Approach to anaemia

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For Pathology students the first class of hematology

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  • Pic- -smear with H,B,T-low p, high P-for morphology-nRBC-TLC-DLC-abn WBCs-parasite-platelet adequacy
  • Approach to anaemia

    1. 1. APPROACH TO ANEMIA
    2. 2. ANEMIA  Defined as quantitative reduction in hemoglobin or erythrocytes or both below the level that is expected for healthy person of same age and sex in the same environment.
    3. 3. LEVELS  Adult male  Adult female  Adult female (Pregnant)  >6-12 yr  6m- 6yr  2- 6m  Newborn  <13  <12  <11  <11.5  <11  <9.5  <13.6
    4. 4. CLASSIFICATION OF ANEMIA
    5. 5. APPROACH TO DX  Severity  Cause
    6. 6. PRESENCE OF ANEMIA HEMOGLOBIN ESTIMATION PCV ESTIMATION  Colorimetric method  Gasometric method  Chemical method  Specific gravity method  Wintrobe method  Microhematocrit method
    7. 7. HISTORY IN A CASE OF ANEMIA  Clinical evaluation  Symptoms Fatigability Effort dyspnoea Palpitation  Signs Pallor  Chronic blood loss  Pregnancy  Pica  Chronic alcoholism  History of malabsorption  Drugs  Hypoplastic  Megaloblastic  IDA  HA
    8. 8. CONT….  Primary underlying disease  CVD  Mlg  Chronic infection  AIDS  ESLD  ESRD  Endocrine ds  Geographic Area
    9. 9. LABORATORY EVALUATION  Initial investigations  Peripheral blood smear  Reticulocyte count  Red cell indices  Specialized investigations  BM exam  Serum iron  Hemoglobin electrophoresis
    10. 10. PERIPHERAL BLOOD SMEAR
    11. 11. PERIPHERAL BLOOD SMEAR  Head  Body  Tail
    12. 12. HOW TO ASSESS THE SIZE OF RBC IN PBS  By comparing the size with the small lymphocyte
    13. 13. NORMOCYTIC NORMOCHROMIC
    14. 14. ANISOCYTOSIS
    15. 15. POIKILOCYTOSIS
    16. 16. MICROCYTIC HYPOCHROMIC
    17. 17. MACROCYTOSIS  Oval  Round
    18. 18. SICKLE CELLS
    19. 19. SPHEROCYTES
    20. 20. TARGET CELLS/CODOCYTES
    21. 21. SCHISTOCYTES
    22. 22. BURR CELLS
    23. 23. TEAR DROP CELL
    24. 24. BASOPHILIC STIPPLING
    25. 25. HOWELL JOLLY BODY
    26. 26. POLYCHROMATIA
    27. 27. RETICULOCYTE COUNT
    28. 28. RETICULOCYTE COUNT  Young red cell that contain RNA element  Stains with supravital stain  Brilliant cresyl blue  New methylene blue  Assess erythropoietic activity of the bone marrow
    29. 29. RETICULOCYTE… SUPRAVITAL STAIN
    30. 30. RETICULOCYTE MEASURES  Reticulocyte count ( % )  0.5 to 2.5 in adult  2 to 5 in newborn  Corrected reticulocyte count  RC x PCV pt / PCV normal  Absolute reticulocyte count  RC x RBC count  Reticulocyte production index
    31. 31. RETICULOCYTOSIS RETICULOCYTOPENIA  Acute blood loss  Hemolytic anaemia  Response to specific therapy in nutritional anemia  Decreased red cell production  Aplastic anemia  Myelopthisic anemia  IDA  ACD  Ineffective erythropoiesis  Megaloblastic  MDS
    32. 32. RED CELL INDICES
    33. 33. aka … ABSOLUTE VALUES  MCV  MCH  MCHC
    34. 34. MEASURED IN …AUTOMATED HEMATOANALYSER
    35. 35. MCV  in femtoliters (fl)  Average volume of a single cell  PCV x 10 / RBC count  RDW  Mentzer index
    36. 36. MCH  Picogram (pg)  Average amount of Hb per cell  Hb x 10 / RBC count  Low in microcytic  High in macrocytic
    37. 37. MCHC  Gm/dl  Average amount of HB in a given amount of RBC  Hb x 100 /PCV  Low in microcytic hypochromic  High in HS
    38. 38. RDW  Degree of variation of red cell size
    39. 39. RDW HELPS TO DIFFERENTIATE IDA Β THALASSEMIA MINOR  Low MCV  Low MCH  Low MCHC High RDW  Low MCV  Low MCH  Normal MCHC Low RDW  Target cell  Basophilic stippling
    40. 40. 3 MAJOR TYPES OF ANEMIA…
    41. 41. CASE 1  35 yr F  Strict vegetarian  Weakness, paresthesias, muscle weakness, or difficulty in walking, glossitis  She had a child with NTD
    42. 42. BLOOD PARAMETER  Hb 8.7gm/dl  TLC 3800/cmm  PLT 98000/L 
    43. 43. ABSOLUTE VALUES  MCV 116 ___ (tell the units)  MCH 33 ___  MCHC 32 ___
    44. 44. RETICULOCYTE COUNT  Low
    45. 45. ?
    46. 46. MACROCYTIC ANEMIA
    47. 47. CAUSES Oval  Megaloblastic anemia  Drug therapy  MDS Round  Alcoholism  Liver disease  Hypothyroidism
    48. 48. WHAT ELSE CAN BE IN PBS  Hyper segmented neutrophil  Howell- jolly body  Cabot’s ring
    49. 49. BM EXAMINATION  Ineffective erythropoiesis  Megaloblastic change in all series  Giant band forms  Giant metamyelocytes
    50. 50. OTHER CAUSES OF MACROCYTOSIS…HOW TO RULE THEM OUT  Hemolytic anaemia  Features of hemolysis in addition with macrocytosis  Liver disease  Target cell will be in the smear  Myelodysplastic syndrome  Elderly patients  Bi/ Pancytopenia  BM exam- ALIP ( abnormal localization of immature precursor)
    51. 51. …CONT..  Pregnancy  Newborn  Cytotoxic chemotherapy  Aplastic anaemia
    52. 52. MICROCYTIC HYPOCHROMIC ANAEMIA
    53. 53. CAUSES  Iron deficiency anaemia  Thalassemia syndrome  Anaemia of chronic diseases  Sideroblastic anaemia
    54. 54. MICROCYTIC HYPOCHROMIC EVALUATION
    55. 55. NORMOCYTIC NORMOCHROMIC ANAEMIA
    56. 56. NORMOCYTIC NORMOCHROMIC EVALUATION
    57. 57. EVALUATION OF HEMOLYSIS  Within circulation  Blackwater fever, mismatch blood transfusion, PNH  Spleen normal  Plsama Hb% markedly increased  Hb in urine +  Hemosiderin in urine+  Within RES  Hb-pathies, Hereditary haemolytic anaemia, AIHA  Size increased  Mild increased  Absent  Absent  Negative
    58. 58. Thank you for your maintained silence

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