C27 p1 Anemia approach

Macrocytic anemia

Microcytic anemia

DDx of IDA and thalassemia –IDA, PB: anisocytosis, (poikilocytosis), RBC poor RBC number, –Thalassemia: PB: less anisocytosis, target cells, poikilocytosis RBC number increase, Treatment of –B12: 1mg daily for one week, weekly for one month, monthly for life( 須先補 b12), if data ok 可用 3 年 –Folate: 1-5 mg /day till –Iron(Fe+2) till ferritin to 100 and more 1/2 yr(foliromin 1# bid)

Thalassemia –a-tha: hemoglobin H: (100X) trait: 1-5#( +),6#(+2) major: 1000#(3+),all(++++) –b-thal A2>4% IDA: –In “male or post menopause female” : 排除腫瘤 –Elder: R/O CA  PES  coloscopy –Younger  R/O ulcer(PES)

IDA: 10% with mild leukopenia and reactive thrombocytosis

Normocytic anemia

3低3低 3高3高 ↑ ↓ 發炎 In MΦ

When to did BM and R/O cancer studies –Clues: PB: leukoerythroblatosis,…..--> BM studies LDH elevated, reticulocytopenia, thrombocytopenia  BM studies ALK  R/O Ca