A.H.Emami MD.

Associate professor of TUMS

Medical Oncologist- Hematologist

ANEMIA; CLINICAL APPROACH

DEFINITION

• Anemia can be rigorously defined as a reduced

absolute number of circulating red blood cells

• In practice, however, a low hemoglobin concentration

or a low hematocrit is most widely employed for this

purpose.

• Anemia is defined as values that are more than two

standard deviations (SD) below the mean

• ….. have proposed different lower limits of normal for

the hemoglobin level, ranging from 13.0 to 14.2 g/dL for

men and 11.6 to 12.3 g/dL for women

• The revised WHO/National Cancer Institute's criteria for

anemia in men and women are <14 and <12 g/dL,

respectively

• These "normal" ranges may not apply to certain

populations:

• Athletes

• Living at high altitude

• Smokers

• African-Americans

• Presence of chronic disease

• Older adults

CAUSES OF ANEMIA

• kinetic approach

decreased RBC production

increased RBC destruction

blood loss

morphologic approach

microcytic

macrocytic

normocytic

HISTORY• Is there a recent history of loss of appetite, weight loss, fever,

and/or night sweats that might indicate the presence of infection

or malignancy?

• Is there a history of, or symptoms related to, a medical condition

that is known to result in anemia (eg, tarry stools in a patient

with ulcer-type pain, significant blood loss from other sites,

rheumatoid arthritis, renal failure)?

HISTORY• Is the anemia of recent origin, subacute, or lifelong? Recent

anemia is almost always an acquired disorder, while lifelong

anemia, particularly if accompanied by a positive family history,

is likely to be inherited

• The patient's ethnicity and province of origin may be

helpful: Thal. SS. Sβ. …

• The use of medications, both prescribed and over-the-

counter, should be examined in some detail. Specific

questions should be asked about the use of alcohol

opium, aspirin, and nonsteroidal antiinflammatory drugs

HIJAMA

BLOOD DONATION

DIET

• Is there evidence for increased red blood cell (RBC)

destruction (either intravascular or extravascular)?

PHYSICAL EXAMINATION

• evaluation for jaundice and pallor is a standard part of the

physical examination

• The major aim of physical examination is to find signs of organ

or multisystem involvement and to assess the severity of the

patient's condition.

• Thus, the presence or absence of tachycardia, dyspnea, fever,

or postural hypotension should be noted

PALLOR

• The sensitivity and specificity for pallor in the palms, nail beds,

face, or conjunctivae as a predictor for anemia varies from 19 to

70 percent and 70 to 100 percent, respectively

• Jaundice may be difficult to detect under artificial (nonfluorescent) lighting conditions . Even under optimal conditions, it may be missed.

• As an example, in a double blind study involving 62 medical observers at various levels of training, the presence of scleralicterus was detected by 58 percent at a total serum bilirubinconcentration of 2.5 mg/dL (42.8 micromol/L) and by only 68 percent at a bilirubin concentration of 3.1 mg/dL (53.0 micromol/L) .

• False positives were mostly attributable to medical students, while false negatives were not related to the level of training

KOILONYCHIA

• lymphadenopathy,

• hepatosplenomegaly,

• bone tenderness

• signs of other hematologic abnormalities, including petechiae

due to thrombocytopenia, ecchymoses,

• signs and symptoms of recurrent infections secondary to

neutropenia or immune deficiency states.

LEAD LINE