6. Anemia Check MCV MCV < 80 Microcytic anemia MCV 80 - 100 Normocytic anemia MCV > 100 Macrocytic anemia Defective synthesis of: Heme iron deficiency anemia anemia of chronic disease sideroblastic anemia lead poisoning Globin chains thalassemias HbE Fe

10. Normal Red Blood Cells

12. Normal Peripheral Smear

13. Iron Deficiency Anemia

15. IRON DEFICIENCY ANEMIA Prevalence

19. IRON Body Compartments - 75 kg man 3 mg Absorption < 1 mg/day Excretion < 1 mg/day Stores 1000mg Tissue 500 mg Red Cells 2300 mg

21. IRON CYCLE Fe Fe Fe Fe Fe Ferritin Hemosiderin slow Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Ferritin Transferrin Receptor RBC PRECURSOR CIRCULATING RBCs Fe Fe TRANSFERRIN MONONUCLEAR PHAGOCYTES

28. KOILONYCHIA

29. Smooth tongue

33. Hematocrits Normal, Hemorrhage, IDA, Leukemia, Hemolysis, B12, P Vera Plasma White cells Red cells

34. Second-line investigations of anaemia Direct antiglobulin test (DAT) - if DAT neg: G6PD screen, refer to haematologist Evidence of haemolysis Coeliac antibodies and/or duodenal biopsy - if small bowel malabsorption, refer to gastroenterologist Low red cell folate Gastric parietal cell antibodies (not specific), intrinsic factor antibody (specific for pernicious anaemia), Schilling test (B12 absorption test) Low serum B12 Oesophagogastroduodenoscopy (OGD), colonoscopy, gynaecological examination, coeliac antibodies (anti-tissue transglutaminase) Iron deficiency

35. Third-line investigations of anaemia Thyroid function tests, Liver function tests, Haemolysis screen (if not already performed) Macrocytic anaemias Renal function, Haemolysis screen (if not already performed), Immunoglobulins and paraprotein screen, Search for evidence of underlying infective, inflammatory or neoplastic disorder Normocytic anaemias Haemoglobin electrophoresis Search for evidence of underlying infective, inflammatory or neoplastic disorder (blood cultures, ESR, C-reactive protein, ANA, CXR etc.) Microcytic anaemias

36. N HB A 2 ,F increase N N HB electro Ring form present absent absent Blast iron present present Present Absent BM Iron I N N D Ferritin Normal Normal D I TIBC Inc Normal D D Serum Iron D D D decrease MCHC D D D “ MCH Decrease Decreas e Low/N decrease MCV Sidero Thal ACD Fe Def Investigation

38. IDA bone marrow

46. THANK YOU