1 / 35

ANAEMIA

ANAEMIA. Dr. M Aamir Mirza MBBS, MCPS, MPhil, Ph.D C S Path (UAE), MABCP (USA). ANEMIA - DEFINITION . WHEN THE HEMOGLOBIN LEVEL IN THE BLOOD IS BELOW THE LOWER EXTREME OF THE NORMAL RANGE FOR THE AGE AND SEX OF THE INDIVIDUAL. Definition:.

cato
Download Presentation

ANAEMIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ANAEMIA Dr. M Aamir Mirza MBBS, MCPS, MPhil, Ph.D C S Path (UAE), MABCP (USA)

  2. ANEMIA - DEFINITION • WHEN THE HEMOGLOBIN LEVEL IN THE BLOOD IS BELOW THE LOWER EXTREME OF THE NORMAL RANGE FOR THE AGE AND SEX OF THE INDIVIDUAL

  3. Definition: Anemia is operationally defined as a reduction in one or more of the major RBC measurements: hemoglobin concentration, hematocrit, or RBC count Keep in mind these are all concentration measures

  4. The reticulocyte count(kinetic approach) • Increased reticulocytes (greater than 2-3% or 100,000/mm3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemias will present with a normal reticulocyte count due to immune destruction of red cell precursors. • Retic counts are most helpful if extremely low (<0.1%) or greater than 3% (100,000/mm3 total).

  5. Anemia? Production? Survival/Destruction? The key test is the …..

  6. IRON DEFICENCY - STAGES • Prelatent • reduction in iron stores without reduced serum iron levels • Hb (N), MCV (N), iron absorption (), transferin saturation (N), serum ferritin (), marrow iron () • Latent • iron stores are exhausted, but the blood hemoglobin level remains normal • Hb (N), MCV (N), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent) • Iron deficiency anemia • blood hemoglobin concentration falls below the lower limit of normal • Hb (), MCV (), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent)

  7. BLOOD PARAMETERS • Hemoglobin concentration (Hg) • F: 7,2 –10; M: 7,8-11,3 mmol Fe/l (12-18 g/dl) • Erythrocytes count (RBC) • F: 4-5,5; M: 4,5-6 x1012/l (4-6 x106 /l) • Hematocrit (Hct) • F: 37-47; M: 40-54; (37-54%) • Platelet count (Plt) • 150 – 450 x 103/l (150-450 x 109/l) • Leukocytes count (WBC) • 4-10 x 109/l (4-10 x 103/ l)

  8. Erythrocytes parameters • Mean corpuscular volume (MCV) • N: 80-100 fl • RDW(Red cell Distrubution Width) • Mean corpuscular hemoglobin (MCH) • N: 27-34 pg • Mean corpuscular hemoglobin concentration (MCHC) • N: 310 – 370 g/lRBC (31-37 g/dl)

  9. IRON DEFICIENCY ANEMIA • IRON METABOLISM • ABSORPTION IN DUODENUM • TRANSFERRIN TRANSPORTS IRON TO THE CELLS • FERRITIN AND HEMOSYDERIN STORE IRON • 10% of daily iron is absorbed

  10. Most body iron is present in hemoglobin in circulating red cells • The macrophages of the reticuloendotelial system store iron released from hemoglobin as ferritin and hemosiderin • Small loss of iron each day in urine, faeces, skin and nails and in menstruating females as blood (1-2 mg daily)

  11. IRON METABOLISM • Iron concentration (Fe) • N: 50-150 g/dl • Total Iron Binding Capacity • N: 250-450 g/dl • Transferrin saturation • Transferrin receptor concentration • Ferritin concentration • N: 50-300 g/l

  12. IRON DEFICIENCY ANEMIA • ETIOLOGY: • CHRONIC BLEEDING • MENORRHAGIA • PEPTIC ULCER • STOMACH CANCER • ULCERATIVE COLITIS • INTESTINAL CANCER • HAEMORRHOIDS • DECREASED IRON INTAKE • INCREASED IRON REQUIRMENT (JUVENILE AGE, PREGNANCY, LACTATION)

  13. IRON DEFICENCY - STAGES • Prelatent • reduction in iron stores without reduced serum iron levels • Hb (N), MCV (N), iron absorption (), transferin saturation (N), serum ferritin (), marrow iron () • Latent • iron stores are exhausted, but the blood hemoglobin level remains normal • Hb (N), MCV (N), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent) • Iron deficiency anemia • blood hemoglobin concentration falls below the lower limit of normal • Hb (), MCV (), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent)

  14. IRON DEFICIENCY ANEMIA • GENERAL ANEMIA’S SYMPTOMS: • FATIGABILITY • DIZZENES • HEADACHE • SCOTOMAS • IRRITABILITY • ROARING • PALPITATION • CHD, CHF

  15. CHARACTERISTICS SYMPTOMS • GLOSSITIS, STOMATITIS • DYSPHAGIA ( Plummer-Vinson syndrome) • ATROPHIC GASTRITIS • DRY, PALE SKIN • SPOON SHAPED NAILS, KOILONYCHIA, • BLUE SCLERAE • HAIR LOSS • PICA (APETITE FOR NON FOOD SUBSTANCES SUCH AS AN ICE, CLAY) • SPLENOMEGALY (10%) • INCREASED PLATELET COUNT

  16. Clinical Presentation • Asymptomatic • Pallor • Irritability, exercise intolerance, fatigue, and tachycardia • Blue sclera • Koilonychia • “Beeturia”

  17. IRON DEFICIENCY ANEMIA • MCV • MCH • MCHC N • Fe • TIBC • TRANSFERIN SATURATION • FERRITIN

  18. Anemia: Lab Evaluation • RBC Parameters • Hgb - Concentration of Hgb in whole blood • Hct - %Volume of blood occupied by RBCs • MCV - Mean Corpuscular Volume • MCHC - Mean Corpuscular Hgb Concentration • RDW - RBC Distribution Width • FEP - Free Erythrocyte Protoporphyrin • RBC - Number of RBCs per unit volume

  19. Normal Periperhal Smear Iron Deficiency Anemia Anemia: Lab Evaluation

  20. BLOOD AND BONE MARROW SMEAR • BLOOD: • microcytosis, hipochromia, anulocytes, anisocytosispoikilocytosis • BONE MARROW • high cellularity • mild to moderate erythroid hyperplasia (25-35%; N 16 – 18%) • polychromatic and pyknotic cytoplasm of erythroblasts is vacuolated and irregular in outline (micronormoblasticerythropoiesis) • absence of stainable iron

  21. Anemia: Lab Evaluation • Mentzer Index • Calculated ratio of MCV / RBC • > 13 - Fe deficiency anemia • < 13 - Hgb defect (ie thalassemia)

  22. Confusing Chart

  23. Management • History and physical examination is sufficient to exclude serious disease (e.g pregnant or lactating women, adolescents) - CURE ANEMIA • History and/or physical examination is insufficient (e.g old men, postmenopausal women) - FIND ETIOLOGY OF ANEMIA AND CURE (CAUSAL TREATMENT) • Benzidine test • Gastroscopy • Colonoscopy • Gynaecological examination

  24. IRON DEFICIENCY ANEMIACURE • ORAL • 200 mg of iron daily 1 hour before meal (e.g. 100 mg twice daily) • How long? • 14 days + (Hg required level – Hg current level) x 4 • half of the dose - 6 – 9 months to restore iron reserve • Absorption • is enhanced: vitC, meat, orange juice, fish • is inhibited: cereals, tea, milk

  25. Intervention • AAP Recommendations • Routine Hgb screening at 9 mos, 5 yrs, 14 yrs • Iron Intake • <4 years - 1 mg/kg/day • 4 to 10 years - 10 mg/day • 11 years and up - 18 mg/day

  26. Summary • Common Problem - especially among toddlers • Asymptomatic in the majority of patients • Leads to significant cognitive and motor deficits • Diagnosis and management fairly simple • Extensive work-up generally not needed • Rx failure needs further evaluation

  27. SIDEROBLASTIC ANEMIAS • HEREDITARY DISORDERS (rare) • SYNONIM FOR MDS (RA,RAES) • DISTURBANCES IN INTRACELLULAR IRON METABOLISM • HIGHER SIDEROBLASTS NUMBER IN BONE MARROW • CORRECT OR HIGHER IRON CONCENTRATION

More Related