Clinical Assessment of Anemia

Signs and symptoms of anemia vary with the rapidity of onset with underlying disease of the cardiovascular system. Thus, rapid blood loss, especially if plasma volume decreases rapidly, or brisk hemolysis may result in cardiovascular reaction, including tachycardia, postural hypotension, vasoconstriction in skin and extremities, dyspnea on exertion, and faintness. Slow developing anemias, such as those resulting from nutritional deficiency, permit gradual expansion of the plasma volume so that increase cardiac output gradually compensates. So the subject may remain asymptomatic for long time or noting only slight exertional dyspnea, pallor of skin and mucous membranes, jaundice, cheilosis, beffy red, smooth tongue and koilonychia are signs that accompany more advanced anemias of different types.

Evaluation of the anemic patient is best served by a systemic evaluation of the clinical and laboratory findings together. First, is the patient truly anemic? Second, is the anemia acquired or inherited? Third is there evidence for blood loss? Fourth is there evidence for nutritional deficiency or malabsorption? Fifth, is there evidence for hemolysis? Sixth is there evidence for toxic exposure or drug ingestion that could cause bone marrow depression and anemia? Finally, dose the patient have chronic inflammatory disease, renal insufficiency, or cancer, each of which is associated with secondary mild anemias, the "anemia of chronic disease"

History

1. Family History of Anemia, Splenomegaly, Jundice, and Splenoctomy.
2. Been rejected as blood donor.
3. Exercise intolerance, syncope, easy fatigue.
4. Pallor and jaundice
5. Blood loss or bleeding tendency,br> 6. Chronic disease
7. Malnutrition, malabsorption and alcoholism
8. Transfusion or iron Therapy
9. Multiple pregnancy menorrhagia

Physical Examination

1. Skin and mucous membranes: Pallor, Jaundice, smooth or beefy tongue, Cheilosis, Koilonychia, Telangiectasia
2. Adenopathy
3. Hepatomegaly
4. Tachycardia, Cardiomegaly, Murmurs
5. Bone Tenderness
6. Neuropathy

Anemia of The chronic Diseases:

The mild to moderate anemia that often observed in patients with infectious, inflammatory, or neoplastic diseases that persist for more than 1 or 2 months is called anemia of chronic disease. The characteristics feature of this syndrome is the occurrence of hypoferremia in the presence of ample reticuloendothelial iron stores. The anemia of chronic disorders is define by the presence of this unique combination of findings.

The anemia of chronic disorders is extremely common, and overall is probably more common than any anemia syndrome other than blood loss with consequent iron deficiency. In a study by cash and Sears, 1986, 52% of anemic patients met laboratory criteria for anemia of chronic disorders. The syndrome is also observed in 27% of outpatients with rheumatoid arthritis and in 58% of new admissions to hospital rheumatology units. In general anemia of chronic disease has the following characteristic:

Accompanies chronic inflammatory, infectious, or neoplastic disorders
One of the most frequent animas
Due to underproduction of red cells
Low reticulocyte production
Most often Normochromic, normocytic anemia
30% - 50% Hypochromic microcytic
Low serum iron despite Adequate iron stores
Low Total iron-binding capacity
Low transferrin saturation

Nonmegalobalstic Macrocytic Anemias Due to Bone Marrow Failure

Diamond-Blackfan Syndrome; an autosomal recessive, Pure red cell aplasia of unknown etiology. It's associated with short stature, Web neck, shield chest, cleft lip & triphalangeal thumb.
Idiopathic Aplastic Anemia; acquired failure of the hematopoietic stem cells results in pancytopenia
Fanconi's anemia; Autosomal recessive disorder that results in pancytopenia and is commonly associated with pigmentary, skeletal, renal and developmental abnormality
Other causes; Drugs, Chronic liver disease and hypothyroidism

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