Clinical Features, Investigation And Diagnosis Of Anemias
An Anemic Patient
Irrespective of the etiology or type, anemic subjects develop a group of symptoms on account of reduction in hemoglobin. The severity of symptoms depends on the rapidity of fall of hemoglobin. When anemias develop slowly, the subject adapts to the lower levels of hemoglobin by reducing his physical activity and the symptoms are less pronounced. With falling levels of hemoglobin, the oxygen carrying capacity of blood diminishes. This is partly compensated by increasing the blood flow to organs by vasodilation. The cardiac output is increased. Most of the general symptoms are attributed to the diminished oxygen carrying capacity of blood and hyperdynamic circulation. These symptoms include fatigue, disinclincation to work, mental apathy, pallor, exertional dypsnea, effort angina and cardiac failure in severe cases.
Symptoms are referable to all systems. Alimentary symptoms include loss of appetite, constipation and abdominal distension. The liver is enlarged and tender due to fatty change. Cardiovascular changes include tachycardia, cardiomegaly, high volume pulse, prominent third heart sound, ejection systolic murmurs heard over the pulmonary and aortic areas and in advanced cases, signs of cardiac failure.
Cardiac murmurs are produced as a result of decreased viscosity of blood and increased cardiac output. Pallor ismost marked over the mucous membranes, skin and nails. There may be graying of the hair and premature baldness. Neurological manifestations include apathy, loss of mental alertness, paraesthesia over the extremities and brisk tendon reflexes. When severe anemia develops rapid signs resembling raised intracranial tension, some other cerebral symptoms may be encountered. These include headache, papilledema and retinal hemorrhages. All these regress with improvement in the hemoglobin levels.
Splenomegaly occurs in many cases, and the frequency and extent depends on the type of anemia. Whereas in Iron deficiency anemia, 10% may show mild splenomegaly; in hemolytic anemias, it is over 90%.
Blood Cells Amount In Anemia
Iron Deficiency Anemic Patient
Investigations And Diagnosis
Any patient with anemia should be approached with the aim of determining the type, severity and cause of the disorder. Anemia may be the only apparent general feature of several underlying disorders, and attempts should be made to detect the etiology. Symptomatic treatment of anemia without identifying the cause should be avoided since in many instances a serious underlying disorder like gastrointestinal malignancy or renal failure may be missed at the early stage when effective treatment is possible.
Detailed history should include the onset, course and duration of anemia. Periodic fluctuation in intensity is common in nutritional and hemolytic anemias. In general, they are of longer duration than aplastic and myelopththisic anemias. Nutritional anemias affect several members of the same family or household. Hemolytic anemias such as spherocytosis, hemoglobinopathies and red cell enzymopathies reveal characteristic genetic patterns.
Common bleeding foci such as hemorrhoids, menorrhagia, peptic ulcer and esophageal varices should be excluded by interrogation and full physical examination. Rectal and pelvic examinations should be undertaken in all cases.
© 2014 Funom Theophilus Makama