2Approach to Anemia – Case 1 37 year old female patient of Caucasian originreferred to the Emergency Room because of anemiaMedical background: generally healthy, normaldiet; during the last week treated with an antibioticbecause of suspected pharyngitisComplains of weakness and low-grade fever
3Approach to Anemia – Case 1 On examination: pallor, slight jaundice; spleen mildly enlarged, soft, tenderNo lymphadenopathy, no bleeding tendency, no glossitisPulse 100, regular, blood pressure and oxygen saturation normal
4Approach to Anemia – Case 1 Laboratory evaluation - Set I:- Hemoglobin – 7.9 gr%- MCV – 100- RDW – 17- WBC – normal- Platelets - normal
5Approach to Anemia – Case 1 Interpretation: macrocytic anemiaDifferential diagnosis:- Megaloblastic anemia- Hemolytic anemia- Myelodysplastic syndrome/Aplastic anemia- Other
6Approach to Anemia – Case 1 Laboratory evaluation - Set II:- Reticulocytes – 14%- Corrected reticulocyte count:/% Retics X (measured to the expected Hb ratio)/14% x 7.9/15 = 7.4%- Reticulocyte Production Index (RPI):/Corrected reticulocyte count/shift correction factor/7.4 / 2 = (>2)
7Approach to Anemia – Case 1 Interpretation: hyperproliferative anemiaDifferential diagnosis:- Megaloblastic anemia? No- Myelodysplastic syndrome/Aplastic anemia?No- Hemolytic anemia? Yes
8Approach to Anemia – Case 1 Laboratory evaluation - Set III:- LDH – high- Bilirubin – high (unconjugated)- Haptoglobin – lowDiagnosis confirmed: Hemolytic anemia
9Approach to Anemia – Case 1 Hemolytic anemia – differential diagnosis:- Intra-corpuscular (hemoglobinopathy, enzymopathy)- Red cell membrane (cytoskeleton, PNH, spur cell anemia)- Extra-corpuscular (hypersplenism, mechanic hemolysis, immune hemolysis, toxic/infectious agents)
10Approach to Anemia – Case 1 Laboratory evaluation - Set IV:Blood smear- Anisocytosis (high RDW)- Polychromasia (reticulocytosis)- Spherocytes? - Ellyptocytes?- Bite cells? Spur cells?- Schistocytes? - Sickle cells?
26Approach to Anemia – Case 2 63 year old male patient presented to your clinic with weakness and anemia; generally healthy, no permanent medications.On examination: afebrile, normal pulse and blood pressure. No hepatosplenomegaly and lymphadenopathy. Scattered purpura over lower extremities and chest.
27Approach to Anemia – Case 2 Laboratory evaluation - Set I:
28Approach to Anemia – Case 2 Interpretation: macrocytic anemia with thrombocytopeniaDifferential diagnosis:
29Approach to Anemia – Case 2 Laboratory evaluation - Set II: