Presentation on theme: "FULL BLOOD COUNT PRESENTATION Clinical Practice A"— Presentation transcript:
1FULL BLOOD COUNT PRESENTATION Clinical Practice A GROUP C
2Iron Deficiency Anaemia Caused by a lack of adequate iron to synthesize haemoglobin and meet body demands in such as during periods of rapid growth and pregnancyUsually due to a diet insufficient in iron or from blood lossDiagnosis includes- Often, the platelet count is elevated (>450,000X109/L)- WBC is usually within reference ranges
3Iron Deficiency blood loss: uterine e.g. menorrhagia gastrointestinal malignancyincreased demands:pregnancyprematuritygrowthothers:malabsorption e.g. gastrectomy, coeliac diseasedietary iron deficiency
4Investigation and Diagnosis Biochemistry:decreased serum ferritin - best biochemical markerincreased total iron binding capacity (TIBC)decreased TIBC saturation - less than 30%; often the best parameter with which to monitor treatmentdecreased serum iron
5Investigation and Diagnosis Haematology:microcytic, hypochromic anaemiablood film shows occasional target cells and pencil-shaped poikilocytesplatelet count may be at or above the upper limit of normal if there is persistent bleedingThe best proof of iron deficiency anaemia is that the anaemia is cured by administration of iron.
6MicrocytosisDefined as a reduced mean cell volume – average volume of a single red cell - of less than 80 femtolitres in adults (norm range fl)Characterized by the presence of microcytes (abnormally small red blood cells) in the blood.
7Causes iron deficiency anaemia - the commonest cause Vit A, C, copper deficiencysideroblastic anaemiathalassaemiasanaemia of chronic diseaselead poisoning
8Clinical Features Possible symptoms: pallor fatigue dyspnoea anorexia headachebowel disturbance
9Investigationto investigate microcytic anaemia , patient has a blood film, then serum iron levels are measured.blood film - iron deficiency anaemia has a microcytic, hypochromic blood film showing anisocytosis and poikilocytosisserum iron, ferritin and total iron binding capacity:- iron deficiency anaemia - low serum iron, low serum ferritin, raised TIBC- other causes are iron loading conditions characterised by raised serum iron, raised ferritin, low total iron binding capacity
11Case History 25 year old female Suspected iron deficiency anaemia Never been pregnant, no change in menstrual flowNormal diet/No medicationsNo GIT problemsLow MCVHigh plateletsNormal Serum B12Low Serum FolateLow Red Cell FolateLow haemoglobin
12Is the MCV result consistent with a diagnosis of iron deficiency? Yes in iron deficiency anaemia, MCV is low, however microcytosis is not always caused by iron deficiency anaemiaWHY?
13Because…In the majority of cases, microcytosis is the result of impaired hemoglobin synthesis. Disorders of iron metabolism and of porphyrin and heme synthesis, as well as impaired globin synthesis, lead to defective hemoglobin production and to the generation of microcytosis.
14Could this patient also have associated B12 or folate deficiency? Serum folate, RBC folate and Vitamin B12 levels differentiate between folate and B12 deficiencyThe patient:Low haemaglobin: anaemiaSerum B12: NormalSerum folate and RBC folate: LOWThus there is a folate deficiency
15Folate DeficiencyLow folate levels can cause macrocytic anaemia – indicated by high MCVThe patient has a low MCV - indicates microcytic anaemia due to iron deficiency
16AnisocytosisHowever, blood film showed anisocytosis: RBC are of unequal size (large and small)Patient can have both iron deficiency anaemia: small size RBC folate deficiency anaemia: large size RBC
17Main causes of folate deficiency Dietary – inadequate intake (Common)Blood lossIncrease physiological requirements eg infant growth or pregnancyMalabsorption due to GIT problems eg Coeliac disease, Crohn’s diseaseOther: Drugs eg Phenytoin, Trimethoprim, Methotrexate, Oral Contraceptives Patient doesn’t display any of these factors
18Is the data typical for patient’s with iron deficiency anaemia? Data is normal as in iron deficiency anaemia, patients display low MCV and low serum ferritin levelsFolate levels are not normally low in iron deficiency anaemia. Thus the levels must be investigated for other possible causes.
20Anisocytosis RBC show abnormal size variation Normal RBC diameter = 6-8 µm. Grades 14 depending on % of abnormalityNormal RDW (Red cell Distribution Width) is Increased RDW suggest anisocytosisSignificance: Sign of many anaemias - Iron deficiency, Vit B12 deficiency
21Target Cells Target cells AKA Codocytes Characterised by thin “bulls-eye” shape and an increase in the surface membrane area to volume ratio due to a decrease in HbSignificance: A sign of Iron Deficiency Anaemia, Vit B12 deficiency Anaemia and other disorders eg Liver Disorders, Thalassemia,
22Pencil CellsOval to elongated, ellipsoid shape with central area of pallor and hemoglobin at both ends of cellSignificance: Iron deficiency anaemia (Elongated cells), Vitamin B12 deficiency anaemia (Oval Cells), can also be Inherited, where by >25% elliptocytes are oval.
23Howell-Jolly Bodies Smooth, round nuclear fragments made up of DNA Observed when erythropoiesis is active>3% is significant and indicates Megaloblastic Anaemia
24Hypersegmented Neutrophils Neutrophils with five or more lobesSignificance: an important clue to the presence of deficiency of vitamin B12 or folic acid
25Folate Deficiency Anaemia ConclusionPatient FBC and Blood film suggest:Iron Deficiency AnaemiaANDFolate Deficiency AnaemiaAs evidenced by Low MCV and Low Folate combined with the presence of Hypochromic, Microcytic Cells, Marked Anisocytosis, Howell-Jolly Bodies, Hypersegmented Neutrophils