CLINICAL PATHOLOGY DEPARTMENT*ANAEMIAS

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Objectives:By the end of this lesson, the students will be able to:Differentiate between different types of anaemia. Choose the proper laboratory tests to diagnose different types of anaemia. Interpret laboratory test results of a case of anaemia.

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*How to approach a case of anaemia? A case of anaemia is diagnosed first by complete blood count with special stress on the indices RBC morphology Reticulocyte count Leukemia must be excluded.

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Hypochromic microcytic anaemia MCV < 75 fl, MCH < 26 pg Iron deficiency anaemiaAnaemia of chronic diseaseSideroblastic anaemiaThalassaemia (, )

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Lab diagnosis of hypochromic microcytic anaemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Iron deficiency anaemiaThalassemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Sideroblastic AnaemiaRinged SideroblastsPB in a case of Sideroblastic anaemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Macrocytic AnaemiaA-Macrocytic Anaemia with reticulocytosis1-Acute bleeding2-Haemolytic anaemiasB-Macrocytic Anaemia without reticulocytosisMegaloblastic anaemia (B12 or folate def.)MyelodysplasiaAplastic anaemiaLiver diseaseThyroid disease

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Megaloblastic Anaemia A group of anaemias in which the erythroblasts in the bone marrow show asynchronous maturation of nucleus & cytoplasm i.e. the nucleus maturation is delayed due to DNA synthesis . It is due to vit. B12 or folate deficiency (commonest folate )

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Lab tests for B12 & folate deficiencyComplete blood picture: Macrocytic anaemia MCV>100 fl Leucopenia, neutrophil hypersegmentation ThrombocytopeniaB.M. examination: Hypercellular, with megaloblasts, giant metamyelocytes. Other tests:Serum B12 Serum folate, Red cell folateAnti-parietal Ab & anti-intrinsic factor Ab.

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Megaloblastic features in the BM:

CLINICAL PATHOLOGY DEPARTMENT

Lab Approach to Haemolytic AnaemiaScreening tests

Increased reticulocyte count Increased urine urobilinogenIncreased indirect bilirubin

CLINICAL PATHOLOGY DEPARTMENT*

CLINICAL PATHOLOGY DEPARTMENT

Lab Approach to Haemolytic Anaemia

Specific tests: Hemoglobin Electrophoresis to detect abnormal hemoglobins.Osmotic fragility test for heriditary spherocytosisCoombs test for immune hemolytic anaemiasG-6-PD assay for favismRed cell morphologyB.M. examination.

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Two Types of Haemolysis1-Extravascular (in RES e.g spleen)2-Intravascular (inside vessels)Main cause : ?????? Specific tests include : HemoglobinaemiaHemoglobinuriaDecreased haptoglobinCLINICAL PATHOLOGY DEPARTMENT*

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Normochromic Normocytic anaemiaNormal MCV , MCH & MCHCHaemolytic anaemias other than thalassemia Ex :sickle cell , hereditary spherocytosis, G6PD deficiency.Acute bleedingAcute systemic disease

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Normochromic, normocytic anaemia in a case of anaemia of chronic disease

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Hereditary ElliptocytosisG6PD deficiencySickle cell AnaemiaSickle cell Anaemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Hereditary Spherocytosis Red cell membrane defectDiagnostic criteria:1-Normochromic Normocytic anaemia with increased MCHC2-Blood film show micro-spherocytes3-Reticulocytosis 4-Increased Saline Osmotic Fragility

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Hereditary SpherocytosisSaline Osmotic Fragility TestControlTestSpherocytes in blood filmSpherocytes in blood film

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Immune haemolytic anaemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*RBCs fragments in haemolytic anaemiaCold Agglutinins

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Aplastic anaemia & BM failureDefinition:Pancytopenia resulting from aplasia of the bone marrow.

Classification:Primary: Congenital (Fanconi, non Fanconi types) and acquired (idiopathic)Secondary: Ionizing radiation, drugs, chemicals & infections.

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Laboratory findings of aplastic anemia:

Normochromic normocytic anaemia with low reticulocyte count.LeucopeniaThrombocytopeniaNo abnormal cells are seen in blood films.Hypocellular bone marrow with replacement of haemopoietic tissue by fat spaces. Aplastic anaemia

CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT*Haemostasis

CLINICAL PATHOLOGY DEPARTMENT

*CLINICAL PATHOLOGY DEPARTMENTBleeding disordersBleeding disorders may be due to abnormalities of the vascular system, platelets, coagulation system or fibrinolytic system.

CLINICAL PATHOLOGY DEPARTMENT

Lab tests for bleeding disordersSCREENING TESTS:BTCTPT /INR to standardize PT results among different labsPTTTT*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

*CLINICAL PATHOLOGY DEPARTMENTLab diagnosis of vascular causesBT: prolongedCT : normalHess test: > 5 purpuric spotsPlatelet count : normalPlatelet function: normal

CLINICAL PATHOLOGY DEPARTMENT

PROLONGED BLEEDING TIMECBC to diagnose thrombocytopeniaPT normal & PTT prolonged..? VWD??BM for thrombocytopeniaPlatelet function tests (aggregometer) to diagnose qualitative platelet disorders.eg. Glanzman disease *CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

*CLINICAL PATHOLOGY DEPARTMENTClotting cascade

CLINICAL PATHOLOGY DEPARTMENT

Prolonged PTTWITH NORMAL PT: DEFECT IN INTRINSIC SYSTEMFACTOR VIII &IX ASSAY (factor VIII deficiency=hemophilia A )(factor IX deficiency=hemophilia B)

PROLONGED PT &PTTDefect in the common pathway: factor X,II,I

*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

PROLONGED PTWith normal PTTHereditary:DEFECT IN extrinsic pathway: factor VII deficiencyAcquired:Hemorrhagic disease of the newborn due to vit K deficiencyLiver disease (synthetic function of the liver)*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

Prolonged thrombin timeIn cases of fibrinogen defects : dysfibrinogenemia, afibrinogenemia, DIC*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

Monitoring of patients on anticoagulant therapyHeparin therapy by PTTOral anticoagulant therapy by PTLMWH (CLEXAN) by anti factor X*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

LAB INVESTIGATIONS OF DICAll screening tests are prolonged: BT,CT PT PTTTHROMBOCYTOPENIAD-DIMER /FDPS positiveFactor assay : decreased activity*CLINICAL PATHOLOGY DEPARTMENT

CLINICAL PATHOLOGY DEPARTMENT

*CLINICAL PATHOLOGY DEPARTMENTInterpretation Of Lab Tests Prolonged PTDefeciency in any factor of the extrinsic or common pathway:7,10,2,1Vit K defeciencyLiver diseaseOral anticoagulant therapy Prolonged PTTdefeciency of any factor in the intrinsic or common pathways: most common VIII, VW, IXHeparin therapy Presence of inhibitors

CLINICAL PATHOLOGY DEPARTMENT