2. Prof. Aziz-ur-Rehman

3.  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

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

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

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

7. RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15

8. RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15

9. RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15

10. HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35

13. HCMC ANAEMIA-1

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

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

16. 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)

17. HCMC ANAEMIA-2

18.  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

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

20. Macrocytic Anaemia

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

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

23. NCNC anaemia-1

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

25.  NCNC anaemia  Pancytopenia  Bone marrow biopsy

26.  Immunosuppressant  BMT/SCT  Blood transfusions

27. NCNC ANAEMIA-2

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

29.  Steroids  Splenectomy  BT  BMT/SCT

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

31.  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

32. Aziz-ur-Rehman