APPROACH TO ANEMIA..................pptx

IMPORTANT

1. APPROACH TO ANEMIA

2. ANEM I A  Defined as quantitative reduction in hemoglobin or erythrocytes or both below the level that is expected for healthy person of same age and sex in the same environment.

3. LEVELS  Adult male  Adult female  Adult female (Pregnant)  >6-12 yr  6m- 6yr  2- 6m  Newborn  <13  <12  <11  <11.5  <11  <9.5  <13.6

4. CLASSIFICATION OF ANEMIA

5. APPROACH TO DX  Severity  Cause

6. PRESENCE OF ANEMIA HEMOGLOBIN ESTIMATION PCV ESTIMATION  Colorimetric method  Gasometric method  Chemical method  Specific gravity method  Wintrobe method  Microhematocrit method

7. HISTORY IN A CASE OF ANEMIA  Clinical evaluation  Symptoms  Fatigability  Effort dyspnoea  Palpitation  Signs  Pallor  Chronic blood loss  Pregnancy  Pica  Chronic alcoholism  History of mal a b s o r pt i on  Drugs  Hypoplastic  Megaloblastic  IDA  HA

8. CONT….  Primary underlying disease  CVD  Mlg  Chronic infection  AIDS  ESLD  ESRD  Endocrine ds  Geographic Area

9. LABORATORY EVALUATION  Initial investigations  Peripheral blood smear  Reticulocyte count  Red cell indices  Specialized investigations  BM exam  Serum iron  Hemoglobin electrophoresis

10. PERIPHERAL BLOOD SMEAR

11. PERIPHERAL BLOOD SMEAR  Head  Body  Tail

12. HOW TO ASSESS THE SIZE OF RBC IN PBS  By comparing the size with the small lymphocyte

13. NORMOCYTIC NORMOCHROMIC

14. ANISOCYTOSIS

15. POIKILOCYTOSIS

16. MICROCYTIC HYPOCHROMIC

17. MACROCYTOSIS  Oval  Round

18. SICKLE CELLS

19. SPHEROCYTES

20. TARGET CELLS/CODOCYTES

21. SCHI S T OC Y TES

22. BURR CELLS

23. TEAR DROP CELL

24. BASOPHILIC STIPPLING

25. HOWELL JOLLY BODY

26. PO L Y CH R OM A TIA

27. RETICULOCYTE COUNT

28. RETICULOCYTE COUNT  Young red cell that contain RNA element  Stains with supravital stain  Brilliant cresyl blue  New methylene blue  Assess erythropoietic activity of the bone marrow

29. RETICULOCYTE… SUPRAVITAL STAIN

30. RETICULOCYTE MEASURES  Reticulocyte count ( % )  0.5 to 2.5 in adult  2 to 5 in newborn  Corrected reticulocyte count  RC x PCV pt / PCV normal  Absolute reticulocyte count  RC x RBC count  Reticulocyte production index

31. RETICULOCYTOSIS RETICULOCYTOPENIA  Acute blood loss  Hemolytic anaemia  Response to specific therapy in nutritional anemia  Decreased red cell production  Aplastic anemia  Myelopthisic anemia  IDA  ACD  Ineffective e r y t h r o p o i e s is  Megaloblastic  MDS

32. RED CELL INDICES

33. aka … ABSOLUTE VALUES  MCV  MCH  MCHC

34. MEASURED IN …AUTOMATED HEMATOANALYSER

35. MCV  in femtoliters (fl)  Average volume of a single cell  PCV x 10 / RBC count  RDW  Mentzer index

36. MCH  Picogram (pg)  Average amount of Hb per cell  Hb x 10 / RBC count  Low in microcytic  High in macrocytic

37. MCHC  Gm/dl  Average amount of HB in a given amount of RBC  Hb x 100 /PCV  Low in microcytic hypochromic  High in HS

38. RDW  Degree of variation of red cell size

39. RDW HELPS TO DIFFERENTIATE Β THALASSEMIA MINOR IDA  Low MCV  Low MCH  Low MCHC  High RDW  Low MCV  Low MCH  Normal MCHC  Low RDW  Target cell  Basophilic stippling

40. 3 MAJOR TYPES OF ANEMIA…

41. CASE 1  35 yr F  Strict vegetarian  Weakness, paresthesias, muscle weakness, or difficulty in walking, glossitis  She had a child with NTD

42. BLOOD PARAMETER  Hb 8.7gm/dl  TLC 3800/cmm  PLT 98000/L 

43. ABSOLUTE VALUES  MCV 116 (tell the units)  MCH 33  MCHC 32

44. RETICULOCYTE COUNT  Low

45. ?

46. MACROCYTIC ANEMIA

47. CAUSES Oval  Megaloblastic anemia  Drug therapy  MDS Round  Alcoholism  Liver disease  Hypothyroidism

48. WHAT ELSE CAN BE IN PBS  Hyper segmented neutrophil  Howell- jolly body  Cabot’s ring

49. BM EXAMINATION  Ineffective erythropoiesis  Megaloblastic change in all series  Giant band forms  Giant metamyelocytes

50. OTHER CAUSES OF MACROCYTOSIS…HOW TO RULE THEM OUT  Hemolytic anaemia  Features of hemolysis in addition with macrocytosis  Liver disease  Target cell will be in the smear  Myelodysplastic syndrome  Elderly patients  Bi/ Pancytopenia  BM exam- ALIP ( abnormal localization of immature precursor)

51. …CONT..  Pregnancy  Newborn  Cytotoxic chemotherapy  Aplastic anaemia

52. MICROCYTIC HYPOCHROMIC ANAEMIA

53. CAUSES  Iron deficiency anaemia  Thalassemia syndrome  Anaemia of chronic diseases  Sideroblastic anaemia

54. MICROCYTIC HYPOCHROMIC EVALUATION

55. NORMOCYTIC NORMOCHROMIC ANAEMIA

56. NORMOCYTIC NORMOCHROMIC EVALUATION

57. EVALUATION OF HEMOLYSIS  Within circulation  Blackwater fever, mismatch blood transfusion, PNH  Spleen normal  Plsama Hb% markedly increased  Hb in urine +  Hemosiderin in urine+  Within RES  Hb-pathies, Hereditary haemolytic anaemia, AIHA  Size increased  Mild increased  Absent  Absent  Negative

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