Transcript Anaemia
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