Anemia
Low hemoglobin
Women<12 gm/dl; Men<13 gm/dl
Clinical presentation
 Asymptomatic in majority
 Malaise, fatigue, DOE, pica
 Palpitation, angina, CHF when severe
 Am...
Evaluation
 CBC- Hb, TLC/DLC, platelets, MCV
 PBS examination
 Reticulocyte count
 Ferritin
 RFT- creatinine, LFT, TF...
Poikilocytes
 Abnormally shaped RBC
 Types-
 Acanthocyte- spur cell- abetalipoproteinemia, liver disease
 Codocyte- ta...
Causes
 Blood loss
 Acute- trauma, GI bleed
 Chronic- GIT, menstrual, urinary
 Decreased production
 Iron deficiency
...
Morphologic classification
 Microcytic- MCV<80
 Iron deficiency
 Thalassemia
 Sideroblastic
 Macrocytic- MCV>100
 Vi...
Treatment
Correct underlying cause
Packed RBC transfusion
Replacement- iron, vitamin B12/FA
Chronic hyperproliferative BM
 MDS-
myelodysplastic
syndrome
 RA- refractory
anemia
 RAEB
 Sideroblastic
anemia
 CMML...
Aplastic anemia
 Typically pancytopenia
(PRCA- anemia only)
 Causes- autoimmune, chloramphenicol,
carbamazepine, radiati...
HSCT
 Hematopoietic stem cell transplantation
 BMT or PBSCT (preferred) or cord blood
 Indications-
 Multiple myeloma
...
HSCT considerations
 Cost
 HLA matched donor (allogeneic)
 Complications-
 Infections
 Mucositis
 Hepatic veno-occlu...
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Anemia

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A practical approach to a common problem

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Anemia

  1. 1. Anemia Low hemoglobin Women<12 gm/dl; Men<13 gm/dl
  2. 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. 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. 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. 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. 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. 7. Treatment Correct underlying cause Packed RBC transfusion Replacement- iron, vitamin B12/FA
  8. 8. Chronic hyperproliferative BM  MDS- myelodysplastic syndrome  RA- refractory anemia  RAEB  Sideroblastic anemia  CMML  MPD- myeloproliferative disorders  Polycythemia vera  CML  Essential thrombocythemia  Myelofibrosis
  9. 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. 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. 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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