Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Fifth stage خالد نافع.د Medicine Lec-1 27/10/2015 Diagnostic Approaches To Anemia 1. Is the patient anemic ? 2. How severe is the anemia ? 3. What type of anemia ? 4. Why is the patient anemic? 5. What should be done ? 1- IS THE PATIENT ANAEMIC Visual diagnosis of anemia; observation of paler. Measurement of Hb & HCT MCV = HCT/RBCs X 10 ( 85-95) MCH = Hb/RBC X 10 (29-31) MCHC= Hb/HCT X 10 ( 33% ± 2) CLASSIFICATON OF ANAEMIA According To Cell Indices *Normocytic ; MCV 85-95fl MCH 28-32pg MCHC 27-35g/dl *Macrocytic MCV > 100 MCH > 34 MCHC 31-32 *Microcytic MCV < 70 MCH < 25 MCHC < 28 1 2-How Severe Is The Anemia? Severity of anemia depend on ; 1. Hb level & HCT 2. Rapidity of onset Mild ; Hb > 9g/dl Moderate ; Hb 6-9g/dl Severe ; Hb< 6g/dl Compensatory Mechanism In ANAEMIA 1.Cardiac Output. 2. 2,3Diphosphoglycerate 3-WHAT TYPE OF ANAEMIA? 1- Is the anemia accompanied by alteration in WBC orPlatelet ? 2-Is it the result of reduced red cell production or increased cell destruction? * RETICULOCYTE COUNT( corrected ) 1.High= increase cell destruction. 2.LOW=reduce cell destruction. Information Gained From Clinical Examinations 1- Pallor of mucosa; anaemia 2-Enlarged lymph node ; systemic disease 3- Hepatosplenomegaly; systemic disease, chronic hemolysis 4-Bruises; Bleeding disorder 5-Jaundice; Hemolysis 2 Simple Laboratory Test To Evaluate Anemia 1.Hb, PCV(HCT), MCHC. 2.WBC count & differential. 3.Peripheral Smear. 4.Reticulocyte count. 5. Urinalysis. 6.Occult Blood In Stool. 7.Serum Iron ,Total Iron Binding Capacity(TIBC). 8.Serum vitamin B12, Folic acid level. 9.Indirect bilirubin. 10.Haptoglobin leve. 11.Direct Coob`s test. 12.Sickle Cell Preparation. 13.Hb- electrophoresis. 14.Hb A2 %. 15.Hb F. 16.Osmotic Fragility. 17.Autohemolysis. 18.Red Cell Enzyme Assay. 19.Heinz bodies. 20.Acid lysis. 21.Platelet Count. 22.Bone Marrow Biopsy & Aspiration. 4- Why Is The Patient Anemic? *Anemia due to decrease production of RBC 1-Lack of necessary nutrient; a.Iron deficiency 3 b. Folic acid deficiency c. Cobalamine deficiency d.Combined deficiency 2-Bone Marrow defect;* Generalized a. Primary Aplastic Anemia. b. Replacement. * Limited to RBC a. Congenital b Acquired *Anemia Due to Excessive Destruction Of RBC 1.Formation of abnormal RBC A.Hb defect; Thalassemia. B.Hereditary Spherocytosis. C.Metabolic defect; Pyruvate kinase deficiency , other enzyme defect 2- Formation of RBC hypersensitive to hemolysis; A. G6PD deficiency B. Certain Hbpathies. 3- Presence of extracorpuscular factors a.Immune hemolytic anemia .b. Cold agglutinin c.Hemolytic uremic syndrome d. Anemia of acute infection e. Hypersplenism f. Anemia of collagen disease. 5-What Should Be Done? # Treatment of the cause, once recognized; 1- Available modality of treatment; Iron, Folic acid , B12, B6, Steroid. 2- Splenectomy ; Indication a. RBC coated by antibody. b.Hereditary Spherocytosis. 4 c.Pyruvate Kinase deficiency. 3- Blood Transfusion ; Indication a. Anaemia +CHF b.Sickle cell anemia,Thalassemia c. Failure of all logic approaches d.Hb < 4 gm/dl. 5