Prof. Aziz-ur-Rehman

 Very common problem  Subtle or no symptoms, usually incidental finding  Various causes; ID is the commonest  Simple iron replacement is not the solution  Investigate before starting treatment

 Nutrition  Chronic blood loss  Menorrhagia  GI blood loss  Liver disease  Worm infestation  Transfusions  Family history

 Pallor  Koilonychia  Splenomegaly  Purpura  Lympadenopathy Routine features Serious problem?

Routine  CBC; Hb%, Hct, RBC indices Specilised  Iron studies  Hb. Electrophoresis  Reticulocyte count  Peripheral smear  Bone marrow  Other haematological  Non haematological

RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

RBC= 4-5.5M HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= RDW 11-15

HGB= HCT= MCV= 78-98fL MCH= 27-32pg MCHC= TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35

HCMC ANAEMIA-1

 Very common; diagnosis by default  Chronic blood loss, malnutrition  Total iron depletion  Various lab tests, serum ferritin best

ParameterEffect Hb & HctReduced MCV, MCH, MCHCReduced FerritinReduced IronReduced TIBC/TSIncreased BM ironAbsent Retic countLow

1. Identify and treat the cause 2. BT hardly ever indicated 3. Oral iron; various form, FeSO4 best 4. Parenteral iron 5. Good nutrition (meat, fish & poultry)

HCMC ANAEMIA-2

 Family history  Mild to severe anaemia  Splenomegaly  HCMC anaemia (ID excluded)  Hb electrophoresis:  Hb A2 & Hb F levels high: beta thalassaemia  Hb A2 & Hb F levels normal: alpha thalassaemia  DNA analysis

 None  Counseling  BMT/SCT  Iron contraindicated  Desferrioxamine

Macrocytic Anaemia

 Inherited disorder  Intrinsic factor deficiency  Vit. B12 not absorbed

ParameterEffect Hb, HCTReduced MCV, MCH, MCHCIncreased, Normal, Reduced Vit B12low Folatelow Retic countLow; prompt rise after treatment BM examinationMegaloblastic picture

NCNC anaemia-1

ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal TLClow Plateletslow DLCReversed P/L ratio Retic countLow BM examinationAplastic picture

 NCNC anaemia  Pancytopenia  Bone marrow biopsy

 Immunosuppressant  BMT/SCT  Blood transfusions

NCNC ANAEMIA-2

ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal to slightly increased Haptoglobinlow BilirubinIncreased (unconjugated) Retic countHigh, polychromasia HaemoglobinaemiaPresent Hemoglobinuriapresent BM examinationHyperplastic picture

 Steroids  Splenectomy  BT  BMT/SCT

 Rare disease  Mixed pattern  Partially treated  Blood transfusion

 Anaemia is a common and treatable problem  History, PE & CBC gives important clues to the diagnosis  IDA is the commonest type, oral iron replacement is the treatment of choice  BT needed rarely

Aziz-ur-Rehman