Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Anaemia Summary

1,484 views

Published on

  • Be the first to comment

Anaemia Summary

  1. 1. AnaemiaDefinition Classification by mechanism of anaemia Men: Hb <14 g/dL ↓ RBC production Fe, B12 or folate deficiency Women: Hb <12 g/dL Hypoplasia Malignant invasion of bone marrowSymptoms: ↑ RBC loss Blood loss Fatigue Anorexia Haemolysis Dyspnoea Dyspepsia Hypersplenism Palpitations Bowel disturbance Headache Angina – pre-existing CAD Classification by MCV Dizziness, postural hypoTN Pica—compulsive eating of Normal / Low MCV: Tinnitus non-nutritive substance e.g. ice, Reticulocyte count dirt, paint Normal / Low HighSigns: Pallor Jaundice + pallor = Haemolytic anaemia until proven otherwise Jaundice Retinal hemorrhages PBF Bleeding Hyperdynamic circulation ∼ Tachycardia Haemolysis ∼ Systolic murmurs ∼ Cardiac enlargement Heart failure ∼ Edema ~ gallop ∼ Cardiac dilatation ~flow murmur Hypochromia Target cells Dimorphic Non-specific• Postural drop in BP Low MCV Basophilic stippling Bone marrow FerritinHistory: Ferritin biopsy Normal or high Fe loss: GI symptoms and menstrual history. Low Poor Fe / folate intake - diet (eg vegans) and Sx resection of stomach / Hb electropho- small bowels resis for HbA2 Chronic diseases FMHx of haemolytic anaemia or pernicious anaemia Fe Deficiency Raised: β Sideroblastic ?Anaemia of Drugs – may cause blood loss (aspirin, NSAIDs), haemolysis or thalassaemia Chronic Dz aplasia Normal: α Jaundice – haemolytic anaemias Invx cause thalassaemiaCauses of anaemia: Consider bone marrow biopsy∼ Commonest cause: Fe deficiency due to blood loss. and iron studies
  2. 2. High MCV Low MCV Fe deficiency (commonest Thalassaemia cause) Sideroblastic anaemia (rare) Check Hx: Normal MCV Haemolysis Bone marrow failure EtOH Anaemia of Chronic Dz Renal failure Liver dz Pregnancy Hypothyroidism FMHx pernicious anaemia High MCV B12 / folate deficiency Reticulocytosis eg haemolysis Hypothyroid Antifolate drugs eg phenytoin Myelodysplastic syndromes Drugs Alcohol Marrow infiltration Prev. abdo Sx Liver disease Cytotoxics Hypothyroidism *Haemolytic anaemias may be normo- or macro-cytic. Suspect if reticulocytosis is present PBF + Reticulocyte count Investigations – Anaemia workup: • FBC • U/E/CrHypersegmented polymorphs Drugs/cytotoxics • Reticulocyte count • LFT – liver dz & ↑LDH in haemolytic anaemia • PBF • TFT • Fe / TIBC / Ferritin • Fecal occult blood • Folate + B12 • Direct Coomb’s test – Haemolytic anaemiasFolate, B12 levels Low Invx & treat • Hb electrophoresis • ± OGD for UGI bleed/colonoscopy for LGIB • ±Bone marrow biopsyTarget cells, stomatocytes LFT Interpreting Plasma Iron Studies Iron TIBC FerritinDysplasia / cytopenia ?Myelodysplasia Fe deficiency ↓ ↑ ↓ Marrow Anaemia of Chronic dz ↓ ↓ ↑ Chronic haemolysis ↑ ↓ ↑Dimorphic ?Sideroblastic Haemchromatosis ↑ ↓/N ↑ Pregnancy ↑ ↑ N Sideroblastic anaemia ↑ N ↑ Polychromasia / High Retic count ?Bleeding ↑ Bilirubin & LDH Haemolytic anaemias - look for fragments
  3. 3. Iron Deficiency Anaemia Sideroblastic Anaemia Causes: 1. menorrhagia 6. diverticulitis Dyserythropoiesis + iron loading (bone marrow + haemosiderosis ie 2. oesophagitis haemorrhoids endocrine, liver and cardiac damage) 3. PUD 7. hookworms Causes: Idiopathic, Congenital (rare, X-linked), EtOH or lead excess, 4. GI CA 8. poor diet / special diet myeloproliferative disease, malignancy, malabsorption, anti-TB drugs 5. colitis 9. malabsorption (celiac dz) Hypochromic RBC on PBF + sideroblasts in marrow. Rx: Oral iron (eg Fe sulfate 200mg/12-8h PO) – should increase Hb by 1 g/dl/week. SE: constipation, black stoolsHaemolytic Anaemias Causes: Membrane problems Hereditary spherocytosis Elliptocytosis Enzyme problems G6PD deficiency Pyruvate kinase deficiency Hb problems Thalassaemia Sickle cell disease Others Infection: Malaria, HUS Hypersplenism Mechanical heart valves Autoimmune Ab (AIHAs) Snake venom Investigations ↓ Hb ↑ Unconjugated Bilirubin ↑ LDH ↑ Reticulocyte count ↓ haptoglobulin DCT: + in AIHAAnaemia of Chronic Disease Causes: Infection, collagen vascular dz, rheumatoid arthritis, malignancy, renal failure Rx: treat underlying cause. Recombinant erythropoietin for renal Digitally signed by DR WANA HLA SHWE failure DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI University, School of Medicine, KT-Campus, Terengganu, ou=Internal Medicine Group, email=wunna.hlashwe@gmail.com Reason: This document is for UCSI University, School of Medicine students. Date: 2009.03.08 09:31:58 +0800

×