1. Anaemia is a low red blood cell count or low hemoglobin level. It has many potential causes including blood loss, nutritional deficiencies like iron deficiency, and chronic diseases that interfere with red blood cell production.
2. A complete blood count (FBC) provides important information for evaluating anaemia, including the red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume (MCV), and red cell distribution width (RDW). Low MCV indicates microcytic anemia while high MCV suggests macrocytic anemia.
3. Iron deficiency anaemia is the most common cause of microcytic anemia and develops in stages from iron store depletion to impaired red blood
1. Anaemia is a low red blood cell count or low hemoglobin level. It has many potential causes including blood loss, nutritional deficiencies like iron deficiency, and chronic diseases that interfere with red blood cell production.
2. A complete blood count (FBC) provides important information for evaluating anaemia, including the red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume (MCV), and red cell distribution width (RDW). Low MCV indicates microcytic anemia while high MCV suggests macrocytic anemia.
3. Iron deficiency anaemia is the most common cause of microcytic anemia and develops in stages from iron store depletion to impaired red blood
1. Anaemia is a low red blood cell count or low hemoglobin level. It has many potential causes including blood loss, nutritional deficiencies like iron deficiency, and chronic diseases that interfere with red blood cell production.
2. A complete blood count (FBC) provides important information for evaluating anaemia, including the red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume (MCV), and red cell distribution width (RDW). Low MCV indicates microcytic anemia while high MCV suggests macrocytic anemia.
3. Iron deficiency anaemia is the most common cause of microcytic anemia and develops in stages from iron store depletion to impaired red blood
1. Anaemia is a low red blood cell count or low hemoglobin level. It has many potential causes including blood loss, nutritional deficiencies like iron deficiency, and chronic diseases that interfere with red blood cell production.
2. A complete blood count (FBC) provides important information for evaluating anaemia, including the red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume (MCV), and red cell distribution width (RDW). Low MCV indicates microcytic anemia while high MCV suggests macrocytic anemia.
3. Iron deficiency anaemia is the most common cause of microcytic anemia and develops in stages from iron store depletion to impaired red blood
1 The diagnosis TABLE 1: CAUSES OF IRON DEFICIENCY Physiological Causes Increased requirements menstruation, blood donation Dietary Pathological Malabsorption Gastrectomy, atrophic gastritis, 2 Although a thorough surgery and coeliac disease. Chronic blood • Gastrointestinal: Oesophageal varices, loss Helicobacter pylori, hiatus hernia,
GETTING TO KNOW THE FBC AND ITS ROLE IN THE WORK-UP
OF ANAEMIA angiodysplasia, haemorrhoids, etc. • Renal: Haematuria or haemoglobinuria • Pulmonary: Haemoptysis, pulmonary haemosiderosis • Bleeding disorder ethnicity and pregnancy.3 When interpreting a FBC, the • Drug related
pump inhibitors
• 7
• Thus, it is critical to note that a normal FBC does not
• RBC count •
An increased RDW usually indicates that a multitude
TABLE 2: THE SEQUENCE OF EVENTS IN THE DEVELOPMENT OF
underlying pathology. IRON DEFICIENCY ANAEMIA THE MEAN TEAM STEP 1 STEP 2 STEP 3 Depletion erythropoiesis anaemia stores • When the iron stores • Hypochromic, as small, normal or large. • The serum are depleted, the microcytic red WHAT IF THE MCV IS LOW (SMALL RBCS)? cells present on the blood anaemia is smear. present. • The MCV and MCH are receptors increases. • • At this stage, the reticulocyte haemoglobin, mean cell haemoglobin
3 These are the most common 2
ampath.co.za 18 ANAEMIA OF CHRONIC DISEASE TABLE 4: DIFFERENTIATING BETWEEN MACROCYTIC ANAEMIA BASED ON MORPHOLOGY OF THE RED CELLS Megaloblastic Non megaloblastic (oval macrocytes) (round macrocytes) It is caused by inadequate Alcohol, liver disease, aplastic anaemia, the macrophage iron stores to the red cell precursors in dysplastic syndrome, 11 The pathogenesis also includes an myelodysplastic syndrome. myeloma, drugs, etc. decreased EPO production and shortened red cell survival.
macrocytes are present, megaloblastic anaemia needs
impairment, rheumatoid arthritis and other
TABLE 5: CAUSES OF VITAMIN B12 AND FOLATE DEFICIENCIES • Malignancy
Dietary restrictions alcoholics and the elderly Malabsorption: Pernicious
IDA and ACD can be especially challenging.12 disease
ileal resections TABLE 3: HOW TO DIFFERENTIATE BETWEEN CAUSES OF MICROCYTIC ANAEMIA pump inhibitors anticonvulsants, alcohol Test Iron Chronic Thalas- Sidero- saemia blastic Pregnancy, chronic mation anaemia haemolysis Blood MCV/MCH Serum iron N N testing and a reticulocyte count.12 In elderly patients, Bone marrow Iron stores Absent Present Present Present syndrome. Again, the morphology reported on the Sideroblasts Absent Absent Present Ringed sideroblasts Haemoglobin Normal Normal HbA2 Normal electrophoresis
elevated.
WHAT IF THE MCV IS NORMAL?
WHAT IF THE MCV IS HIGH A normal MCV denotes a normocytic anaemia. (RED BLOOD CELLS ARE TOO BIG)?
• • Haemolytic anaemia 8 Further subdivision into • Acute blood loss • •
ampath.co.za 19 Appropriate initial investigations include a reticulocyte count. A high reticulocyte count indicates the increased
due to increased red cell production. Normal bone 10
myelodysplastic syndrome, certain viruses, e.g. HIV,
response. Figure 1 summarises a diagnostic approach to
anaemia.13
Anaemia (low Hb)
MCV
Normal = normocytic High = macrocytic
Ferritin
Normal Normal/raised
Establish Cause Cause not Establish cause
cause chronic disease or obvious: obvious: haemoglobinopathy e.g. drugs/ Consider bone alcohol
Reticulocyte count
• Haemolysis disease High • or blood loss • •
FIGURE 1: A DIAGNOSTIC APPROACH TO ANAEMIA
GETTING TO KNOW THE LINGO
TABLE 6: ELABORATION OF TERMINOLOGY USED IN THE FBC REPORT
What is seen under the microscope What to consider Additional tests Spherocytes Haemolysis Haemolytic screen
Hb electrophoresis Iron studies cells and elliptocytes Hb electrophoresis Thalassaemia Possible haemolysis Haemolytic screen Polychromasia Blood loss Haemolytic screen Haemolysis
ampath.co.za 20 TABLE 6: ELABORATION OF TERMINOLOGY USED IN THE FBC REPORT (continued) What is seen under the microscope What to consider Additional tests DIC screen DIC, TTP, HUS, HELLP syndrome ADAMSTS13 Haemolytic screen
Megaloblastic anaemia Vitamin B12
neutrophils and megaloblasts Folate
Liver disease, hyperlipidemia,
hypothyroidism
Malaria parasites Malaria Malaria antigen testing
Malaria PCR
KEY MESSAGES
REFERENCES
−9. 13. Moore C. Basic Approach to Abnormal FBC: Part I regional, and national incidence, prevalence, and −2. Available
2017; 390:1211−
2016; 387:907−916.
−1843. 8. Alli N, Vaughn, J Patel M. Anaemia: Approach to −27.
