Written by Dr.Md.Redwanul Huq (Masum)

Saturday, 03 March 2012 05:58

Causes of anaemia:

i) Blood loss anaemia:

a) Acute

i. Surgical

ii. Accidental

b) Chronic

i. Bleeding peptic ulcer

ii. Hookworm infestation

iii. Bleeding piles

iv. Menorrhagia

v. Epistaxis

vi. Ruptured esophageal varices

vii. Carcinoma of stomach or colon

ii) Impaired red cell production:

a) Inadequate supply of essential elements for erythropoisis

i. Iron deficiency anaemia

ii. Folic acid deficiency

iii. Vit-B12 deficiency

iv. Protein – calorie malnutrition (Nutritional anaemia)

b) Anaemia due to replacement of normal bone marrow

i. Lymphoma

ii. Leukemia

iii. Myelodysplastic disorders

iv. Myeloproliferative disorders

v. Myeloma

c) Depression of erythropoietic activity

d) Aplastic anaemia

e) Anaemia associated with chronic disorders

i. Infection

ii. Connective tissue disorders

iii. Inflammatory disorders

iv. Disseminated malignancy

f) Anaemia due to inherited disorders, e.g. Thalassaemia

g) Anaemia associated with renal failure.

iii) Haemolytic anaemia (Due to excessive red cell destruction):

1. Due to intrinsic defects in red cells

I) Congenital

a. Membrane defects

i) Hereditary spherocytosis

ii) Hereditary eliptocytosis

b. Haemoglobin defects

i) Haemoglobinopathies: Sickle cell anaemia

ii) Thalassaemia: Beta-thalassaemia major, Hb-H disease

iii) Double heterozygous disorders: Sickle cell beta-thalassaemia

c. Enzyme defects

i) Non-spherocytic congenital haemolytic anaemia

1. Glucose 6- phosphate dehydrogenase(G6PD) deficiency

2. Pyruvate kinase deficiency

ii) Drug induced haemolytic anaemia and favism

II) Acquired: Paroxysmal nocturnal haemoglobinuria (PNH)

2. Due to extrinsic effects on red cells

Acquired

a. Immune mechanisms

1. Autoimmune acquired haemolytic anaemia

i) Warm antibody

ii) Cold antibody

2. Incompatible blood transfusion

3. Haemolytic disease of the new born(HDN)

4. Drug induced haemolytic anaemia

b. Non immune mechanisms(mechanical haemolytic anaemia)

i) Cardiac haemolytic anaemia

ii) Microangiopathic haemolytic anaemia

iii) March haemoglobinuria

c. Miscellaneous causes of anemia

1. Infections

i) C. perfringes

ii) Malaria

2. Burn

3. Drugs and chemicals

4. Lead (Pb) poisoing

Causes of anaemia in children:

1. Iron deficiency anaemia
2. Parasitic infestations
3. Congenital haemolytic anaemia (e.g. Thalassaemia)
4. Leukemia
5. Aplastic anaemia
6. Anaemia of chronic disease – i) Prolonged infections ii) Renal diseases.

Most common causes of anasarca (generalized edema):

1) Nephrotic syndrome

2) CCF

3) CLD

4) Malabsorption syndrome (Protein losing enteropathy).

Causes of fever:

Following are the causes of fever–

1) Infections (30%)-

a) Viral infection, e.g. dengue fever

b) Bacterial infection-

e.g. In lungs: TB, Pneumonia

In Heart: Infective endocarditis

In intestine: Enteric fever

In Urinary tract: UTI

c) Parasitic Infection: e.g. Malaria, Kala-azar

d) Fungal Infection

2) Malignancy (20%)-

a) Lymphoma

b) Leukemia

3) Connective tissue disorders (15%)

a) Rheumatoid arthritis

b) Systemic lupus erythematosus (SLE)

4) Miscellaneous (20%)

5) Undiagnosed (15%).

Causes of Hectic(Consumptive) temperature:

Malaria

Acute pyelonephritis

Abscess: Sub diaphragmatic abscess & abscess in any part of the body.

Septicemia

Cholengitis

Pneumonia.

Causes of generalized itching:

I) Skin diseases:

i. Urticaria

ii. Scabies

iii. Eczema

iv. Lichen planus

II) Parasitic infestation: Onchocerciasis

III) Thyroid diseases:

i) Hyperthyroidism

ii) Hypothyroidism

IV) Liver disease:

i) Obstructive jaundice

ii) Liver failure

V) Hematologic disorders:

i) Hodgkin’s lymphoma

ii) Iron deficiency anaemia

iii) Polycythaemia rubra vera

VI) Renal disease: Chronic kidney disease

VII) Viral infection: HIV infection

VIII) Metabolic disease: DM

IX) Drug induced:

i) Morphine

ii) Cocaine

X) Neoplasia: Bronchogenic carcinoma.

Causes of generalized lymphadenopathy:

1)  Infective causes:

a) Bacterial infection, eg, disseminated TB, Brucellosis

b) Viral infection, e.g. Infectious mononucleosis, HIV, Dengue

b) Rickettsial infection

c) Fungal infection, eg, Coccidio idomycosis

d) Protozoal infection, eg, Kala-azar, Toxoplasmosis

2) Malignant disorders, e.g. lymphoma, leukemia

3) Connective tissue disorders, e.g. SLE, Rheumatoid arthritis (RA)

4) Sarcoidosis

5) Amyloidosis

6) Drugs, e.g. Phenytoin, Carbamazepin.

Causes of rash with gum bleeding:

i) Leukemia

ii) Aplastic anemia

iii) Idiopathic thrombocytopenic purpura (ITP)

iv) Dengue hemorrhagic fever.