What is anaemia

Anaemia is a deficiency in the number or quality of red blood cells. The red blood cells carry
oxygen around the body, using a particular protein called haemoglobin. Anaemia means that
either the level of red blood cells or the level of haemoglobin is lower than normal.

Lab diagnosis of anaemia

Diagnosis of anemia includes the following laboratory analyses and tests (1-5):

A routine blood count. Blood sample taken from a vein in the arm is assessed
for blood counts. Anemia is detected if the level of haemoglobin is lower than
normal.

There may be fewer red blood cells than normal. Under the microscope the
RBCs may appear smaller and paler than usual in case of iron deficiency
anemia.

The small size is termed microcytic anemia. In vitamin B12 of folate deficiency
the RBCs may appear pale but larger than their usual size. This is called
macrocytic anemia.

Ferritin stores Ferritin is a protein that stores iron. If the blood levels of
ferritin are low it indicates low iron stores in the body and helps detect iron
deficiency anemia.

Blood tests include mean cell volume (MCV) and red blood cell distribution
width (RDW).

Reticulocyte count is a measure of young RBCs. This shows if the RBC

production is at normal levels.

Vitamin B12 and folate levels in blood these help detect if the anemia if due
to deficiency of these vitamins.

Bone marrow analysis to detect too many immature RBCs as seen in aplastic
anemia or blood cancers. Lack of iron in bone marrow also points towards
iron deficiency anemia.
 Bone marrow is obtained by inserting a hollow needle into the breast bone or
hip bone and withdrawing small amount of the marrow. The sample is then
placed on a glass slide and stained with special dyes. This is examined under
the microscope.

Iron binding capacity. Lower capacity of iron binding indicates iron deficiency
anemia.

In women of African, Mediterranean or Southeast Asia ancestry, mild anemia

that does not respond to iron therapy may be due to thalassemia minor or
sickle cell trait.

These can be detected by genetic tests and electrophoresis of blood.

Hemoglobin electrophoresis identifies various abnormal hemoglobins in the
blood. It is used to diagnose sickle cell anemia, the thalassemias, and other
inherited forms of anemia.

Complete work ups including assessment of hidden foci for bleeding in the
abdomen or intestines. Liver and kidney functions are evaluated to check if
the anemia is due to chronic liver or kidney disease.

Types of anaemia

The most common types of anaemia are

Iron deficiency anaemia

Thalassaemia - Thalassemia is an inherited blood disorder in which the body makes an

abnormal form of hemoglobin

Aplastic anaemia - Aplastic anaemia is a blood disorder in which the body's bone marrow doesn't
make enough new blood cells.

Haemolytic anaemia - Haemolytic anaemia is a condition in which red blood cells are destroyed
and removed from the bloodstream before their normal lifespan is up.

Sickle cell anaemia

Pernicious anaemia - Pernicious anaemia is a condition in which the body can't make enough
healthy red blood cells because it doesn't have enough vitamin B12
Fanconi anaemia - Fanconi anaemia, or FA, is a rare, inherited blood disorder that leads to bone
marrow failure. FA is a type of aplastic anaemia that prevents your bone marrow from making
enough new blood cells for your body to work normally.

Morphological classification

The mean cell volume (MCV), provided as part of FBC results, is used to categorise
anaemia and determine which additional investigations are appropriate. The MCV is
measured in femtolitres (fL equal to 1015L), and divides anaemia into three
categories:3
o Microcytic anaemia MCV < 80 fL
o Normocytic anaemia MCV 80 95 fL
o Macrocytic anaemia MCV > 95 100 fL
The adult reference range for MCV is 80 95 fL, 3 although there is some debate
about the cut-off for the upper limit of normal. Some references define macrocytic
anaemia as > 100 fL.

Factors causing anaemia

A diet lacking in certain vitamins. Having a diet that is consistently low in

iron, vitamin B-12 and folate increases your risk of anemia.

Intestinal disorders. Having an intestinal disorder that affects the absorption

of nutrients in your small intestine such as Crohn's disease and celiac
disease puts you at risk of anemia.

Menstruation. In general, women who haven't experienced menopause have

a greater risk of iron deficiency anemia than do men and postmenopausal
women. That's because menstruation causes the loss of red blood cells.

Pregnancy. If you're pregnant and aren't taking a multivitamin with folic acid,
you're at an increased risk of anemia.

Chronic conditions. If you have cancer, kidney failure or another chronic

condition, you may be at risk of anemia of chronic disease. These conditions
can lead to a shortage of red blood cells.

Slow, chronic blood loss from an ulcer or other source within your body can
deplete your body's store of iron, leading to iron deficiency anemia.

Family history. If your family has a history of an inherited anemia, such as

sickle cell anemia, you also may be at increased risk of the condition.
 Other factors. A history of certain infections, blood diseases and autoimmune
disorders, alcoholism, exposure to toxic chemicals, and the use of some
medications can affect red blood cell production and lead to anemia.

Age. People over age 65 are at increased risk of anemia.

Treatement and management

Iron supplementation, vitamin C supplements are also usually advised in order to increase
iron absorption
Treatment of microcytic hypochromic anaemia is dependant upon the underlying cause for
the iron deficiency. Treatments include:
o No treatment if the cause is a thalassemia trait
o Investigation and treatment of underlying conditions such as coeliac disease,
menorrhagia, bowel cancer
o Dietary review and management - to ensure adequate iron intake in the diet
o Iron supplementation - used when the patient is stable and the underlying cause has
been identified, to restore haemoglobin levels and replenish iron stores
o Blood transfusion - for management of severe anemia where there is evidence of end
organ compromise such as cardiac ischaemia or cardiac failure