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Anemia Paolo Aquino PGY-I January 2005 VA Hospital
Definition Anemia is a reduction of hemoglobin or volume of red blood cells from normal limits Variation due to age, gender Decreased production Increased loss
History Signs of blood loss Onset- rapid vs. gradual Family history Exposures Diet History of infection PMH- cancer, renal, endocrine
Physical exam Appearance Vital signs HEENT Heart Abdominal
Laboratory studies Hemoglobin and hematocrit Mean corpuscular volume Reticulocytes Peripheral smear
Microcytic anemia Most common cause: iron-deficiency anemia Thalassemia Lead poisoning Sideroblastic anemia Anemia of chronic disease
Normocytic anemia Marrow hypoplasia Marrow infiltration Myelofibrosis Renal insufficiency Anemia of chronic disease Mild iron deficiency Mixed microcytic/macrocytic
Approach History and physical Hemoglobin, hematocrit Reticulocytes decreased production, increased loss Remember to correct the retic count for the anemia
Approach If reticulocytes low, check MCV Low MCV: check iron studies, examine peripheral blood smear, hemoglobin electrophoresis Normal MCV: check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration
Peripheral smear Normal RBC size equal to nucleus of a mature lymphocyte Shape Spherocytes Sickle cell Helmet cells Tear drop cells
Peripheral smear Color Hypochromasia Iron deficiency Sideroblastic Hyperchromasia Megaloblastic anemia Spherocytosis
Peripheral smear Morphology Howell-Jolly bodies Basophilic stippling Heinz bodies Requires supravital stain Cabot ring Nuclear remnants
Peripheral smear Morphology Rouleaux formation Parasites Nucleated RBCs Target cells
Summary Once anemia is established Check reticulocyte count Correct count for anemia Increased retic count indicates RBC loss- hemolysis or bleed Decreased retic count indicates decreased RBC production Check MCV
Summary Decreased reticulocyte count Normocytic check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration Microcytic check iron studies, examine peripheral blood smear, hemoglobin electrophoresis
THALASSAEMIA A group of chronic, inherited anemias characterised by defective Hemoglobin (Hb) synthesis and ineffective erythropoiesis, particularly common.
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