Approach to Anemia

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History of Present Illness: ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Salient features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Admitting Impression: ,[object Object],[object Object],[object Object]

Differential Diagnoses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Course in the Wards ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CBC with PC Hgb – 49  Hct – 0.15  WBC – 10.68 Neutro – 0.41 Lympho – 0.46 Mono – 0.13 Platelet – 137 MCV – 116.0  Chemistries Na: 135↓ K: 3.7 BUN: 2.7↓ Crea: 66 PT: 13.3/12/79.2/1.11 N urinalysis - 0.1 0.1 sugar WBC epith - 0.1 0.3 protein RBC bacteria Blood type A+ Antibody screening (-) CXR PA: Normal

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SGOT:45 SGPT 42 Upper abdominal Ultrasound: small left hepatic lobe cyst (0.9cm). N GB, BT, pancreas and spleen Fecalysis: (-) blood (-) mucus. NOPS, no amoeba

3rd HD S> “feeling better” Amenable for blood lead level determination O> VSS A> same P> Requested labs & diagnostics ECG: NSR 1 st HD 3 rd HD Hgb 49 ↓↓ 83 ↓ Hct 0.15 ↓↓ 0.26 ↓ RBC 1.31 2.44 WBC 10.68 7.29 Eosinophils 0.02 Stabs 0.02 Neutrophils 0.41 0.25 Lymphocytes 0.46 0.55 Monocytes 0.13 0.10 Platelet Count 137 83 ↓ RDW 27.5 25.6 MCV 116.0 ↑ 108 ↑ MCH 37.4 34 MCHC 32.2 31.9

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Uric Acid 0.42 BT 2min, 30 sec CT 6min, 30 sec PT 12.4/12/88/1.03 PTT: 28.1/28.5 Coombs test: Direct- neg, Indirect-neg TB: 20.4 DB 1.0 IB 19.4  ( 0-19.0) Amylase: 59

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ca 2.01  TFT FT3: 5.5 FT4 17.88 TSH: 1.4 N

6 th HD ,[object Object],[object Object],[object Object],1 st HD 3 rd HD 6 th HD Hgb 49 ↓↓ 83↓ 148 Hct 0.15 ↓↓ 0.26↓ 0.44 RBC 1.31 2.44 4.54 WBC 10.68 7.29 7.49 Eosinophils 0.02 0.03 Stabs 0.02 0.01 Neutrophils 0.41 0.25 0.52 Lymphocytes 0.46 0.55 0.31 Monocytes 0.13 0.10 0.30 Platelet Count 137 83 ↓ 214 RDW 27.5 25.6 25.6 MCV 116.0↑ 108↑ 98.2 MCH 37.4 34 32 MCHC 32.2 31.9 33.2

Discharge Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

OPD Follow-Up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Final Diagnosis ,[object Object],[object Object],[object Object],[object Object],Plans Repeat CBC after 1 month Continue Multivitamins (Appebon) 2 tabs OD Refer to GI for co-management

Definition ,[object Object],[object Object],[object Object]

Evaluation of the Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of the Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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And also… ,[object Object],[object Object],[object Object],[object Object],[object Object]

Approach to the diagnosis of Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Thalassemia ACD Iron deficiency Lead toxicity Early dse process Aplastic anemia Renal insufficiency B12, folate deficiency Liver dse Alcohol abuse Hypothyroidism

Role Out Disease Rationale Patient Thalassemia Mediterranean descent, (+) mongoloid facie Normal facie Hemolytic anemia Coombs-positive Coombs-negative Renal Insufficiency  BUN and Creatinine BUN: 2.7 ↓ Crea: 66 Liver disease  AST, ALT Normal TB, B1, B2 Amylase, ALT, AST UTZ: L hepatic lobe cyst (0.9cm) Hypothyroidism  TSH,  FT3, FT4 Normal TSH, FT3, FT4

Disease Rationale Patient Infection (parasitism) Fever  WBC Normal CBC,U/A, Fecalysis No eosinophilia Leukemia Frequent infection Bleeding tendencies  WBC Normal WBC, PC Lymphoma Fever, night sweats, weight loss Lymphadenopathy (+) wt loss

Fonte, R. "Anaemia and abdominal pain due to occupational lead poisoning." Haematologica . 92.2 (2007): 13-14 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

("Lead exposure in," 2008)

("Lead exposure in," 2008) Lead determination 6/7/2010 UP College of Public Health Mean lead concentration: 12.3 ug/dl Biological exposure limit: CDC, Atlanta - 20.0 ug/dl American Conference of Governmental Industrial Hygienists (ACGIH) - 30.0 ug/dl Occ. Safety & Health Center (OSHC), Department of LAbor and Employment - 40.0 ug.dl

DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nutritional deficieny ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Folate ,[object Object],[object Object],[object Object],[object Object],[object Object]

Multivitamins ,[object Object],[object Object],[object Object],[object Object],[object Object]

Your Take Home Message ,[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object]

Approach to Anemia

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Approach to Anemia