0
1. Full blood count
2. Hb
3. Blood picture
4. Bone marrow investigations
5. Reticulocyte count
6. Serum iron studies
7. El...
1.
2.
3.
4.
5.
6.

RBC count
Heamatocrit
MCV
MCH
MCHC
RDW
WHO recommended Haemoglobin levels to
diagnose anaemia at sea level (g/l)±

Non -Anaemia*
Children 6 - 59 months of age 11...
Summary for anaemic
heamoglobin concentrations
•Male
•Female
•Infant /children up to 12 yr
•Pregnant female

< 13 mg/dl
<1...
Normocytic
 Macrocytic
 Microcytic


80-96 fL
>96 fL
< 80 fL
•Normochromic (32-36 mg/dl)
•hypochromic
1. Blood picture





Iron deficiency anaemia
Thalasaemia
Sideroblastic anaemia
Iron deficiency anaemia
blood picture

Normal blood picture
SERUM IRON LEVELS
TOTAL IRON BINDING
CAPACITY
SERUM FERRITIN
LEVEL
TRANSFERRIN
SATURATION

Significantly decrease
Increase...



Alpha-Thalassemia
Beta-Thalassemia

Thalassemia major
Thalassaemia trait
Sideroblastic anaemia
Normal blood picture
Low MCV
Blood film
Serum iron

High

Bone marrow
iron
Sideroblastic
anaemia

Normal/High

Low

Hb F/A2
Ferritin

Thalassae...
Macrocytic
anaemia

Non megaloblastic
anaemia

Megaloblastic
anaemia
Hypothyroidism

Vit B12
dificiency
anaemia

Folate
di...
Blood

film

normal

macrocytic

Large RBCs
Decrease number of
RBCs
Bone marrow- normal

Bone marrow –macrocytic
anemia
Vit B12 Dificiency aneamia
We can do further
investigations to confirm the
cause
Intrinsic factor antibody test
Schill...
Some of main causes are
Excess alcohol
Liver disease
Aplastic anaemia
Hypothyroidism
Drugs

This causes can confirm...
High
MCV/MCH
Blood film

Normal or
low

Reticulocyte
count
Non
megaloblastic

Normoblastic

Bone
marrow
morpology

Megalob...
Normal
MCV/MCH
Blood film

Reticulocyte
count

High

Acute blood
loss

Hemolysis

Normal or low

Bone marrow
morpology
Increased RBC production
Reticulocytosis

Increased RBC break down
serum bilirubin
LDH
Urobilinogen
+ ve haemosiderin
Plas...






Autoimmune hemolytic disease
Hereditary spherocytosis
G6PD deficiency
Sickle cell anaemia
Non autoimmune-microa...
1. Coombs test
2. osmotic fragility test
Blood Picture
Hereditary spherocytosis
patient

Normal blood picture
Bite or Blister cells
Aplastic anaemia

Normal bone marrow
biopsy
Normal distribution and
cellularity are seen
Aplastic patient
a – bone marrow ...
1 Primary congenital
chemicalsbenzene
,toluene

Insecticides

Infections: Viralhepatitis, HIV
, erythrovirus
Othertubercul...
Normal

Bone marrow
morphology

Anaemia of
Chronic disease

Hypoplastic

Abnormal
Infiltration/Fibrosis
Acute myeloid
leukemia
Acute

Leukemia

Chronic

Acute
lymphoid
leukemia
Chronic
myeloid
leukemia
Chronic
lymphoid
leukemi...
Chronic myeloid leukemia- blood
picture
Acute myeloid
leukemia

Chronic myeloid
leukemia
Chronic

Lymphocytic

Blood Picture

Leukaemia

Bone marrow
Blood Picture

Bone Marrow
Bone Marrow


Anaemia of chronic
disease
 ESR
 S.creatinine
 Further
investigations for
neoplasm
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
Investigations in  diagnosing  type  and causes of anaemia
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Investigations in diagnosing type and causes of anaemia

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Transcript of "Investigations in diagnosing type and causes of anaemia"

  1. 1. 1. Full blood count 2. Hb 3. Blood picture 4. Bone marrow investigations 5. Reticulocyte count 6. Serum iron studies 7. Eletrophoresis 8. Coombs test 9. Osmotic fragility test 10.ESR 11.Serum creatinine levels
  2. 2. 1. 2. 3. 4. 5. 6. RBC count Heamatocrit MCV MCH MCHC RDW
  3. 3. WHO recommended Haemoglobin levels to diagnose anaemia at sea level (g/l)± Non -Anaemia* Children 6 - 59 months of age 110 or higher Mild 100-109 Anaemia* Moderate 70-99 Children 5 - 11 years of age 115 or higher 110-114 80-109 lower than 80 Children 12 - 14 years of age 120 or higher 110-119 80-109 lower than 80 Non-pregnant women (15 years of age and above) 120 or higher 110-119 80-109 lower than 80 Pregnant women 110 or higher 100-109 70-99 lower than 70 Men (15 years of age and above)130 or higher 110-129 80-109 lower than 80 Severe lower than 70
  4. 4. Summary for anaemic heamoglobin concentrations •Male •Female •Infant /children up to 12 yr •Pregnant female < 13 mg/dl <12 mg/dl <11 mg/dl < 11 mg/dl
  5. 5. Normocytic  Macrocytic  Microcytic  80-96 fL >96 fL < 80 fL
  6. 6. •Normochromic (32-36 mg/dl) •hypochromic
  7. 7. 1. Blood picture
  8. 8.    Iron deficiency anaemia Thalasaemia Sideroblastic anaemia
  9. 9. Iron deficiency anaemia blood picture Normal blood picture
  10. 10. SERUM IRON LEVELS TOTAL IRON BINDING CAPACITY SERUM FERRITIN LEVEL TRANSFERRIN SATURATION Significantly decrease Increased Decreased Significantly decrease
  11. 11.   Alpha-Thalassemia Beta-Thalassemia Thalassemia major Thalassaemia trait
  12. 12. Sideroblastic anaemia Normal blood picture
  13. 13. Low MCV Blood film Serum iron High Bone marrow iron Sideroblastic anaemia Normal/High Low Hb F/A2 Ferritin Thalassaemia Iron deficiency anaemia
  14. 14. Macrocytic anaemia Non megaloblastic anaemia Megaloblastic anaemia Hypothyroidism Vit B12 dificiency anaemia Folate dificiency anaemia Aplastic anaemia Chonic liver disaese Alcoholic dugs
  15. 15. Blood film normal macrocytic Large RBCs Decrease number of RBCs
  16. 16. Bone marrow- normal Bone marrow –macrocytic anemia
  17. 17. Vit B12 Dificiency aneamia We can do further investigations to confirm the cause Intrinsic factor antibody test Schilling test Upper gastro intestinal endoscopy History taken Folate Dificiency anaemia Red cell folate test Serum folate test
  18. 18. Some of main causes are Excess alcohol Liver disease Aplastic anaemia Hypothyroidism Drugs This causes can confirmed by History taken of the patient
  19. 19. High MCV/MCH Blood film Normal or low Reticulocyte count Non megaloblastic Normoblastic Bone marrow morpology Megaloblastic Folate and vit B12 Dyserypoietic Folate low Chronic liver disease Alcoholic Myelodys Folate B 12 low B 12
  20. 20. Normal MCV/MCH Blood film Reticulocyte count High Acute blood loss Hemolysis Normal or low Bone marrow morpology
  21. 21. Increased RBC production Reticulocytosis Increased RBC break down serum bilirubin LDH Urobilinogen + ve haemosiderin Plasma haptoglobulin Confirm hemolytic anemia
  22. 22.      Autoimmune hemolytic disease Hereditary spherocytosis G6PD deficiency Sickle cell anaemia Non autoimmune-microangeopathic hemolytic anaemia
  23. 23. 1. Coombs test
  24. 24. 2. osmotic fragility test
  25. 25. Blood Picture Hereditary spherocytosis patient Normal blood picture
  26. 26. Bite or Blister cells
  27. 27. Aplastic anaemia Normal bone marrow biopsy Normal distribution and cellularity are seen Aplastic patient a – bone marrow aspiration a ̶ bone marrow biopsy Hypocellularity can be seen
  28. 28. 1 Primary congenital chemicalsbenzene ,toluene Insecticides Infections: Viralhepatitis, HIV , erythrovirus Othertuberculosis 2 Secondary causes Ionizing radiation antibioticschlorampheni col ,gold ,penicillamine , phenytoin ,carbimazole
  29. 29. Normal Bone marrow morphology Anaemia of Chronic disease Hypoplastic Abnormal Infiltration/Fibrosis
  30. 30. Acute myeloid leukemia Acute Leukemia Chronic Acute lymphoid leukemia Chronic myeloid leukemia Chronic lymphoid leukemia
  31. 31. Chronic myeloid leukemia- blood picture
  32. 32. Acute myeloid leukemia Chronic myeloid leukemia
  33. 33. Chronic Lymphocytic Blood Picture Leukaemia Bone marrow
  34. 34. Blood Picture Bone Marrow
  35. 35. Bone Marrow
  36. 36.  Anaemia of chronic disease  ESR  S.creatinine  Further investigations for neoplasm
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