iron deficiency anaemia

2. HISTORY TAKING IN
ANAEMIA
1. Blood loss
2. Malabsorption
3. Physiological demands

3. Gastrointestinal Blood Loss
I. Men and Postmenopausal women
I. Worm infestation – Hookworm, Schistosomiasis
II. Chronic use of aspirin or NAIDS (Intestinal Erosions and
Impaired platelet function)
III. Chronic hemoptysis or Hematuria

4. II. Child bearing age
i. Menstrual loss
ii. Pregnancy
iii. Breast feeding

5. Malabsorption
 Hypochlorhdria- elderly, drugs like PPI
 Previous gastric surgery
 Coeliac DS
Child – diarrhoea, delayed growth
Adult – Weight loss, oral ulceration, dyspepsia,
bloating

6. Physiological Demand
 During pregnancy
 At times of rapid growth, infancy, puberty

7. Complaints- Most Common
 Easy fatigueability, tiredness, generalised muscular
weakness

8. CVS (Complaints)
 Dyspnoea, Angina, Intermittent Claudication
 (Grade IV- Hb <3g/dl or less

9. CNS (Complaints)
 Faintness, giddiness, headache, roaring and banging in the
ears.
 Tinnitus, spots before eyes, lack of concentration,
numbness, tingling of hands and feet.

10. G.I.T (Complaints)
 Anorexia – MC Symptom
 Flatulence, Nausea, Dysphagia
 PICA – Clay- (geophagia)
ICE – (Pagophagia)

11. CLINICAL EXAMINATION
 Pallor
 Pallor without anemia
Myxoedema, anasarca, MI, nephrotic syndrome,
cirulatory stock.

12. CONJUNCTIVA
ANAEMIA NORMAL

13. Atropic glossitis

14. Plummer-Vinson Syndrome
 Diagnosed by endoscopy, barium swallow

15. Koilonychia
(Koilos-hollow)
 Spoon shaped nail, due to retarded growth of nail
plate.

16. CVS (Clinical examination)
ankle edema, anasarca
Raised JVP, Tachycardia, Collapsing pulse,
Hyperdynamic Apex beat.
haemic murmur- midsystolic, over pulm. area
cervical venous hum

17. CXR

18. ECG
-Hb < 6 gm / dl
-Normal QRS, depression of ST segments,
-Flattening or inversion of T waves

19. Investigation
 GI endoscopy (upper/lower) or barium studies
 Men>40, post-menopausal women
 To R/O occult gastric, colorectal malignancies, peptic
ulcerations, IBD, polyp, diverticulosis

20. Investigation
Recurrent anemia with features of malabsorption
 young men with normal diet
 Young women with normal diet and normal
menstruation
 Serum antigliadin, antiendomysium antibody
 Duodenal biopsy

21. Stool for parasites
Helminth infection:
 Daily loss of blood - 0.05 ml for each Necator
americanus
- 0.23ml for A. duodenale
 Trichuriasis (whipworms)- Intestinal bleeding
 Schistosomiasis - Bladder (Urinary)
Colon(Intestinal)