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Paolo Aquino PGY-I January 2005 VA HospitalAnemia 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 historyExposures Diet History of infection PMH- cancer, renal, endocrine
Physical exam Appearance Vital signs HEENT Heart Abdominal
Laboratory studies Hemoglobin and hematocrit Mean corpuscular volumeReticulocytes Peripheral smear
Microcytic anemia Most common cause: iron-deficiency anemiaThalassemia Lead poisoning Sideroblastic anemia Anemia of chronic disease
Normocytic anemia Marrow hypoplasia Marrow infiltration MyelofibrosisRenal insufficiency Anemia of chronic disease Mild iron deficiency Mixed microcytic/macrocytic
Approach History and physical Hemoglobin, hematocritReticulocytes decreased production, increased loss Remember to correct the retic count for the anemia
Approach If reticulocytes low, check MCVLow 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 Hyperchromasia Iron deficiencySideroblastic Hyperchromasia Megaloblastic anemia Spherocytosis
Peripheral smear Morphology Howell-Jolly bodies Basophilic stipplingHeinz bodies Requires supravital stain Cabot ring Nuclear remnants
Peripheral smear Morphology Rouleaux formation ParasitesNucleated RBCs Target cells
Summary Once anemia is established Check reticulocyte countCorrect 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 Microcyticcheck iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration Microcytic check iron studies, examine peripheral blood smear, hemoglobin electrophoresis
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Erythrocytic Morphology and Associated Diseases(Size and Shape)
Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.
RED BLOOD CELL MORPHOLOGY
Abnormal Blood Cell Morphology
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Approach to Anemias. Objectives At the end of this session you should be able to: describe history and physical examination findings pertinent to anemia.
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Classification of Anaemia By, Mosaab A. Omar. What is Anaemia? Definition of Anaemia Anemia is reduced Haemoglobin concentration in blood more than.
Reticulocyte. RETICULOCYTE Young red blood cell; still have small amounts of RNA present in them Can be detected using supravital stain Tend to stain.
Hematopathology. Peripheral Blood Film Examination Normal RBC : The normal human erythrocytes are biconcave disc, 7.2 Mm in diameter, and the thickness.
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