Anaemia - I - PDF

Anaemia Dr U.M Wariyapperuma  Intended Learning Outcomes Define the term anaemia. Describe signs and symptoms of patients with anaemia. Understand the important haematological parameters in evaluating a patient with anaemia Classify anaemia Based on mor...

Anaemia Dr U.M Wariyapperuma  Intended Learning Outcomes Define the term anaemia. Describe signs and symptoms of patients with anaemia. Understand the important haematological parameters in evaluating a patient with anaemia Classify anaemia Based on morphological features of RBC Depending on the causes Describe the hematological and basic clinical features of various types of anaemia Describe with reasons the investigations required in the management of a patient who is suspected of having anaemia What is anaemia? Decrease in Hb in the blood below the reference level for the age and sex of the individual Anaemia is not a final diagnosis- always look for the underlying cause Raised plasma volume produces a spurious anaemia - in pregnancy. SYMPTOMS SIGNS These are all non-specific Pallor Tachycardia. fatigue, Systolic flow murmur. headaches and faintness Cardiac failure. breathlessness angina intermittent claudication palpitations koilonychia -iron deficiency anaemia Jaundice – found in haemolytic anaemia Bone deformities – found in thalassaemia major Leg ulcers – occur in association with sickle cell disease. Important red cell indices in relation to anaemia Morphological classification Hypochromic microcytic with a low MCV Normochromic normocytic with a normal MCV Macrocytic with a high MCV Evaluation History and examination Investigations Peripheral Blood Bone marrow Other procedures/laboratory studies  Investigations Peripheral blood Firstline FBC – (red cell indices, Other cell lines) Iron studies ( Serum iron,TIBC, Transferrin saturation, ferritin) The reticulocyte count (as this indicates marrow activity) The blood film- Aids diagnosis in iron deficiency, megaloblastic,sickle cell, thalassemia Second line ( To identify specific causes) B12 and folate levels Serum bilirubin, serum hptoglobulin,DAT, LDH ,urine hemosiderin Endoscopy and colonoscopy Hb electrophoresis Celiac screening and intrinsic factor antibodies Osmotic fragility test Enzyme assays- G6PD,Pyruvate kinase Flow cytometry  Bone marrow – Aspiration and trephine biopsy cellularity of the marrow type of erythropoiesis (e.g. normoblastic or megaloblastic) cellularity of the various cell lines infiltration of the marrow, i.e. presence of non-haemopoietic cells such as cancer cells iron stores  Take Home … Anaemia is not a final diagnosis Knowledge of red cell indices interpretation is a useful tool in the evaluation Detailed history, examination and first line investigations will help narrow down the differentials Specialized investigations are sometimes needed to determine the aetiology References Kumar and Clark’s clinical medicine Hematology- Basic Principles and Practice- Ronald Hoffman Thank You