Anaemia

Report
Prof. Aziz-ur-Rehman
 Very
common problem
 Subtle or no symptoms, usually incidental
finding
 Various causes; ID is the commonest
 Simple iron replacement is not the solution
 Investigate before starting treatment
 Nutrition
 Chronic




blood loss
Menorrhagia
GI blood loss
Liver disease
Worm infestation
 Transfusions
 Family
history
 Pallor
 Koilonychia
Routine features
 Splenomegaly
 Purpura
 Lympadenopathy
Serious problem?
Routine
 CBC; Hb%, Hct, RBC indices
Specilised
 Iron studies
 Hb. Electrophoresis
 Reticulocyte count
 Peripheral smear
 Bone marrow
 Other haematological
 Non haematological
RBC= 4-5.5M
HGB= 12-18
HCT= 37-52
MCV= 78-98fL
MCH= 27-32pg
MCHC= 31-36
RDW 11-15
RBC= 4-5.5M
HGB= 12-18
HCT= 37-52
MCV= 78-98fL
MCH= 27-32pg
MCHC= 31-36
RDW 11-15
RBC= 4-5.5M
HGB= 12-18
HCT= 37-52
MCV= 78-98fL
MCH= 27-32pg
MCHC= 31-36
RDW 11-15
TLC= 3.2
P= 30%
L= 65%
RBC= 2.5M
PLT= 32
HGB= 10
HCT= 24
MCV= 82fL
MCH= 29pg
MCHC= 35
HGB= 12-18
HCT= 37-52
MCV= 78-98fL
MCH= 27-32pg
MCHC= 31-36
CBC
Hb% & Hct
CBC
MCV, MCH,
MCHC
HCMC
Iron
deficiency
anaemia
Macrocytic
Thalassaemia
NCNC
Aplastic
Anaemia
Haemolytic
Anaemia
HCMC
Serum Ferritin
Low
Normal or high
IDA
Hb
Electrophoresis
Replace Fe
Find & treat the
cause
Hb A2 & Hb F high
Beta
Thalassaemia
Hb A2 & Hb F
normal
Alpha
Thalassaemia
HCMC ANAEMIA-1
 Very
common; diagnosis by default
 Chronic blood loss, malnutrition
 Total iron depletion
 Various lab tests, serum ferritin best
Parameter
Effect
Hb & Hct
Reduced
MCV, MCH, MCHC
Reduced
Ferritin
Reduced
Iron
Reduced
TIBC/TS
Increased
BM iron
Absent
Retic count
Low
1.
2.
3.
4.
5.
Identify and treat the cause
BT hardly ever indicated
Oral iron; various form, FeSO4 best
Parenteral iron
Good nutrition (meat, fish & poultry)
HCMC ANAEMIA-2
 Family
history
 Mild to severe anaemia
 Splenomegaly
 HCMC anaemia (ID excluded)
 Hb electrophoresis:


Hb A2 & Hb F levels high: beta thalassaemia
Hb A2 & Hb F levels normal: alpha thalassaemia
 DNA
analysis
 None
 Counseling
 BMT/SCT
 Iron
contraindicated
 Desferrioxamine
Macrocytic Anaemia
 Inherited
disorder
 Intrinsic factor deficiency
 Vit. B12 not absorbed
Parameter
Effect
Hb, HCT
Reduced
MCV, MCH, MCHC
Increased, Normal, Reduced
Vit B12
low
Folate
low
Retic count
Low; prompt rise after treatment
BM examination
Megaloblastic picture
NCNC anaemia-1
Parameter
Effect
Hb, HCT
Reduced
MCV, MCH, MCHC
Normal
TLC
low
Platelets
low
DLC
Reversed P/L ratio
Retic count
Low
BM examination
Aplastic picture
 NCNC
anaemia
 Pancytopenia
 Bone marrow biopsy
 Immunosuppressant
 BMT/SCT
 Blood
transfusions
NCNC ANAEMIA-2
Parameter
Effect
Hb, HCT
Reduced
MCV, MCH, MCHC
Normal to slightly increased
Haptoglobin
low
Bilirubin
Increased (unconjugated)
Retic count
High, polychromasia
Haemoglobinaemia
Present
Hemoglobinuria
present
BM examination
Hyperplastic picture
 Steroids
 Splenectomy
 BT
 BMT/SCT
 Rare
disease
 Mixed pattern
 Partially treated
 Blood transfusion
 Anaemia
is a common and treatable problem
 History, PE & CBC gives important clues to
the diagnosis
 IDA is the commonest type, oral iron
replacement is the treatment of choice
 BT needed rarely
Aziz-ur-Rehman

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