Anaemia MD3 5-3-18.pptx notes 12224i77377

Anemia notes for studying

1. Anemia Emmanuela Ambrose MD .

2. Layout Definition Patient characteristics Classification of anaemia Severity of anaemia (WHO) Evaluation (History, PE, Labs) Diagnostic approach

3. Definition Anemia may be defined as a reduction in red blood cell (RBC) mass or blood hemoglobin concentration. In practice, It most commonly is defined by reductions in one/both of; Hematocrit (HCT) − fractional volume of a whole blood sample occupied by Hemoglobin (HGB) − This is a measure of the concentration of the RBC pigment hemoglobin in whole blood. Note : Normal ranges for HGB and HCT vary substantially with age, race, and sex

4. Patient characteristics Age of patient   Birth to three months   physiologic anemia, which occurs at approximately six to nine weeks of age. Decrease in Erythropoiesis production Pathologic anemia in newborns Anemia (HGB <13.5 g/ dL ) within the first month of life Signs of hemolysis ( eg , jaundice, scleral icterus, or dark urine) or symptoms of anemia ( eg , irritability or poor feeding)

5. Birth to three months   Common causes of pathologic anemia in newborns Blood loss, Immune hemolytic disease ( ie , Rh or ABO incompatibility), Congenital infection, Twin-twin transfusion, and Congenital hemolytic anemia eg , membrinopathies,enzymopathies Note : Hyperbilirubinemia in the newborn --hemolytic etiology. Microcytosis at birth --chronic intrauterine blood loss or thalassemia.

6. Cont..   Anaemia of prematurity have shorter red blood cell (RBC) life span, and have impaired erythropoietin production due to immature liver function Infants three to six months  − 3-6 months suggest a hemoglobinopathy . Nutritional iron deficiency (premier/ cow milk fed term infants) Children-Adolescents  − In toddlers, older children, and adolescents, acquired causes (IDA)

7. Cont … Sex  — Some inherited causes of anemia are X-linked eg , Male predominance-G6PD deficiency and X-linked sideroblastic anemia. Girls- excessive menstrual bleeding Race and ethnicity   SCD ; Africa/ Hispahic Thalassemia ; of Mediterranean and Southeast Asian descent G6PD deficiency ; Sephardic Jews, Filipinos, Greeks, Sardinians, Kurds, and black populations

8. Classifications Of Anemia Anaemia is being classified according to; Severity The cause Severity of anaemia (WHO) Mild anaemia 9-11 g/dl Moderate anaemia 7-10 Severe anaemia <7

9. Classfication according to Cause Physiologic classification Disorders resulting in an inability to adequately produce red blood cells ( ie , bone marrow depression). Disorders resulting in rapid RBC destruction (hemolysis) or RBC losses from the body (bleeding). Note ; reticulocyte count aids in defining the aetiology . Morphologic classification —RBC size Mean corpuscular volume (MCV) -represents the mean value of the volume of individual RBCs in the blood sample. low (microcytic), normal (normocytic), or large (macrocytic) Mean corpuscular hemoglobin concentration (MCHC) —(HGB/HCT), yielding a value of grams of HGB per 100 mL of RBC. Normal value indicate that cells are normochromic lower values indicate the presence of hypochromia.

10. History  ; Thorough history. Symptoms (clinical features)  helps elucidate the severity and chronicity of anemia Onset and severity of symptoms − Common symptoms of anemia include lethargy, tachycardia, and pallor. Hemolysis − Changes in urine color, scleral icterus, or jaundice such as G6PD deficiency Bleeding symptoms

11. Evaluation Birth history eg . gestational age, history of jaundice and/or anemia in the newborn period Drug and toxin exposure  — e.g. G6PD deficiency, lead exposure. Family history  — eg . jaundice, gallstones, VOC, splenomegaly Dietary history —focus on assessing iron intake, diet, type of formula Developmental history   congenital anaemia eg falcon

12. Physical examination Examine; skin, eyes, mouth, facies, chest, hands, and abdomen Pallor ; conjunctiva, palm, and nail beds Signs of scleral icterus , jaundice, and hepatosplenomegaly

13. Laboratory evaluation Complete blood count (CBC)/Full blood picture (FBP)   Hemoglobin and hematocrit   RBC indices Mean corpuscular volume (MCV)  Red cell distribution width (RDW) Mean corpuscular hemoglobin concentration (MCHC)  White blood count and platelet count

14. Laboratory evaluation Blood smear RBC size   Central pallor Fragmented cells Other features  Sickle cells,Elliptocytes , Stomatocytes , spherecytes •Pencil cells, Target cells, Bite cells and Heinz bodies ,Howell-Jolly Reticulocyte count  

15. Laboratory evaluation Confirmatory testing If hemolytic anemia is suspected, serum indirect bilirubin, lactate dehydrogenase, and haptoglobin levels direct antiglobulin test, G6PD deficiency screening test, osmotic fragility, and/or  hemoglobin electrophoresis .

16. Laboratory evaluation If IDA is suspected Serum ferritin, iron, and total iron binding capacity (TIBC). In Leukemia or marrow fairule Bone marrow aspirate   Bone  biopsy Others serum folate, B12, and lead levels

17. Treatment According to severity and cause Blood transfusion in severe anaemia Iron sulphate 6mg/kg/day Diet restriction(milk etc ) Iron reach foods Folate supplementation Avoidance of triggers eg , fava beans, etc