Anaemia

Description
Diagnosis
Referral

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DESCRIPTION

A condition characterised by low haemoglobin (Hb), clinically recognised by pallor, tiredness, shortness of breath.

It is commonly caused by:

• Nutritional deficiency of iron or folate or vitamin B₁₂.
• Chronic systemic diseases such as HIV, TB, malignancy.
• Blood loss (bleeding/haemorrhage) e.g. caused by parasites, ulcers, tumours, abnormal menstruation.

Other causes include:

• Infiltration or replacement of the bone marrow.
• Abnormal Hb or red cells.
• Haemolysis.

DIAGNOSIS

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Children < 5 years of age

Anaemia is most often due to iron deficiency. See Anaemia, iron deficiency.

Children > 5 years of age and adults

Request a full blood count.

• If MCV is normal (normocytic):
  • then systemic disease or haemolysis are likely causes.
• If MCV is low (microcytic):
  • then iron deficiency is the most likely cause.
• If MCV is high (macrocytic):
  • then folate and/or vitamin B₁₂ deficiency is the most likely cause.

Pregnant women

See: Anaemia in pregnancy.

REFERRAL

• Unknown cause.
• Symptomatic anaemia e.g. palpitations and shortness of breath.
• Evidence of cardiac failure.
• Signs of chronic disease (investigate for HIV and TB before referral).
• Anaemia associated with enlargement of the liver, spleen or lymph nodes.
• Evidence of acute blood loss or bleeding disorder.
• Menorrhagia or dysfunctional uterine bleeding.
• Blood in stool, or melaena.
• Pregnant women > 34 weeks of gestation and Hb < 7 g/dL.
• Children with Hb ≤ 7 g/dL (If Hb cannot be done, look for severe palmar pallor).
• Anaemia associated with other abnormalities on FBC or smear.
• No improvement despite correct treatment.

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See Anaemia, iron deficiency and Anaemia, macrocytic or megaloblastic.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition