Management of Anaemia

Clinical features

Meticulous history is essential (e.g. history of previous hospitalization for sickle cell disease, blood loss due to menorrhagia).

Clinical features of anaemia include:

- Irritability, restlessness, anorexia, easy fatigability.

- Pallor of the mucous membranes (conjunctivae, lips and tongue), nail beds and palms.

- There may be splenomegaly and a short, soft, apical systolic murmur.

- Heart failure and shock (severe cases).

 

Investigations

- Hb estimation 

- Thin blood film examination for cell morphology and blood parasites

-  Stool for ova of helminths, occult blood

- Full haemogram

- Sickling test / Hb electrophoresis

- Bone marrow

- Urinalysis

Management

Identify the cause and treat

Malaria:

 Give a full course of an appropriate antimalarial drug. Thereafter give antimalarial prophylaxis for 3 months. If the spleen is palpable continue prophylaxis until it is not palpable.

Iron deficiency:

 Give iron orally if;

− the anaemia is mild or moderate

− the patient is malnourished and not on antibiotics or soon after the completion of antibiotics

Dose: Children: 6 mg/kg/day of iron (ferrous sulphate 30 mg contains 6 mg of elemental iron)

Adults: ferrous sulphate 200 mg TDS

Review the patient and check the Hb every 2 weeks. Treatment should continue until the Hb has reached normal limits, and then for at least another 4-6 weeks in order to build up body iron stores.

Folic deficiency:

Give Folic Acid to all patients who have malaria and anaemia.

Dose:

 < 2 years of age 2.5 mg daily for 3 months

 > 2 years of age 5 mg daily for 3 months

Hookworm treatment:

− Give albendazole 400 mg STAT for adults

− 200 mg STAT for children or levamisole 2.5 mg/kg as single dose

Sickle cell anaemia:

− Folic acid

− Malaria prophylaxis

− DO NOT GIVE Blood transfusion unless patient develops cardiorespiratory distress (nasal flaring, intercostal or subcostal retractions, heart failure, grunting).

Management Blood transfusion:

 Use blood only when required to save life

 Do not transfuse based on Hb alone, but also on the clinical status of the patient

 Transfuse patient if the Hb is < 5 g/dl AND there is ALSO:

− high fever

− severe infection

− heart failure

− severe symptoms e.g. grunting, intercostal or subcostal retractions, shock, nasal flaring, very rapid breathing, orthostatic hypotension, dizziness.

Transfuse any patient if the Hb < 8 g/dl AND there is ALSO:

− more than 20% blood loss (more than 1 litre in an adult)

− active bleeding with shock, hypotension, cold extremities, slow capillary refill.

A multidisciplinary approach  against anaemia

- Increased iron intake. Iron supplements, iron-rich diets, increasing iron absorption and fortification.

- Infection control. Public health measures to control hookworm infections, malaria and schistosomiasis.

- Improved nutritional status. Control of major nutrient deficiencies, diet diversification and infection prevention.

(According to the Clinical Guidelines for Diagnosis and Treatment of Common Conditions in Kenya)

In the photos pregnant and lactating women, and children: the two groups most exposed to anaemia.

 

Dr Nadia Chiapello

Dr Br Giuseppe Gaido