common anemias haematology dr. janis bormanis common anemias 4 iron deficiency 4 megaloblastic...
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COMMON ANEMIAS
Haematology
Dr. Janis Bormanis
Common anemias
Iron deficiency Megaloblastic anemias Secondary anemias to chronic diseases
Anemia of chronic disease Hemolytic anemias
Spherocytic
fragmentation
RE
LAT
IVE
F
RE
QU
EN
CY
IRON OVERLOADDEFICIENCY
IDA IDWAHC
BODY IRON IN THE POPULATION
INCSTR
STAGES OF IRON DEPLETION
Loss of body storesFall in serum ironAnemia develops MicrocytosisHypochromasia
ASSESSMENT OF IRON STATUS
Identify high risk groups Children Menstruation Pregnancy - Lactation Frequent Blood Donors Chronic GI loss Malabsorption Diet
SOURCES OF IRON
Heme Iron– Meat
– 10-15% absorbed
Non-Heme– Vegetables, Fruit, Cereal– Major source in Third World
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
Microcytic, hypochromic
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
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
Oval Macrocytes Hypersegmented neutrophils
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
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
Spherocytosis
G6PD deficiency - Oxidative hemolysis
Fragmentation Prosthetic heart valves
Which anemia is this ?
Hemoglobinopathies and Thalassemias
These are just some of the anemias which illustrate
principles of diagnosis
Approach to anemia
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