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