Hb below age/sex norm (M <130, F <120 g/L) reducing oxygen-carrying capacity.
Causes
- • Microcytic: Fe deficiency, thalassaemia, sideroblastic, anaemia of chronic disease (late)
- • Normocytic: ACD, CKD, mixed, haemolysis, acute blood loss
- • Macrocytic: B12/folate, alcohol, hypothyroidism, MDS, drugs
Investigations
- • FBC, MCV, reticulocytes
- • Iron studies, B12, folate
- • U&E, LFT, TFT, CRP
- • Haemolysis screen (LDH, haptoglobin, bilirubin, blood film, DAT)
- • Endoscopy if Fe-deficient and no obvious cause
Management
- • Treat cause
- • Oral ferrous fumarate 200 mg OD–TDS or IV iron
- • B12/folate replacement (B12 first to avoid subacute combined degeneration)
- • Transfusion only if symptomatic / Hb <70
Clinical pearls
- • Iron deficiency in male / post-menopausal female → consider GI malignancy
- • Pernicious anaemia: anti-IF antibodies, lifelong IM B12
Educational — verify locally.
