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Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
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Anemia

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A practical approach to a common problem

A practical approach to a common problem

Published in: Health & Medicine
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  • 1. Anemia Low hemoglobin Women<12 gm/dl; Men<13 gm/dl
  • 2. Clinical presentation  Asymptomatic in majority  Malaise, fatigue, DOE, pica  Palpitation, angina, CHF when severe  Amenorrhea/menorrhagia  Pallor, jaundice, koilonychia  Tachycardia, wide pulse pressure, flow murmurs, cardiomegaly  Splenomegaly
  • 3. Evaluation  CBC- Hb, TLC/DLC, platelets, MCV  PBS examination  Reticulocyte count  Ferritin  RFT- creatinine, LFT, TFT  Stool- occult blood  Bone marrow examination  Other- Coomb’s test, Hb electrophoresis, vitamin B12/RBC folate levels
  • 4. Poikilocytes  Abnormally shaped RBC  Types-  Acanthocyte- spur cell- abetalipoproteinemia, liver disease  Codocyte- target cell- thalassemia, HbC disease, post-splenectomy  Echinocyte- burr cell- uremia  Ovalo/elliptocyte- hereditary ovalo/elliptocytosis  Spherocyte- hereditary spherocytosis, AIHA  Drepanocyte- sickle cell- sickle cell anemia  Dacrocyte- tear-drop cell- myelofibrosis  Schistocyte- fragmented, irregular RBC- MAHA
  • 5. Causes  Blood loss  Acute- trauma, GI bleed  Chronic- GIT, menstrual, urinary  Decreased production  Iron deficiency  Vitamin B12/FA deficiency  BM defect- aplastic, myelophthisic  Increased destruction  Hemolytic anemia- AIHA, SCD, thalassemia
  • 6. Morphologic classification  Microcytic- MCV<80  Iron deficiency  Thalassemia  Sideroblastic  Macrocytic- MCV>100  Vitamin B12/FA deficiency  Drugs- methotrexate, zidovudine  CLD, alcoholism, hypothyroidism  Normocytic- MCV 80-100  Hemolytic  Aplastic/Myelophthisic  Anemia of chronic disease  Acute blood loss
  • 7. Treatment Correct underlying cause Packed RBC transfusion Replacement- iron, vitamin B12/FA
  • 8. Chronic hyperproliferative BM  MDS- myelodysplastic syndrome  RA- refractory anemia  RAEB  Sideroblastic anemia  CMML  MPD- myeloproliferative disorders  Polycythemia vera  CML  Essential thrombocythemia  Myelofibrosis
  • 9. Aplastic anemia  Typically pancytopenia (PRCA- anemia only)  Causes- autoimmune, chloramphenicol, carbamazepine, radiation, benzene  s/s- of pancytopenia  Dx- bone marrow examination- biopsy  Rx- ATG/ALG with Cyclosporin-in elderly or HSCT-in young
  • 10. HSCT  Hematopoietic stem cell transplantation  BMT or PBSCT (preferred) or cord blood  Indications-  Multiple myeloma  AML in remission, ALL in second remission, CML  Relapsed lymphoma  Aplastic anemia  MDS  Congenital storage disorders, immunodeficiencies, hemoglobinopathies  Collagen vascular disease  Autologous or Allogeneic
  • 11. HSCT considerations  Cost  HLA matched donor (allogeneic)  Complications-  Infections  Mucositis  Hepatic veno-occlusive disease  GVHD (allogeneic)- acute or chronic  Mortality- 10-20%

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