen your systematic evaluation and management of anaemia.
What's inside
Approach to Anaemia II By Dr CK Mwandama Haematology Unit, Department of Internal Medicine, UTH, Lusaka, Zambia 04/02/2022 Learning Objectives At the end of this session, learners should be able to do the following: • Be familiar with algorithmic approach to diagnosis of anaemia. • Understand presentation, pathogenesis and management of: Iron deficiency anaemia. Vitamin B₁₂ deficiency anaemia. Folate deficiency anaemia. Anaemia of chronic disease. Autoimmune haemolytic anaemias. Approach to microcytic anaemia Approach to macrocytic anaemia Approach to normocytic anaemia Anaemia with suspected Haematologic abnormalities Iron Deficiency Anaemia • Iron deficiency is the most common cause of anaemia in the world • The body has limited ability to absorb iron. • Iron frequently lost through haemorrhage. • Most iron occur in insoluble ferric (Fe³⁺) form, which has poor bioavailability. • Ferrous (Fe²⁺) is more readily absorbed. • Iron classified as: Non-haem iron , mainly derived from cereals Haem iron derived from haemoglobin and myoglobin in red or organ meats. • Haem iron is better absorbed than non-haem iron Iron absorption • Most haem iron is absorbed in the proximal intestine. • Intestinal haem transporter, haem carrier protein 1(HCP1) is the main carrier protein. • HCP1 highly expressed in the duodenum and upper jejunum. • HCP1 expression is upregulated by hypoxia and iron deficiency • Non-haem iron absorption occurs primarily in the duodenum. • Non-haem iron is reduced from the ferric to the ferrous form by a brush border ferrireductase • Divalent metal transporter1 (DMT1) transports iron (and other metals) across the apical (luminal) surface of the mucosal cells • Iron become internalized through transporter molecule ferroportin on basolateral aspect of enterocyte into blood stream and bind to transferrin • Hepcidin regulates iron absorption by binding to ferroportin causing its internalization and degradation. • Iron deficiency anaemia develops when there is inadequate iron for haemoglobin synthesis • Causes of IDA include: Reproductive Menorrhagia GIT Hook worm infestation, Oesophagitis,Oesophageal varices, Hiatus hernia, Peptic ulcer, Inflammatory bowel disease,Haemorrhoids,Carcinoma( stomach, colorectal), Angiodysplasia Malabsorption Coeliac disease, Atrophic glossitis, Gastrectomy Physiological Growth spurts, Pregnancy Dietary Vegan Genitourinary system Haematuria Others PNH,Frequent venesection e,g.blood donation • Clinical features include: PICA-abnormal cravings e.g. for ice or soil Brittle nails Spoon-shaped nails (koilonychia) Atrophy of the papillae of the tongue Angular stomatitis Brittle hair, A syndrome of dysphagia and glossitis (Plummer–Vinson or Paterson–Brown–Kelly syndrome. Clinical features of underlying cause if any e.g.Portal hypertension with bleeding varices
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