Anemia.pptx
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This document discusses different types of anemia. It begins by defining anemia as a decrease in red blood cells (RBCs) or hemoglobin (Hb). It then covers the main causes of anemia which are decreased red cell production or increased red cell loss. Several types of anemia are described based on mean corpuscular volume (MCV), including microcytic, normocytic, and macrocytic anemias. Specific anemias discussed include iron deficiency anemia, thalassemia, sickle cell anemia, and megaloblastic anemia. The document provides guidance on diagnosing and differentiating between different anemic conditions.
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Anemia.pptx
- 1. Anemia Dr. Irtaza Rehman (Author of the book The Extraordinary Life)
- 3. Learning Objectives • To highlight the important concepts of different types of anemia • To learn the clinical approach to diagnose different types of anemia
- 4. Q. 29 years old presents with lethargy and irritability for the last 5 years. Labs revealed Hb of 9.6, MCV 70 and MCHC is low. WBC & Platelets are normal. She was prescribed iron supplements, yet after 2 months has Hb 10. Which lab investigation should be ordered to find the underlying cause of persistent anemia? • Ans. Hb electrophoresis
- 5. What is decreased in Anemia?? RBC Hb Hct Dec O2 carrying capacity Dec healthy RBCs
- 6. Why anemia?? • 1. Decreased red cell production A. Hematopoietic cell damage (Infections, Drugs) B. Factors deficiency (Iron for heme) (VB12/Folate for DNA) 2. Increased Red cell loss A. External blood loss B. RBC destruction Etiologic Classification
- 7. TACSI • Thalassemia • Anemia of Chronic disease • Sideroblastic anemia • Iron deficiency anemia MCV < 80 fl Microcytic Anemia
- 8. Q. How will you differentiate between IDA and Anemia of chronic disease? • TIBC is decreased in AOCD Q. How will you differentiate between B- Thalassemia major and minor? • Increased Hb-F in major • Increased Hb-A2 in minor
- 9. Target cells (Inc Cell.mem:cell volume) • Hb-C disease • Asplenia • Liver disease • Iron deficiency anemia • Thalassemia
- 10. Q. A 22 years old man has congenital anemia that has required multiple transfusions of RBCs for many years. On physical examination, she has no significant findings. However LFT show reduced serum albumin. Which of the following would most likely appear in a liver biopsy specimen? Ans. Hemosiderin (in hepatocytes)
- 11. Q. 65 years old lady treated for arthritis now presented with weakness and bruises. Examination reveal pancytopenia, Retic count 0.1%, hypocellular bone marrow with normal cell morphology. Diagnosis is • Ans. Aplastic Anemia
- 13. • All Megaloblastic anemia are Macrocytic anemia but all Macrocytic anemia are not Megaloblastic anemia.
- 14. MCV > 100 fl MCV > 100 fl Abnormally large blood cells precursors in bone marrow
- 15. FAT RBC Folate def-Fetus (pregnancy) Alcohal Thyroid (hypothyroidism) Reticulocytosis B12 deficiency Chronic liver disease
- 16. Drugs causing Macrocytic anemia • Hydroxyurea • Methotrexate • Phenytoin • Zidovudine • Sulfonamides (Septran) HMP-ZShunt
- 17. GIT resection and anemia Gastrectomy of a patient done after 4 years patient came with anemia Megaloblastic anemia Terminal ileum resection causes Vit B12 deficiency anemia
- 18. • I can cause loss of sense of vibration • I can cause tingling sensation • I can cause positive Babinski sign • I am more common in veggies • I am associated with anemia What am i?
- 19. M C H C MCV
- 20. Q. A patient has end stage renal disease and is on dialysis for 6 months. She has received multiple blood transfusions. Her Hb 8. MCV 86 and low MCHC. What type of anemia does she have? • A. Hyperchromic microcytic • B. Normocytic hypochromic • C. Normocytic normochromic • D. Hyperchromic macrocytic • E. Macrocytic hypochromic Ans. B
- 21. Q. A pregnant lady for antenatal visit having Hb 7. She was prescribed iron supplements. This should be given. • A. Before meal • B. After meal • C. Early morning • D. with citrus fruits (juice) • E. with milk Ans. D
- 22. Q. The most common cause of anemia in pregnancy (If Serum ferritin is normal) is? Ans. Hemodilution Q. A pregnant lady came in her first trimester, her Hb was 12. Now her Hb in last trimester is 10. Ans. Normal Physiologic (Relative) anaemia
- 23. Blood loss Anemia • Acute blood loss Normocytic normochromic • Chronic blood loss Initially N-N later on Microcytic hypochrochromic (Iron deficiency anemia)
- 24. Q. A boy had Road traffic accident and suddenly loses 1.5 liters of blood. What will be seen on peripheral smear? • Ans. Normocytic normochromic anemia
- 26. Drugs causing G6PD • Sulfonamides • Primaquine • Aspirin • Isoniazid, Ibuprufen • Nitrofurantoin Dapsone
- 27. Hemolytic anemia • Presents with “Unconjugated Hyperbilirubinemia” • Decreased haptoglobin • Intrinsic hemolysis • Extrinsic hemolysis
- 28. Intrinsic Hemolytic Anemia • Hereditary spherocytosis Small round RBC with less surface area & no central pallor • G6PD Self limiting, only males, Heinz bodies • Sickle cell anemia Chronic leg ulcers, autosplenectomy (Howel-Jolly bodies), acute chest syndrome (Membrane stability test)
- 29. • Autoimmune Warm antibody H.A IgG • Autoimmune Cold agglutinin disease IgM Coombs test positive • Microangiopathic H.A Schistiocyte (helmet cells) • Macroangiopathic H.A Schistiocyte (helmet cells) • Infections Extrinsic Hemolytic Anemia
- 30. Q. A boy having Hb 5.6 deeply jaundiced. Plt 260,000 and TLC 10,000. Retic count 10%, conjugated bilirubin 0.9, hypersplenism having non healing ulcers, abdominal pain after tooth extraction. Diagnosis? • A. Hemolytic crisis • B. Thrombotic crisis • C. Vasoclusive crisis • D. Sequestration crisis • E. Aplastic crisis Ans. A
- 31. One tricky Question Q. Dapsone given to a lady for treatment of erythema nodosum by dermatologist. Now she has decreased Hb, MCV is 110 fl. Diagnosis is?? A. Megaloblastic anemia B. G6PD anemia Ans. A
- 32. Anti D antibody can cause Hemolytic anemia OR Anti D antibody can prevent hemolytic anemia??? BOTH
- 34. • Counseling for Rh+ father and Rh- mother should be Hemolytic disease of newborn may occur • Rh agglutinins predominantly IgG • Maternal anti D antibodies cross placental barrier hemolytic anemia • To prevent Rh incompatibility in second child, mother should be given Anti D antibody injection Erythroblastosis fetalis
- 35. Diagnose quickly • MCV/MCHC • Retic count • Iron profile • LDH/Haptoglobin/In direct bilirubin • Coomb’s test • Peripheral blood smear
- 42. Jazakumullahu Khair ♥ (May ALLAH swt reward you with goodness)