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Introduction to Haematology!

Introduction to Haematology!. Starting with anaemias !. Elliot Catchpole PCMD. Objectives. To be able to define what an anaemia is To describe the symptoms of classical anaemia

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Introduction to Haematology!

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  1. Introduction to Haematology! Starting with anaemias! Elliot Catchpole PCMD

  2. Objectives • To be able to define what an anaemia is • To describe the symptoms of classical anaemia • To identify the different aetiologies of anaemia and how to differentiate between them (which investigations to perform) • To be able to select an appropriate course of management for anaemia based on the aetiology.

  3. Lets begin... • What is in blood?

  4. CELLS Platelets Plasma WBC RBC ROTEINS P E N LECTROLYTES UTRIENTS

  5. ERYTHROBLAST KIDNEY • What is in blood? • Red blood cells? EPO RETICULOCYTE RBC RBC RBC RBC RBC

  6. ANAEMIA • “A reduction in haemoglobin, either through a decreased RBC mass or increased plasma volume” • Measuring RBC activity • Haematocrit (or PCV)= % concentration of RBC’s in blood Males = 45(13-18Hb) Females = 40 (11.5-16Hb)

  7. MCV • Mean Cell Volume = The size of each RBC MACROCYTIC >96 Normocytic 76-96 Microcytic <76 Haemolysis Non-Megaloblastic • -IRON deficiency • Thalassaemias • Sideroblastic -Alcohol -Liver Disease -G6PD Deficiency -Hereditary spherocytosis -Paroxysmal Nocturnal Haemoglobinurea -Autoimmune Haemolysis -Sickle Cell Megaloblastic B12andFolate Chronic Disease

  8. Presentation • All present the same! Severity based on HCT Fatigue Pallor >30 = Asymptomatic 25-30 = Fatigue 20 -25 = Dyspnoea, confusion <20 = MI ANAEMIA Light-headedness

  9. Iron Deficiency • CAUSES = 1) Bleeding 2) Diet (incl. Vit C) • *PRESENTATION* = Spoon nails, angular stomatitis (chronic) • *INVESTIGATIONS* = RDW • TREATMENT = 1) Ferrous Sulphate (PO) 2) Blood Transfusion (IM Fe if cannot tolerate infusion)

  10. Thalassaemia • CAUSES: Genetics (Major=homozygote, minor/trait=heterozygote) • *PRESENTATION* = (minor) MCV, minor symptoms • INVESTIGATIONS – smear – ‘Target cells’ *Electrophoresis* • TREATMENT - Trait = No active treatment Major = Lifelong transfusions

  11. Sideroblastic Anaemia • CAUSES = Genetic, Alcohol, Lead, Medications, Vit B6 deficiency • INVESTIGATIONS = *Prussian Blue stain* • TREATMENT = Genetic/deficiency: Pyridoxine OTHER: Remove cause

  12. Chronic Disease • Caused by many chronic diseases • Treat the underlying cause

  13. Questions • A 54 year old women comes to the clinic due to fatigue. FBC shows a decreases HCT (30) and an MCV of 68.What is the most likely dfiagnosis when the following additional features are described? • Elevated Red-cell distribution of width and high platelets • Low Iron, low TIBC, low reticulocytes. A history of rheumatoid arthritis • A very low MCV with few symptoms and an elevated red-cell count. Normal Iron studies.

  14. Questions • A 23 year old woman has been feeling tired and lethargic for the past 18 months. She occasionally feels dizzy on standing and is generally weak. Otherwise, she is well. FBC showed:Hb – 9.5mgMCV – 69fl • Which is the single most appropriate further investigation to confirm the diagnosis? • a) Hb electrophoresisb) HBA2 levelc) Serum Iron + Ferritind) Thyroid function testse) Vitamin B12 + Folate levels

  15. Questions • A pale 60 year old man presents with feelings of tiredness and light-headedness. MCV – 60flHCT – 30 • His Faecal occult blood test is negative 3 times. What is the next best step in the management of this patient? • a) Start iron replacement therapyb) Electrophoresisc) Transfused) Colonoscopye) Peripheral Blood smear

  16. D) Colonoscopy • There is such a high incidence of microcytic anaemia in colonic malignancy that excluding GI malignancy is very important in this age group.Faecal occult blood is not sensitive enough to exclude colon cancer.

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