Reduction in cell counts - anaemia
Description
- Hb or red cell mass below the reference range for age, sex, ethnicity and altitude
- WHO: Hb <130 g/L (men), <120 g/L (non-pregnant women), <110 g/L (pregnancy)
- Anaemia is a finding, never a diagnosis - the work is finding the cause
Two orthogonal classifiers - use both
- MCV -> microcytic / normocytic / macrocytic
- Reticulocyte count -> production failure (low) vs loss or destruction (high)
| Low retics | High retics | |
|---|---|---|
| Micro | Iron deficiency, ACD, sideroblastic | Thalassaemia (retics inappropriately low for haemolysis) |
| Normo | ACD, CKD, marrow failure/infiltration, early iron deficiency | Acute bleeding, haemolysis |
| Macro | B12/folate, MDS, alcohol, liver, hypothyroid, drugs | Haemolysis with brisk reticulocytosis |
- Spurious anaemia: pregnancy and over-transfusion dilute; a raised MCV can be artefact from cold agglutinins, an old sample, hyperglycaemia or leucocytosis**
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