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Fifth stage
Medicine
Lec-1
د.خالد نافع
17/11/2015
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
Visual diagnosis of anemia; observation of paler.
Measurement of Hb & HCT
MCV = HCT/RBCs X 10 ( 85-95)
MCH = Hb/RBC X 10 (29-31)
MCHC= Hb/HCT X 10 ( 33% ± 2)
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
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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.
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10. Haptoglobin leve.
11. Direct Coob`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;
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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.