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Prof. Aziz-ur-Rehman  Very common problem  Subtle or no symptoms, usually incidental finding  Various causes; ID is the commonest  Simple iron replacement.

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Presentation on theme: "Prof. Aziz-ur-Rehman  Very common problem  Subtle or no symptoms, usually incidental finding  Various causes; ID is the commonest  Simple iron replacement."— Presentation transcript:

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2 Prof. Aziz-ur-Rehman

3  Very common problem  Subtle or no symptoms, usually incidental finding  Various causes; ID is the commonest  Simple iron replacement is not the solution  Investigate before starting treatment

4  Nutrition  Chronic blood loss  Menorrhagia  GI blood loss  Liver disease  Worm infestation  Transfusions  Family history

5  Pallor  Koilonychia  Splenomegaly  Purpura  Lympadenopathy Routine features Serious problem?

6 Routine  CBC; Hb%, Hct, RBC indices Specilised  Iron studies  Hb. Electrophoresis  Reticulocyte count  Peripheral smear  Bone marrow  Other haematological  Non haematological

7 RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

8 RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

9 RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

10 HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35

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13 HCMC ANAEMIA-1

14  Very common; diagnosis by default  Chronic blood loss, malnutrition  Total iron depletion  Various lab tests, serum ferritin best

15 ParameterEffect Hb & HctReduced MCV, MCH, MCHCReduced FerritinReduced IronReduced TIBC/TSIncreased BM ironAbsent Retic countLow

16 1. Identify and treat the cause 2. BT hardly ever indicated 3. Oral iron; various form, FeSO4 best 4. Parenteral iron 5. Good nutrition (meat, fish & poultry)

17 HCMC ANAEMIA-2

18  Family history  Mild to severe anaemia  Splenomegaly  HCMC anaemia (ID excluded)  Hb electrophoresis:  Hb A2 & Hb F levels high: beta thalassaemia  Hb A2 & Hb F levels normal: alpha thalassaemia  DNA analysis

19  None  Counseling  BMT/SCT  Iron contraindicated  Desferrioxamine

20 Macrocytic Anaemia

21  Inherited disorder  Intrinsic factor deficiency  Vit. B12 not absorbed

22 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCIncreased, Normal, Reduced Vit B12low Folatelow Retic countLow; prompt rise after treatment BM examinationMegaloblastic picture

23 NCNC anaemia-1

24 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal TLClow Plateletslow DLCReversed P/L ratio Retic countLow BM examinationAplastic picture

25  NCNC anaemia  Pancytopenia  Bone marrow biopsy

26  Immunosuppressant  BMT/SCT  Blood transfusions

27 NCNC ANAEMIA-2

28 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal to slightly increased Haptoglobinlow BilirubinIncreased (unconjugated) Retic countHigh, polychromasia HaemoglobinaemiaPresent Hemoglobinuriapresent BM examinationHyperplastic picture

29  Steroids  Splenectomy  BT  BMT/SCT

30  Rare disease  Mixed pattern  Partially treated  Blood transfusion

31  Anaemia is a common and treatable problem  History, PE & CBC gives important clues to the diagnosis  IDA is the commonest type, oral iron replacement is the treatment of choice  BT needed rarely

32 Aziz-ur-Rehman


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