Chittima Sirijerachai

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Approach to Anemia

• Chittima Sirijerachai

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• ????? CBC, blood smear, red cell indices ???
  reticulocyte count ???

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• iron deficiency anemia,
• thalassemia,
• Autoimmune hemolytic anemia (AIHA)
• aplastic anemia (AA)
• G-6-PD deficiency

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Recommended book

• Blood physiology and pathology Chris
  Pallister. 1994
• Williums Text book of hematology 5 th ed. 1995
• Wintrobe Text book of hematology 9 th ed. 1993
• ???????????????????????? ??. 2539
• Short note in medicine ??. 2543
• ?????????????? ??????? ????????? ??. 2537

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Criteria for Diagnosis Anemia
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Mechanism of anemia
1. Decreased RBC production - Nutritional
deficiency - Aplastic anemia - Myelophthisis
anemia - Chronic renal failure
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Mechanism of anemia

• 2. Increased RBC destruction
• Intravascular hemolysis
• Extravascular hemolysis

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Mechanism of anemia
3. Blood loss
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Anemic symptoms
- fatigue - dyspnea - edema - chest pain
- dizziness - confusion - coma
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History

• Duration, onset
• Severity

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Anemia
Acute
Chronic
( gt 2 Months )
( lt 7 Days )
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Acute anemia
Acute hemolysis
Acute blood loss

• History of
• dark urine
• jaundice

• History of
• GI bleeding
• hypermenorrhea

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Acute anemia
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Chronic anemia

• Dietary intake
• Absorption
• Chronic blood loss

• Family history
• Hx of blood transfusion

• Bleeding tendency

• Hx of dark urine

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Anemia
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• Systolic hypertension
• tachycardia
• bounding pulse
• Systolic ejection murmur

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glossitis
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Koilonychia - spoon shaped nail
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Iron deficiency anemia
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Nutritional deficiency anemia
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Bone marrow failure
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Chronic extravascular hemolytic anemia
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Mongoloid facies
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Investigation initial

• CBC, blood smear
• red cell indices
• reticulocyte count

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Red cell indices

• MCV -mean corpuscular volume
• -normal 85-95 fl
• MCH -mean corpuscular hemoglobin
• MCHC -mean corpuscular hemoglobin
• concentration

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CBC and RBC indices
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MCV

• Iron deficiency
• thalassemia
• lead poisoning
• B6 deficiency

• reticulocytosis
• megaloblastic anemia
• AA
• liver disease

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Corrected Reticulocyte count
retic. Count X Pt . Hct normal Hct
Normal Hct. male 45
female 40
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Blood smear

• ???????? ?????????
• anisocytosis, poikilocytosis
• hemolysis? - microspherocyte
• abnormal red cell target, schistocyte etc

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anisocytosis, poikilocytosis
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Investigation for definite diagnosis

• Inclusion body - thalassemia
• saline agglutination - AIHA
• Hb typing - thalassemia
• Coomb's test - AIHA
• Bone marrow - AA

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inclusion bodies
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Heinz body
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Case discussion
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22-year-old female anemia with jaundice for 2
wk no hepatosplenomegaly
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• CBC- Hb 8 gm, WBC 12,000 /mm3 Plt-adq, N 78, L
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• MCV 102 fl
• Reticulocyte count 10.2

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polychromasia
NRC
microspherocyte
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autoagglutination
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22-year-old female anemia with jaundice for 2
wk no hepatosplenomegaly
Hemolytic anemia
investigation
Autoimmune hemolytic anemia
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Treatment
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?????????????? 16 ?? ?????????????????????? ?? 1
??????? ??????????? pale, jaundice, no
hepatosplenomegaly
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• CBC- Hb 7 gm, WBC 12,500 /mm3, plt-adq, N 90 ,
  L 10
• UA- sp.gr. 1.020, blood 3, cell 0
• MCV 102 fl
• Reticulocyte 9.5

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?????????????? 16 ?? ?????????????????????? ?? 1
??????? ??????????? pale, jaundice, no
hepatosplenomegaly
investigation
G-6-PD deficiency with acute hemolysis
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G-6-PD deficiency
complication
Treatment
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??????????????? 25 ?? ????????????????????? 4-5
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Chronic anemia
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• CBC HCT 20 , WBC 6700 /mm3, plt - adequate, N
  56 , L 30 , E 14
• MCV 73 fl
• reticulocyte count 1.2
• stool exam - hook worm egg

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hypochromic, microcytic
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??????????????? 25 ?? ????????????????????? 4-5
?????
Iron deficiency anemia
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Iron deficiency anemia
??????
Treatment
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??????????????? 20 ?? ????????????????????????????
??? ???????????????????????
Chronic hemolytic anemia
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Investigation

• CBC HCT 23 , WBC 5600 /mm3, plt - adequate, N
  65 , L 35
• MCV 65 fl
• reticulocyte 9

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HCMC, aniso-poikilocytosis
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Thalassemia
Treatment
Genetic counselling
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