Docstoc

COMMON ANEMIAS

Document Sample
COMMON ANEMIAS Powered By Docstoc
					CLUES TO THE
DIAGNOSIS IN
   ANEMIA
PRINCIPLES
 Anemia is not a disease
 There is usually a cause
 investigation should be logical
 Start with CBC and Blood film
 Leads to other tests
  – non specific
  – specific
 Guides therapy
Further Principles
 Symptoms are more related to rate of fall in
  hemoglobin not level.
 Non specific symptoms
 More specific symptoms
 Drug History
 Physical examination
  – splenomegaly
Starts With CBC
 High yield parameters
  – Hgb
  – MCV
  – RBC #
 Morphology
 Confirmatory tests

 Lets apply
This is a 55 year old woman who has fatigue. Her only
other symptom is a craving for chewing ice cubes. Apar
from being pale her examination is normal.



  Test results           Blood film
  Hgb  77 g/L
  MCV 66f/L
  RBC 3.2 x1012/L
  WBC 5.6 x106/L
  Plat 525 x109/L
Microcytic, hypochromic
STAGES OF IRON DEPLETION


     Loss of body stores
     Fall in serum iron
     Anemia develops
     Microcytosis
     Hypochromasia
ASSESSMENT OF IRON STATUS

 Identify high risk groups
 Children
 Menstruation
 Pregnancy - Lactation
 Frequent Blood Donors
 Chronic GI loss
 Malabsorption
 Diet
IRON BALANCE

 Ingest 10-20 mg. per day
 Absorb 1-3 mg. per day
 Lose 1 + mg per day
  – menstrual loss 30-50 ml
 Total iron 35-50 mg/kg
 Stores 1 gram
 Easy to achieve negative balance
Dx of IRON DEFICIENCY
 Symptoms and signs
 CBC - Anemia - microcytosis -
  Hypochromia
 Blood Film - Oval - pencil - Tear
 Serum Fe and TIBC Fe low TIBC high
 Serum Ferritin
 Cause of Iron Deficiency
INVESTIGATION OF CAUSE
 Investigate when cause not Clear
 Symptoms of cause often unreliable
 Upper GI cause higher Yield
 If upper GI lesion found then a colonic
  lesion unlikely
 TESTS - Radiologic, Endoscopic Biopsy,
  Angiographic.
THERAPY

Replace iron
Anemia of Chronic disease
 Usually mild to moderate anemia
 normocytic normochromic
 low retic count
 Low serum Fe and low TIBC sat % 15-20
 Ferritin normal or high
 A responsible disease is present
 Usually a systemic disorder
Hemochromatosis
Hemochromatosis
 Fe overload
 Genetic predisposition to increased Fe
  absorption
 Common
 Screen with Fe saturation (ferritin)
 Confirm with Genetic testing
 2 genes 282Y H63D
 Treatment - phlebotomy
A 65 year old woman is referred to you because of me
loss. Her family physician had received tests which incl
bilirubin of 28  mol/L and an LDH of 1560 U/L. He wa
puzzled by these results.


 Test results            Blood Film
 Hgb  85 g/L
 MCV 110 fL
 RBC 3.9 x1012/L
 WBC 2.4 x106/L
 Plat 89 x109/L
Oval Macrocytes
Hypersegmented neutrophils
Megaloblastic Anemias
      Vitamin B12
       Folic Acid
Reasons for measuring B12
 Investigation of macrocytic anemia
 Investigation of any anemia
 Investigation of fatigue
 Routine Geriatric Screen
 Investigation of neurologic symptoms
Symptom Complex
 Classic presentation uncommon
 Often a screen in older patients
 Memory loss prominent
 Neuropathy
 Changes in evoked potential
 Non specific symptoms of anemia
Causes
Pernicious anemia
 10 % of all cobalamin deficiencies


 Majority are due to malabsorption
Causes of Low Serum B12
Malabsorption of free cobalamin
 Pernicious anemia
 Post gastrectomy state
 Small bowel diseases
Causes of Low Serum B12
Malabsorption of food cobalamin
 Atrophic gastritis
 Postgastrectomy state
 Chronic nonspecific gastritis (H pylori ?)
 H2 receptor blocking agents
Tests
 CBC - RBC indices
  – Most are macrocytic
 Blood film
  – Macro-ovalocytes - hypersegmented polys
 Biochemical abnormalities
  – LDH bilirubin
 Serum B12
 Schilling test
Folic acid deficieny
 Dietary source is vegetables
 Absorption no specific carrier
 Deficiency mainly dietary.
 Alcoholism a risk
 Anemia macrocytic
 No neurologic symptoms
 Measure RBC folate
      Therapy

Replace B12 - folic acid
Therapy
 Vitamin B12
 IM
 Oral
 Folic acid
   – pregnancy
   – treatment
Hemolytic anemias
 History of jaundice and anemia
 May have splenomegaly
 May have a family history
 anemia with reticulocytosis
 specific morphologic changes
 serum bilirubin and LDH as markers
 Specific tests follow morphology
What is the abnormality ?
What is the abnormality ?
What is the abnormality
Which anemia is this ?
A Common Condition
Common anemias
 Iron deficiency
 Megaloblastic anemias
 Secondary anemias of chronic diseases
 Anemia of chronic disease
 Hemolytic anemias
  Spherocytic
  fragmentation
PRINCIPLES
 Anemia is not a disease
 There is usually a cause
 investigation should be logical
 Start with CBC and Blood film
 Leads to other tests
  – non specific
  – specific
 Guides therapy

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:2
posted:10/1/2011
language:English
pages:36