There’s never none of these demure boys come to any proof; for their drink doth so over cool their blood, and making many fish-meals, that they fall into a kind of male green-sickness.
WILLIAM SHAKESPEARE (1564–1616), KING HENRY IV
Anaemia is a label, not a specific diagnosis. Anaemia is defined as a reduction in red blood cell numbers or a haemoglobin (Hb) level below the normal reference level for the age and sex of that individual.
The WHO defines anaemia as haemoglobin <130 g/L for men, <120 g/L for women and <110 g/L in pregnant women and school-aged children.
Anaemia is regarded as a masquerade because the problem can develop surreptitiously and the patient may present with many seemingly undifferentiated symptoms before the anaemia is detected. Once identified, a cause must be found.
Key facts and checkpoints
In Australia, most people with anaemia will have iron deficiency ranging from up to 5% for children to 20% for menstruating females.1
The remainder will mainly have anaemia of chronic disorders.
The incidence of haemoglobinopathy traits, especially thalassaemia, is increasing in multicultural Western societies.
If a patient presents with precipitation or aggravation of myocardial ischaemia, heart failure or intermittent claudication, consider the possibility of anaemia.
The serum ferritin level, which is low in cases of iron-deficiency anaemia, is probably the best test to monitor iron-deficiency anaemia as its level reflects the amount of stored iron.
Normal reference values for peripheral blood are presented in TABLE 22.1.
Table 22.1Normal reference values for peripheral blood: adults |Favorite Table|Download (.pdf) Table 22.1 Normal reference values for peripheral blood: adults
| ||Male ||Female |
|Haemoglobin (g/L) ||130–180 ||115–165 |
|Red cells (× 1012/L) ||4.5–6 ||4–5.5 |
|PCV (haematocrit) ||40–53 ||35–47 |
|MCV (fL) ||80–100 |
|Platelets (× 109/L) ||150–400 |
|White cell count (× 109/L) ||4–11 |
|Neutrophils ||2.5–7.5 |
|Lymphocytes ||1.5–4 |
|Monocytes ||0.2–1 |
|Eosinophils ||<0.5 |
|Reticulocytes (%) ||0.5–2 |
|ESR (mm/hour) ||<20 mm |
| ||<35 mm if >70 years |
DxT fatigue + palpitations + exertional dyspnoea ➜ anaemia
Patients with anaemia may be asymptomatic. When symptoms develop they are usually nonspecific. Symptoms can include:
Non-specific signs include pallor, tachycardia, systolic flow murmur and angular cheilosis.
If severe, signs can include ankle oedema and cardiac failure.
Specific signs include jaundice—haemolytic anaemia, and koilonychias (spoon-shaped nails)—iron-deficiency anaemia.
The history may indicate the nature of the problem:
iron deficiency: inadequate diet, pregnancy, GIT loss, menorrhagia, NSAID and anticoagulant ingestion
folate deficiency: inadequate diet ...