hematology

Diagnostic Approaches To Anemia

1. Is the patient anemic ? 2. How severe is the anemia ? 3. What type of anemia ? 4. Why is the patient anemic? 5. What should be done ?

1- IS THE PATIENT ANAEMIC

CLASSIFICATON OF ANAEMIA According To Cell Indices
*Normocytic ; MCV 85-95fl MCH 28-32pg MCHC 27-35g/dl *Macrocytic MCV > 100 MCH > 34 MCHC 31-32 *Microcytic MCV < 70 MCH < 25 MCHC < 28

2-How Severe Is The Anemia?

Severity of anemia depend on ; 1. Hb level & HCT 2. Rapidity of onset Mild ; Hb > 9g/dl Moderate ; Hb 6-9g/dl Severe ; Hb< 6g/dl Compensatory Mechanism In ANAEMIA 1.Cardiac Output. 2. 2,3Diphosphoglycerate

3-WHAT TYPE OF ANAEMIA?

1- Is the anemia accompanied by alteration in WBC orPlatelet ? 2-Is it the result of reduced red cell production or increased cell destruction? * RETICULOCYTE COUNT( corrected ) 1.High= increase cell destruction. 2.LOW=reduce cell destruction.

Information Gained From Clinical Examinations

1- Pallor of mucosa; anaemia 2-Enlarged lymph node ; systemic disease 3- Hepatosplenomegaly; systemic disease, chronic hemolysis 4-Bruises; Bleeding disorder 5-Jaundice; Hemolysis


Simple Laboratory Test To Evaluate Anemia 
1.Hb, PCV(HCT), MCHC. 2.WBC count & differential. 3.Peripheral Smear. 4.Reticulocyte count. 5. Urinalysis. 6.Occult Blood In Stool. 7.Serum Iron ,Total Iron Binding Capacity(TIBC). 8.Serum vitamin B12, Folic acid level. 9.Indirect bilirubin. 10.Haptoglobin leve.

11.Direct Coomb`s test. 12.Sickle Cell Preparation. 13.Hb- electrophoresis. 14.Hb A2 %. 15.Hb F. 16.Osmotic Fragility. 17.Autohemolysis. 18.Red Cell Enzyme Assay. 19.Heinz bodies. 20.Acid lysis. 21.Platelet Count. 22.Bone Marrow Biopsy & Aspiration.

4- Why Is The Patient Anemic?

*Anemia due to decrease production of RBC 1-Lack of necessary nutrient; a.Iron deficiency b. Folic acid deficiency c. Cobalamine deficiency d.Combined deficiency 2-Bone Marrow defect;* Generalized a. Primary Aplastic Anemia. b. Replacement. * Limited to RBC a. Congenital b Acquired

*Anemia Due to Excessive Destruction Of RBC

1.Formation of abnormal RBC A.Hb defect; Thalassemia. B.Hereditary Spherocytosis. C.Metabolic defect; Pyruvate kinase deficiency , other enzyme defect 2- Formation of RBC hypersensitive to hemolysis; A. G6PD deficiency B. Certain Hbpathies. 3- Presence of extracorpuscular factors a.Immune hemolytic anemia .b. Cold agglutinin c.Hemolytic uremic syndrome d. Anemia of acute infection e. Hypersplenism f. Anemia of collagen disease.

5-What Should Be Done?

# Treatment of the cause, once recognized; 1- Available modality of treatment; Iron, Folic acid , B12, B6, Steroid. 2- Splenectomy ; Indication a. RBC coated by antibody. b.Hereditary Spherocytosis. c.Pyruvate Kinase deficiency. 3- Blood Transfusion ; Indication a. Anaemia +CHF b.Sickle cell anemia,Thalassemia c. Failure of all logic approaches d.Hb < 4 gm/dl.