Anaemia is defined as a haemoglobin concentration of<13.5 g/dL in men and<11.5 g/dL in women. Classification of anaemia according to red cell indices is useful because specific investigations can be tailored accordingly. Important aspects of the history are to enquire about symptoms suggestive of the diagnosis of anaemia, and to establish any underlying cause. The symptoms of anaemia are dependent on the degree of anaemia, speed of onset, age and the presence of co-existing disease. Mild to moderate chronic anaemia may be asymptomatic in young, fit individuals. Symptoms of anaemia include tiredness, lethargy and dyspnoea. Anaemia can precipitate or worsen angina and lower limb claudication. Blood loss is a common cause of iron deficiency anaemia and frank bleeding can easily be established from the history. Occult bleeding from the gastrointestinal tract is an important cause of chronic blood loss. Patients may have melaena and may also experience upper abdominal pains from peptic ulceration, gastritis, gastro-oesophageal reflux or gastric carcinoma (p. 3). The causes of lower gastrointestinal bleeding are detailed on p. 399. The amount and frequency of blood loss with menstruation should be documented and the presence of haemoptysis and haematuria should be ascertained. Malabsorption can cause a deficiency of substrate or coenzyme requirements for the synthesis of haemoglobin. Gastrectomy or atrophic gastritis with pernicious anaemia may impair both iron and vitamin B12 absorption due to alterations in pH and effects on intrinsic factor, respectively. Impairment of vitamin B12 absorption may also result from extensive disease or resection involving the terminal ileum and predisposes to megaloblastic anaemia. A history of travel to areas where malaria and hookworm infections are endemic should be sought.
Anaemia
Symptoms and Signs
Symptoms of anaemia
History of the underlying disorder
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