Download Anemia Due to Excessive Destruction Of RBC

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
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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
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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
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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.
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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.
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