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Hypochromic anemia
Hypochromic anemia is a type of anemia where red blood cells appear paler than normal. There are two main classifications - iron deficiency anemia and non-iron deficiency anemia which includes conditions like sideroblastic anemia, thalassemia, and anemia of chronic diseases. Iron deficiency anemia is caused by low iron intake, decreased absorption, blood loss, drugs, or transport defects. Clinical evaluation involves taking a thorough history and conducting a physical exam looking for pallor, nail changes, enlarged spleen or liver, and cardiovascular abnormalities. Investigations help determine the severity through tests like hemoglobin, ferritin, and peripheral smear examination. Treatment depends on the underlying cause but commonly involves oral or
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Hypochromic anemia
- 1. HYP CHR MICANEMIA PRESENTER - ASHWIN GOBBUR
- 2. Definition • Hypochromic anemiais a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal. (Hypo - less, chromic - color.)
- 3. ETIOLOGIC CLASSIFICATION 1. IRONDEFICIENCY ANEMIA 2. NON-IRON DEFICIENCY ANEMIA Sideroblasic anemia Thalassaemia Anemia of chronic diseases Lead poisoning
- 4. IRON DEFICIENCY ANEMIA i.LOW INTAKE - ii. DECREASED ABSORPTION - iii.BLOOD LOSS - iv. DRUGS - v. TRANSPORT DEFECT -
- 5. CLINICAL APPROACH HISTORY : •Age at presentation – thalassamia by 4-6 months • History of repeated blood transfusion • Diet – poor intake of grean leafs, meat • Recurrent diarrhea • Passing worms …
- 6. Continued… • Dysphagia • PICA •Drug intake: NSAID • Surgery of stomach • Recurrent upper resp. tract infection • Consanguinity : Thalassemia • Poor concentration (enzyme co-factor)
- 7.
- 8. CLINICAL APPROACH EXAMINATION : GENERALPHYSICAL • pallor • koilonychia • platonychia • hemolytic facies • cirrhotic features
- 9. Examination contd… SYSTEMIC : Perabdomen – • Firm spleno-hepatomegaly – hemolytic anemia – thalassaemia • Evidence of cirrhosis – spider naevi, oedema, splenomegaly CVS – • Physiological murmr
- 10. INVESTIGATION I. FINDING THECAUSE • USG • Endoscopy - site of bleed ( portal hypertension, hemorrhoids, worms … ) • Occult blood in stool (Benzidine test)– GI bleed • Stool examination – Ova (hook/round)
- 11. Investigation contd… II. Evaluatingthe severity • Hb estimation • Serum iron • Serum ferritin – Normal: 50-150 mic/dl high in NIDA low in IDA • Serum TIBC • MCV, MCHC • RDW * 14-16 – N, >16 – IDA, <13 – Th. minor • RBC count : high NIDA low chronic organ / disease.
- 12. Contd… • Peripheral smearexamination o microctic hypochromic anemia o IDA - poikilocytosis o Thalassaemia - nucleated RBC, target cells o Sideroblastic anemia – Bone marrow (ring sideroblasts)
- 13. PS examination Normocytic Normochromic Macrocytic– Megaloblastic anemia Microcytic Hypochromic – IDA Microcytic Hypochromic – Thalassemia (Target cells, NRs)
- 14. TREATMENT I. Treat underlyingcause II. Treat iron deficiency state Ferrous sulphate – gold standerd. 3-5 mg/kg (20% absorbable) (ideally empty stomach, with food if GI upset) Ferrous fumerate Ferrous gluconate Ferrous ascorbate Ferrros EDTA
- 15. Rx contd … •Ferric preparations available good compliance, poor efficacy (<10%) Ferric ammonium citrate Ferric hydroxide Colloidal iron …
- 16. Rx contd… • Parenteraliron – mg = 2.4 x body wt kg x Hb deficit + 500mg Iron sucrose Iron polymaltose Sideroblastic – give pyridoxine supplement (5-10 mg/kg) CRF – injection erythropoietin
- 17. Rx contd… • BLOOD Intoleranceto oral and parenteral iron Severe anemia CRF – packed cell ( PCV 10ml/kg) *5ml/kg packed cell Hb by 2g
- 18. RESPONSE 24 hr– appetite concentration smiling child 1 week – reticulocyte count – 10-15% Hb slowly increases (1-2g/dl at the end of 1 month) IF NO RESPONSE REVISE DIAGNOSIS