Differential Diagnostic Considerations of Anaemias
DOI: 10.3238/zfa.2014.0031-0036PDF german translation / full article
Summary: Anaemia is a widespread disease, not only in developing nations but also in industrial countries. For family practitioners it is essential to know the most important laboratory biomarkers for the differential diagnosis of anaemia to make further diagnostic and therapeutic decisions. Using the definition of the World Health Organisation (WHO), a haemoglobin (Hb) concentration lower than 12 g/dl in women and 13 g/dl in men is diagnosed as anaemia. The erythrocyte indices “mean corpuscular volume” (MCV) and the “mean corpuscular haemoglobin” (MCH) and also the reticulocyte count are the most important laboratory parameters for a feasible rapid differential diagnosis of anaemia. Anaemias can be classified in “microcytic”, “normocytic” and “macrocytic”, furthermore in “hyperregenerative or “hyporegenerative” forms. Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most frequent diagnostic possibilities of the microcytic type. Three merged levels of possible iron status can be differentiated: iron depletion (no storage of iron in the body), iron deficient erythropoiesis (ferritin decreased, transferrin and hypochromic erythrocytes increased, reticulocyte hemoglobin (CHr) decreased) and iron deficiency anaemia (low Hb, MCV, MCH and CHr). In normocytic anaemia the determination of the reticulocyte count allows a division in “hyperregenerative” forms and “hyporegenerative” forms. Underlying causes of macrocytic anaemia are vitamin B12 and folic acid deficiency, alcohol, medication or a severe hematological disease. The preoperative classification and treatment of anaemias is one important column of “Patient Blood Management” (PBM). PBM is an evidence-based, multidisciplinary concept. Anaemias of patients with elective surgery should be diagnosed and treated adequately before and after a surgical intervention. Clinicians, specialists and family practitioners are invited for interdisciplinary cooperation.