There's never none of these demure boys come to any proof; for their drink doth so over cool their blood, and making many fish-meals, that they fall into a kind of male green-sickness.

William Shakespeare (1564-1616) King Henry IV

Anaemia is a label, not a specific diagnosis. Anaemia is defined as a haemoglobin (Hb) below the normal reference level for the age and sex of that individual. It is regarded as a masquerade because the problem can develop surreptitiously and the patient may present with many seemingly undifferentiated symptoms before the anaemia is detected. Once identified, a cause must be found.

• In Australia, most people with anaemia will have iron deficiency ranging from up to 5% for children to 20% for menstruating females. 1

• The remainder will mainly have anaemia of chronic disease.

• The incidence of haemoglobinopathy traits, especially thalassaemia, is increasing in multicultural Western societies.

• If a patient presents with precipitation or aggravation of myocardial ischaemia, heart failure or intermittent claudication, consider the possibility of anaemia.

• The serum ferritin, which is low in irondeficiency anaemia, is probably the best test to monitor iron-deficiency anaemia as its level reflects the amount of stored iron.

• Normal reference values for peripheral blood are presented in Table 19.1 .

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