Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Cause | Clinical Features | Investigations | Management |
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Anaemia (Iron Deficiency) |
- General fatigue, dizziness, weakness, and pallor.
- Often associated with shortness of breath on exertion. - Koilonychia (spoon-shaped nails) or glossitis in severe cases. |
- Full blood count (FBC): Low haemoglobin, low mean corpuscular volume (MCV).
- Serum ferritin: Low. - Serum iron and total iron-binding capacity (TIBC). |
- Oral iron supplementation (e.g., ferrous sulfate).
- Dietary advice to increase iron intake (red meat, leafy greens). - Address underlying cause (e.g., blood loss from GI tract). |
Anaemia of Chronic Disease |
- Mild to moderate pallor, often with fatigue.
- Associated with chronic illness (e.g., rheumatoid arthritis, chronic infections, malignancy). |
- FBC: Low haemoglobin, normal to low MCV.
- Serum ferritin: Normal or elevated. - Reduced serum iron and low TIBC. |
- Treat underlying chronic disease.
- Erythropoiesis-stimulating agents (ESAs) in selected cases. - Iron supplementation if iron deficiency coexists. |
Acute Blood Loss |
- Sudden onset of pallor, dizziness, and tachycardia.
- Hypotension if the volume of blood loss is significant. - May be associated with visible bleeding (e.g., trauma, GI bleed). |
- FBC: Low haemoglobin and haematocrit.
- Blood group and crossmatch for potential transfusion. - Coagulation studies if bleeding is unexplained. |
- Immediate fluid resuscitation with IV fluids.
- Blood transfusion if haemodynamically unstable. - Address source of bleeding (e.g., endoscopy for GI bleed, surgery for trauma). |
Vitamin B12 or Folate Deficiency |
- Mild to moderate pallor, often with glossitis and weakness.
- Neurological symptoms in B12 deficiency (e.g., paresthesia, ataxia, memory loss). |
- FBC: Macrocytic anaemia (increased MCV).
- Serum B12 and folate levels: Low. - Blood smear: Hypersegmented neutrophils. |
- B12 deficiency: Intramuscular B12 injections.
- Folate deficiency: Oral folic acid supplementation. - Address underlying cause (e.g., dietary insufficiency, malabsorption). |
Chronic Kidney Disease (CKD) |
- Pallor, fatigue, and lethargy.
- Oedema, shortness of breath, and uraemic symptoms (e.g., nausea, pruritus) in advanced CKD. - Often associated with hypertension and electrolyte imbalances. |
- FBC: Normocytic, normochromic anaemia.
- Renal function tests (creatinine, eGFR): Impaired. - Serum erythropoietin (low). |
- Erythropoiesis-stimulating agents (e.g., epoetin) to correct anaemia.
- Iron supplementation if necessary. - Manage underlying CKD with renal replacement therapy (dialysis) if indicated. |
Heart Failure |
- Pallor, fatigue, breathlessness, and peripheral oedema.
- Cool extremities, cyanosis, or tachycardia in severe cases. - Jugular venous distension (JVD), ascites. |
- FBC: May show anaemia of chronic disease.
- BNP or NT-proBNP: Elevated in heart failure. - Echocardiogram to assess ejection fraction and cardiac function. |
- Optimise heart failure management with ACE inhibitors, beta-blockers, diuretics.
- Treat any underlying anaemia. - Fluid restriction and careful monitoring of electrolytes. |
Hypothyroidism |
- Pallor, weight gain, dry skin, and constipation.
- Bradycardia, fatigue, cold intolerance, and myxoedema in severe cases. - Slow reflexes and cognitive slowing. |
- Thyroid function tests (TSH, free T4): TSH elevated, low free T4.
- FBC: Normocytic anaemia. - Lipid profile: May show hyperlipidaemia. |
- Thyroid hormone replacement (levothyroxine).
- Monitor TSH and T4 levels regularly. - Address any coexisting anaemia or other metabolic derangements. |
Leukaemia |
- Pallor, fatigue, frequent infections, and easy bruising or bleeding.
- Weight loss, night sweats, and lymphadenopathy. - Bone pain may be present in some cases. |
- FBC: Anaemia, thrombocytopenia, and leukocytosis or leukopenia.
- Blood smear: Blast cells (immature white blood cells). - Bone marrow biopsy for definitive diagnosis. |
- Chemotherapy or targeted therapies based on the type of leukaemia.
- Blood transfusions for severe anaemia. - Bone marrow transplant in selected cases. |