Page 40 - Essential Haematology

26 / Chapter 2 Erythropoiesis and anaemia

14
Neonates Men
13 Infants
Haemoglobin (g/dL) 12 Women

11

10 Children

9
1 2 3 1 5 10 20 30 40 50 60 70
Age: Months Years

Figure 2.13 The lower limit of normal blood haemoglobin concentration in men, women and children of various
ages.

(a) (b)

Figure 2.14 Pallor of the conjunctival mucosa (a) and of the nail bed (b) in two patients with severe anaemia

(haemoglobin 6.0 g/dL).

9 – 10 g/dL (Fig. 2.14 ). Conversely, skin colour is The association of features of anaemia with
not a reliable sign. A hyperdynamic circulation may excess infections or spontaneous bruising suggest
be present with tachycardia, a bounding pulse, car- that neutropenia or thrombocytopenia may be

diomegaly and a systolic flow murmur especially at present, possibly as a result of bone marrow failure.
the apex. Particularly in the elderly, features of con-
gestive heart failure may be present. Retinal haem-

orrhages are unusual (Fig. 2.15 ). Classification and l aboratory fi ndings
Specific signs are associated with particular types in a naemia

of anaemia, e.g. koilonychia (spoon nails) with iron Red c ell i ndices
deficiency, jaundice with haemolytic or megaloblas-

tic anaemias, leg ulcers with sickle cell and other The most useful classification is that based on red

haemolytic anaemias, bone deformities with thalas- cell indices (Table 2.3 ) and divides the anaemia into
saemia major. microcytic, normocytic and macrocytic (Table 2.4 ).