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Anemia

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    Anemia Anemia Presentation Transcript

    • Anemia D/D Ortho R2 侯君翰 2002/12/23
    • Criteria
      • Hb < 12 g/dL(Hct < 36%) in women
      • Hb < 14 g/dL (Hct < 41%) in men
    • Clinical Manifestation
      • Vary depending on the disorder’s etiology, degree, and rapidity of onset,
      • Other underlying disorders
      • Hb <7: symptom of tissue hypoxia
        • Fatigue, headache, dyspnea, light-headness, angina
        • Pallor, visual impairment, syncope, and tachycardia => anemic hypovolemia
    • History & PE
      • Acute vs. Chronic
      • Family Hx , Drug exposure, Blood loss
    • Lab
      • Hb, Hct
      • % Reticulocyte count
        • absolute reticulocyte count
      • MCV –microcytic; normocytic; macrocytic
      • Peripheral blood smear
        • Anisocytosis, poikilocytosis
      • Additional testing:
        • G6PD, Hb electropheresis
    • Decreased RBC production
      • Iron Deficiency anemia (IDA)
      • Thalassemia
      • Myelodysplastic syndrome (MDS)
      • Megaloblastic anemia
      • Anemia from chronic renal insufficiency
      • Anemia from chronic disease
      • Anemia associated with HIV infection
      • Aplastic anemia
    • Increased RBC loss or destruction
      • Bleeding
      • Hemolytic anemia
        • Intravascular hemolysis
        • Extravascular hemolysis
      • Sickle cell disease
      • G6PD deficiency
      • Autoimmune hemolytic anemia (AIHA)
      • Drug-induced hemolytic anemia
      • Microangiopathic hemolytic anemia
    • Decreased RBC production
    • Iron-deficiency anemia (IDA)
      • History + PE
      • PB smear: hypochromic microcytic
      • Ferritin <10ng/ml in women or 20 ng/dl in men => low iron storage
        • acute-phase reactant
      • Fe <50 ug/dl
      • TIBC >420 ug/dl
      • BM biopsy: absent iron staining
    • Thalassemia
      • Alpha-thalassemia
        • HbH, Hydops fetalis
      • Beta-thalassemia
        • Insoluble tetramer, more severe
        • Thalassemia minor (trait)
        • Thalassemia intermedia
        • Thalassemia major (Cooley’s anemia)
    • Thalassemia 2
      • FH
      • Splenomegaly
      • Microcytic, hypo-chromic, poikilocytosis
      • Hb electrophoresis
    • Myelodysplastic syndrome (MDS)
      • Acquired clonal disorder of hematopoietic stem cell
      • Idiopathic or secondary to C/T, R/T, toxin
      • MCV +/-
      • PB smear: marked anisocytosis and poikilocytosis
      • Diagnosis ! = Abnormal hematopoietic cell in BM
    • Megaloblastic anemia
      • A group of disorders associated with altered morphology of hematopoietic cells and other rapidly dividing cells because of abnormalities in DNA synthesis.
      • Folic acid deficiency (months)
        • Alcoholism, malabsorption, increased use
      • Vit B12 deficiency (years)
        • Pernicious anemia, gastrectomy, pancreatic insufficiency, intestinal bacterial overgrowth, ileitis or ileal resection , intestine parasite
    • Megaloblastic anemia 2
      • S/S: anemia
      • Neurologic (VitB12)
      • Macrocytic anemia (leukopenia+ thrombocytopenia)
      • PB smear: hypersegmented neutrophil
      • LDH, indirect Bil 
      • Serum VitB12, RBC folate
      • Serum methylmalonic acid and homocysteine (HC)
      • Schilling test (pernicious anemia)
      • BM biopsy
    • Anemia from CRI
      • Decreased EPO production
      • Normocytic, Hct 20%-30%, normochromic
        • Echinocytes (burr cell); Acanthocyte (spur cell)
    • Anemia from chronic dz
      • Long-standing inflammatory dz, malignancy, autoimmune disorders, and chronic infection.
      • Usually normocytic, normochromic
      • PB smear: normal
      • Ferritin: normal usually, but may elevated
      • No lab test.
    • Anemia -HIV
      • BM: similar to MDS
      • Mycobacterium avium complex
      • Parvovirus B19
        • Transfusion-dependent anemia with low reticulocyte count
        • Ab. Not elevated
        • PCR
      • Zivovudine
    • Aplastic anemia
      • Acuired abdnormality of BM stem cell.
      • Idiopathic (most cases)
      • 20% related to drug or chemical
      • 10% viral (EBV, hepatitis, CMV)
      • pancytopenia
    • Increased RBC loss or destruction Increased erythropoiesis (elevated reticulocyte count)
    • Bleeding elevated normal LDH elevated normal Bil Less common More common hemolysis bleeding
    • Hemolytic anemia
      • Intravascular hemolysis
        • F/C, T/C, bachache
        • Serum haptoglobin  , urine hemosiderin (chronic),
      • Extravascular hemolysis
        • RBC destruction in RE system (spleen)
        • Splenomegaly, Jaundice
        • Direct Coomb’s test
    • Sickle cell anemia
      • Structurally abnormal Hb molecule that polymerize under reduced oxygen conditions.
      • S/S: vary widely (Infant & child)
      • Hb 5-10 g/dl
      • Chronic neutrophilia 10K-20K
      • PB smear
    • G6PD deficiency
      • Sex-linked
      • RBC susceptible to oxidant
      • Mild / severe / most severe
      • PB smear: bite cell / RBC inclusion (Heinz bodies)
      • Lab : G6PD level
    • Autoimmune hemolytic anemia (AIHA)
      • Warm AIHA
        • IgG
        • Idiopathic; underlying malignancy, autoimmune dz or drugs
        • Haptoglobin  , LDH  , DAT for IgG(+)
      • Cold AIHA
        • Cold agglutinin dz
        • Paroxysmal cold hemoglobulinuria
    • Drug-induced hemolytic anemia
      • Drug-induced autoantibodies
      • Haptens
      • Immune complex
    • Microangiopathic hemolytic anemia
      • Traumatic intravascular hemolysis caused by deposition of fibrin strands in the lumen of small BV
      • DIC
      • TCP
      • HUS
      • PB smear: fragmented RBC, thrombocytopenia
    • Thank you 感謝 4C1 同仁一個月來對我的幫忙、指導、教育與鞭策
    • 柯公文哲的 「結論」
      • 治療為什麼沒效?因為診斷不對!
      • 開哪裡想哪裡
      • 養成習慣,看不懂就回去唸書,再不然叫 intern 回去唸書…
      • 增加知識沒有壞處
      • 我什麼苦日子沒待過…
      • 我是國考第一名 !!!