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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. APPROCH TO ANEMIA. CLINICAL PRESENTATION OF ANEMIA Anemia is most often recognized by abnormal screening laboratory tests.

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم

  2. APPROCH TO ANEMIA

  3. CLINICAL PRESENTATION OF ANEMIA Anemia is most often recognized by abnormal screening laboratory tests. The gradual onset of anemia , particularly in young patients, may not be associated with signs or symptoms until the anemia is severe: Hemoglobin < 7 to 8 g/dl DIFINATION : Male : Hb < 14 - 16 g/dl Female : Hb < 12 - 14 g/dl

  4. Primary Labortory Test For Anemia • CBC –PLT • HCT • RBC • MCV 80-100fl HCT(G//L) / RBC (* 1000,000,000,000/L) • MCH 30-34 PG HB(G/dl) /RBC (*1000.000,000,000) • MCHC 30-36G/DL) HB( G/L) / HCTL/L) • RDW 12 - 14 • HB • WBC & DIF • PERIPHERAL BLOOD SMEAR • RET% & BUN / CR

  5. APPROUCH TO ANEMIA RPI > OR= 2 < 2 HEMOLYTIC ANEMIA HEMORRHAGE MCV POST TREATMENT DECREASED NORMAL INCREASED FE TIBC FERITIN MEGALOBLASTIC ANEMIA MDS AA NO IDA IDA HB ELECTEROPHERESIS R/O ANEMIA OF CHRONIC DISEASE

  6. Labortory test for anemia RETICULOCYTE PRUDUCTION INDEX (RPI) RPI=RET%*PHCT/NHCT/ SI

  7. EXAMPLE FOR RPI CALCULATION 35 YEARS AGED MALE WITH : HB=8 G/DL MCV=105 fl RET%=3% CRC=24 / 45 X 3 =1.6 RPI=1.6 / 2 = 0.8

  8. CALCULATTION USED FOR INTERPRETING RBC INDEX IN MICROCYTIC ANEMIA

  9. Labortory test for anemia • IRON RESERVE TESTS • SERUM IRON : 50 to 150 ug/dL TIBC :300 to 360 ug/dL • TRANSFERIN SATURATION: • Serum iron * 100 / TIBC • NORMAL RANGE 25 to 50% • IDA : TS % < 18% FERITIN • FFREE ERYTROCYTIC PROTOPURPHIRIN • BBMB STAINING

  10. Serum Ferritin: • Under steady state conditions, the serum ferritin level correlates with total body iron stores • As iron stores are depleted, the serum ferritin fall<15 ug/L • virtually always diagnostic of absent body iron stores.

  11. Red Cell Protoporphyrin Levels is an intermediate in the pathway to heme synthesis Under conditions in which heme synthesis is impaired, protoporphyrin accumulates within the red cell Normal values are less than 30 ug/dL of red cells In iron deficiency, values in excess of 100 ug/dL are seen . Serum Levels of Transferrin Receptor Protein Normal values are 4 to 9 ug/L determined by immunoassay serum levels of TRP reflect the total erythroid marrow mass

  12. HEMOGLOBIN ELECTEROPHORESIS HB A 2 <3 R/O B THAL MINOR HB A2 = 3- 3.5 SUSPICIUOS HB A2 > 3.5 B THAL MINOR HEMOGLOBIN ELECTEROPHORESIS DON’T R/O a THAL SYNDROMS

  13. MCV > 100 RPI RPI<2 RPI>2-3 BMA BMB HEMORRHAGE HEMOLYSIS POSTTREATMENT HYPO OR ACELLULAR CELLULAR MEGALLOBLASTIC CHANGE APLASTIC ANEMIA MYLODYSPLASTIC SYNDROM MEGALLOBLASTIC ANEMIA

  14. MEGALOBLASTIC ANEMIA HYPERSEGMENTED NEUTROPHIL GIANT PLATLET MCV>105 LDH BIL RET B12 FOLAT LEVEL SERUM B12<100 SERUM FOLAT LEVEL < 4 SHILLING TEST GI EVALUATION

  15. Labortory test for anemia • EVALUTION FOR HEMOLYSIS • RRETICULOCYTE PRODUCTION ……………………………………………………………………………………………………………………………………………………………....INDEX • LDH • HAPTOGLUBULIN • HEMOPEXIN • MHEMALBUMIN • URIN HEMOCIDERIN • HEMOGLUBINUREA

  16. HEMOLYSIS COOMBS TEST NEGATIVE POSETIVE PBS OSMOTIC FRAGILITY TEST AUTOHEMOLYSIS TEST ENZYM ASSY SUCROUS LYSIS TEST HAMS’ TEST FLOCYTOMETRY IMMUN HEMOLYTIC ANEMIA

  17. Hereditary spherocytosis OSMOTIC FRAGILITY TEST

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