Investigation and management of anaemia

Anaemia is not a disease but a manifestation of some other process. Once deficiency of iron, vitamin B12 and folic acid have been excluded, other causes, such as infection, inflammation, neoplasia, drug or chemical exposure, or an autoimmune disorder, should be sought. The diagnostic approach should be to obtain details of the patient's personal and family history, ethnic origin, and their dietary and drug history, carry out a clinical examination and request simple laboratory tests. The article presents simple guidelines provided for treating the various abnormalities, once a cause has been established. Defining the type of anaemia means that specific therapy, whether this involves replacing a deficiency or treating a defined abnormality, will usually suffice. Failure to obtain the expected response, provided the patient is complying with treatment, requires review for consideration of an alternative cause.