APPROACH_TO__ANEMIA[1][1].pptx Easy read

Basic understanding of anemia and how to approach the diagnosis and treatment

1. APPROACH TO ANEMIA

2. ANEMIA Anemia is present when the hemoglobin level in the blood is 2 standard deviations below the mean for the particular age and sex. It is a condition in which tissue hypoxia occurs due to inadequate oxygen carrying capacity of blood. Anemia is a sign, it is important to investigate the cause of anemia to ensure that it is not due to any serious underlying ailment and to define the correct management approach.

3. Tiredness, lassitude, easy fatigability and generalised muscular weakness are the most frequent and the earliest symptoms of anemia . Colour of nail beds, oral mucous membranes and conjunctiva are reliable indicators of anemia . Dyspnea on exertion, tachycardia and palpitation are common symptoms. Poor feeding, irritability and inadequate school performance. Severe anemia is characterised by a high output state with elevated pulse pressure and the collapsing character. Clinical features

4. 5 There may be obstetric history of maternal infections, anemia or collagen vascular diseases or presence of prematurity, blood loss, jaundice, or cephalhematoma. Nutritional iron deficiency anemia often occurs between 6 months and 2 years due to inadequate weaning, chronic diarrhea or cow milk allergy. Vegetarian diet and use of goat milk may result in megaloblastic anemia . History of drug intake, pica, chronic diarrhea , prior surgery, acute and prolonged infections, transfusions and age of onset of symptoms should also be taken. Examination is done for clues to the cause of anemia and lymphadenopathy and hepatosplenomegaly. Petechiae, purpura, icterus and bossing also help to diagnose the cause. Approach to diagnosis

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7. Megaloblastic anemia Characterized by macrocytic red blood cells and erythroid precursors, which show nuclear dysmaturity.. . It is very common in vegetarians and those who consume coat milk. In infants it is related to maternal deficiency with inadequate body stores and prolonged exclusive breastfeeding. Rarely inherited metabolic disorders may cause megaloblastic anemia . CLINICAL FEATURES- features characteristically found in megaloblastic anemia include glossitis, stomatitis, hyperpigmentation of the skin on knuckles and terminal phalanges, enlargement of liver and spleen. Petechiae and hemorrhagic manifestations have been reported in 25% cases. Pancytopenia and hepatosplenomegaly can make it difficult to differentiate from leukemia . 9

8. LAB INVESTIGATIONS- macrocytosis (>110 fl highly suggestive of megaloblastic anemia ) cytopenias Hypersegmented neutrophils (nucleus >6 lobes) serum B12 and folate levels are assayed Schilling test, which requires radioactive labeled B12 is used to identify pernicus anemia and for evaluation of deficiency states 10

9. TREATMENT- therapeutic doses of folate (1-5 mg/ day) and vitamin B12 (1000 μg ) are administered. Folate dose of 1-5 mg/day is recommended for 3-4 weeks. Parenteral vitamin B12 at a dose of 1 mg (1000 μg ) is given intramuscularly; lower doses (250 μg ) can be used in infants. In patients with pernicious anemia and malabsorptive states, vitamin B12(1000 μg ) should be given IM daily for 2 weeks, then weekly until the hemntocrit value Is normal and then monthly for life.Patients with neurological complications should receive 1000 microgram IM every day for 2 weeks, then every 2 weeks for 6 months and monthly for life 11

10. IRON DEFICIENCY ANEMIA- there is a decrease in total iron body content, severe enough to diminish erythropoesis and cause anemia.. Treatment The cause of anemia should be identified and corrected Hookworm infestation is the commonest cause of occult gastrointestinal blood loss Oral iron preparations should be taken on an empty stomach or in between meals for best absorption. Most cost effective oral preparation is ferrous sulphate (20% elemental iron) DOSE-3-6 mg/kg/ day elemental iron..  After correction of anemia , oral iron continued for 4-6 months to replenish iron stores 12

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