Investigations To Detect The Etiology And Management Of Anaemia

The course and prognosis of Anemia largely depends upon its type. Nutritional anaemias are generally very insidious in onset and course. Periodic exacerbation results from intercurrent infection or physiological stresses like puberty, growth or pregnancy. The disease progresses over several years and death is due to intercurrent illnesses or rarely severe anaemia per se.

Hemolytic anaemias exhibit wide variability in their course, ranging from fulminant hemolysis ending fatally within weeks to very slow chronic course with periodic exacerbations, extending over several years. Aplastic anaemias have an intermediate course. The onset is within months and the course extends over months to a few or death within a few months in the majority of cases if left untreated. In myelopththisic anaemia, the course and outcome depend entirely on the primary disorders.

1. Microscopic examination of stools for parasites and chemical examination for occult blood to identify gastrointestinal blood loss.
2. Skiagram of the chest to detect tuberculosis.
3. Investigations for gastric lesions- acid studies, barium meal and endoscopy.
4. Studies for detecting malabsorption states.
5. Investigation of the large intestine- barium enema and endoscopy
6. Blood chemistry- blood urea, serum proteins, serum creatinine, levels of nutrients in blood.
7. Skeletal survey- multiple myeloma, secondary deposits, thalassemias and myelosclerosis produce characteristic skeletal changes. Skiagram of the skull, vertebrae, long bones and hands are taken for this purpose.
8. Isotope studies.

• Schilling’s test for determining the absorption of vitamin B12.
• Determination of life span of red cells using ⁵¹Cr labeled erythrocytes.
• Determination of ferrokinetics (absorption, utilization and disposal or iron) using ⁵⁹Fe.
• Whole body scanning for bone marrow activity and presence of secondaries or tumours.

The specific management depends on the etiology.

General principles:

Hospitalisation is advisable when the hemoglobin drops below 7g/dl. With hemoglobin levels below 3g/dl, severe disability occurs and cardiac failure at this stage may be fatal. In such a case, emergency transfusion with packed erythrocytes to raise the hemoglobin above 5 g/dl is life saving. When cardiac failure is present, intramuscular administration of furosemide 40 mg prior to the transfusion serves to prevent fluid overloading.