ANEMIA

Question 1

Define anemia

Answer 1

Anaemia is defined as decreased haemoglobin for the age and sex of the individual (i.e. below 13 g/dL in adult males, 12 g/dL in adult females, 11 g/dL in children, and below 13.5 g/dL in the 1st week of life)

Question 2

Causes of anemia

Answer 2

Nutritional micronutrient and vitamin deficiency
Bleeding
Hemolysis
Bone marrow failure
Chronic diseases
Autoimmune diseases

Question 3

Nutritional micronutrient and vitamin deficiency

Answer 3

Iron
Folic acid
Vitamin B12

Question 4

Investigations in anemia

Answer 4

FBC
Reticulocyte count and blood film comment
Sickling test and HB electrophoresis
Blood film for malaria parasites
Kidney function tests
Serum iron, Vitamin B12 and folate levels
Direct Coomb’s test
Stool for hookworm ova
Stool for occult blood
Urine for schistosoma ova
Specialized tests depending on the suspected cause e.g. bone marrow examination, antinuclear antibody (ANA) test, upper and lower GI endoscopy

Question 5

Bleeding disorders that can cause anemia

Answer 5

Heavy menstruation
Hemorrhoids
Peptic ulcer
Infestations
Solid organ malignant tumors
Haematological malignancies

Question 5

Hemolytic conditions that can cause anemia

Answer 5

Severe malaria
Sickle cell disease
G6PD Deficiency
Hypersplenism
Autoimmune
Drugs

Question 5

Chronic diseases associated with anemia

Answer 5

Kidney disease
Tuberculosis
Hypothyroidism

Question 6

Signs of anemia

Answer 6

Pale mucous membranes and palms
Angular stomatitis or cheilitis
“Spoon shaped” and ridged finger and toe nails
Spleen, liver and lymph nodes may be palpable
Signs of heart failure (in severe anaemia)
Jaundice (in haemolysis)
Petechiae and purpura (bone marrow failure)
Hyperpigmentation of palms and soles of feet

Question 6

Autoimmune diseases associated with anemia

Answer 6

SLE
Pernicious anemia

Question 7

First line treatment fo iron deficiency anemia

Answer 7

Ferrous sulphate (dried or anhydrous), oral,
Adults
200 mg (65 mg elemental iron) 8 hourly for 3-6 months
Children
> 10 years; 200 mg 12 hourly for 3-6 months
8-10 years; 200 mg daily for 3-6 months
5-7 years; 80-120 mg 8-12 hourly for 3-6 months
1-4 years; 45-90 mg 8-12 hourly for 3-6 months
< 1 year; 30-60 mg 8-12 hourly for 3-6 months

Or

Ferrous fumarate, oral,
Adults
200 mg (65 mg elemental iron) 8 hourly
Children
3-6 mg elemental iron/kg per day for 3-6 months

Question 7

Symptoms of anemia

Answer 7

Easy fatiguability
Dizziness
Shortness of breath on exertion
Palpitations
Fresh blood in stools
Black tarry stools
Hematuria
Cola-like urine

Question 7

Treatment objectives in anemia

Answer 7

To treat underlying cause of anaemia
To restore haemoglobin levels to normal
To replenish iron stores after correction of anaemia in iron deficiency
To restore haemoglobin to steady state level in sickle cell disease
patients
To correct anaemia in proven vitamin B12 and folate deficiency and maintain normal levels throughout life

Question 7

Non-pharmacological management of anemia

Answer 7

Advise on a balanced diet. Regular intake of leafy foods as well as
fresh fruits and vegetables, beans, liver, meat, eggs, fish
High fibre diets to reduce bleeding from haemorrhoids
Surgical treatment

Question 8

Treatment for Folate deficiency anemia

Answer 8

Folic Acid, oral,
Adults
5 mg daily
Children
2.5-5 mg daily

Question 8

Treatment for Vitamin B12 deficiency anemia

Answer 8

Vitamin B12 (Hydroxocobalamin), IM,
Adults
1 mg every other day for 6 doses
Then
1 mg every 3 months for life
Children
1 mg stat.
Then
1 mg every 3 months for life

Question 8

Second line treatment for iron deficiency anemia

Answer 8

Iron sucrose, IV,
(as a slow bolus injection over 2-5 minutes)
Adults
200 mg every 3 days for 5 doses
Children
0.5 mg/kg every 4 weeks for 12 weeks (max. 100 mg per dose)
Or
Iron dextran, IV,
(as a slow bolus or IM by deep IM injection)
Adults
25-100 mg daily as needed

Question 8

Treatment for severe symptomatic anemia

Answer 8

Blood transfusion with packed cells