Presentation on theme: "CLUES TO THE DIAGNOSIS IN ANEMIA PRINCIPLES 4 Anemia is not a disease 4 There is usually a cause 4 investigation should be logical 4 Start with CBC and."— Presentation transcript:
PRINCIPLES 4 Anemia is not a disease 4 There is usually a cause 4 investigation should be logical 4 Start with CBC and Blood film 4 Leads to other tests –non specific –specific 4 Guides therapy
Further Principles 4 Symptoms are more related to rate of fall in hemoglobin not level. 4 Non specific symptoms 4 More specific symptoms 4 Drug History 4 Physical examination –splenomegaly
Starts With CBC 4 High yield parameters –Hgb –MCV –RBC # 4 Morphology 4 Confirmatory tests 4 Lets apply
4 Test results Hgb 77 g/L MCV 66 f/L RBC 3.2 x10 12 /L WBC 5.6 x10 6 /L Plat 525 x10 9 /L 4 Blood film This is a 55 year old woman who has fatigue. Her only other symptom is a craving for chewing ice cubes. Apart from being pale her examination is normal.
STAGES OF IRON DEPLETION Loss of body stores Fall in serum iron Anemia develops Microcytosis Hypochromasia
ASSESSMENT OF IRON STATUS 4 Identify high risk groups 4 Children 4 Menstruation 4 Pregnancy - Lactation 4 Frequent Blood Donors 4 Chronic GI loss 4 Malabsorption 4 Diet
IRON BALANCE ; Ingest 10-20 mg. per day ; Absorb 1-3 mg. per day ; Lose 1 + mg per day –menstrual loss 30-50 ml ; Total iron 35-50 mg/kg ; Stores 1 gram ; Easy to achieve negative balance
Dx of IRON DEFICIENCY ; Symptoms and signs ; CBC - Anemia - microcytosis - Hypochromia ; Blood Film - Oval - pencil - Tear ; Serum Fe and TIBC Fe low TIBC high ; Serum Ferritin ; Cause of Iron Deficiency
INVESTIGATION OF CAUSE ; Investigate when cause not Clear ; Symptoms of cause often unreliable ; Upper GI cause higher Yield ; If upper GI lesion found then a colonic lesion unlikely ; TESTS - Radiologic, Endoscopic Biopsy, Angiographic.
Anemia of Chronic disease 4 Usually mild to moderate anemia 4 normocytic normochromic 4 low retic count 4 Low serum Fe and low TIBC sat % 15-20 4 Ferritin normal or high 4 A responsible disease is present 4 Usually a systemic disorder
4 Fe overload 4 Genetic predisposition to increased Fe absorption 4 Common 4 Screen with Fe saturation (ferritin) 4 Confirm with Genetic testing 4 2 genes 282Y H63D 4 Treatment - phlebotomy
4 Test results Hgb 85 g/L MCV 110 fL RBC 3.9 x10 12 /L WBC 2.4 x10 6 /L Plat 89 x10 9 /L 4 Blood Film A 65 year old woman is referred to you because of memory loss. Her family physician had received tests which included bilirubin of 28 mol/L and an LDH of 1560 U/L. He was puzzled by these results.
Hemolytic anemias 4 History of jaundice and anemia 4 May have splenomegaly 4 May have a family history 4 anemia with reticulocytosis 4 specific morphologic changes 4 serum bilirubin and LDH as markers 4 Specific tests follow morphology