How deal with a case of Anemia How deal with a case of Anemia

What is anemia?What is anemia?What is anemia? What is anemia? red red Anemia is a medical condition in which the Anemia is a medical condition in which the

is less than is less than hemoglobinhemoglobincount and count and blood cellblood cellnormal for age and sex .normal for age and sex .normal for age and sex . normal for age and sex . • • Most common hematologic disorder by farMost common hematologic disorder by far• • Almost always a secondary disorderAlmost always a secondary disorder

What causes anemia?What causes anemia?What causes anemia?What causes anemia?

•Any process that can disrupt the normal life span of a red blood cell may cause p yanemia. Normal life span of a red blood cell is typically around 120 days Redcell is typically around 120 days. Red

. bone marrowblood cells are made in the

•Anemia is caused essentially through two basic pathways. Anemia is either caused:p y1-by a decrease in production of red blood cell or hemoglobin orcell or hemoglobin, or

•2-by a loss or destruction of blood.2 by a loss or destruction of blood.

Classification of anemiaClassification of anemiaClassification of anemia Classification of anemia

•There are two major approaches: the "kinetic" approach which involves ppevaluating production, destruction and loss and the "morphologic" approach whichand the morphologic approach which groups anemia by red blood cell size. The morphologic approach uses a quicklymorphologic approach uses a quickly available and cheap lab test as its starting

and MCH). MCVpoint (the

A di h i di i l ifAccording to thes indices ,anemia can classify to:-

1-microcytic hypochromic (low MCV and MCH)2-Normocytic normochromic (normal MCV and MCH)2-Normocytic normochromic (normal MCV and MCH)3- Macrocytic (high MCV)

Microcytic anemiaMicrocytic anemiaIs primarily a result of hemoglobin synthesis failure/insufficiency which could be caused by severalfailure/insufficiency, which could be caused by several etiologies:- Heme synthesis defect y

Iron deficiency anemia-) more commonly presenting as normocytic anemia(Anemia of chronic disease-

Gl bi th i d f t- Globin synthesis defect thalassemia-and beta,-alpha-

- HbE syndrome- HbE syndrome - HbC syndrome - and various other unstable hemoglobin diseases g

- Sideroblastic defect - Hereditary sideroblastic anemia

l d t i itA i d id bl ti i i l di lead toxicityAcquired sideroblastic anemia, including -- Reversible sideroblastic anemia

anemiaanemiaMacrocyticMacrocytic anemiaanemiaMacrocyticMacrocyticMegaloblastic anemiaMegaloblastic anemiaMegaloblastic anemiaMegaloblastic anemiathe most common cause of the most common cause of macrocyticmacrocytic anemia,anemia,

, , 1212vitamin Bvitamin Bis due to a deficiency of either is due to a deficiency of either (or both).(or both).folic acidfolic acid ( )( )

is caused by a lack of is caused by a lack of Pernicious anemiaPernicious anemiaintrinsic factorintrinsic factorintrinsic factorintrinsic factor

MacrocyticMacrocytic anemia anemia Non Non MegaloblasticMegaloblastic

-Chemotherapy- liver diseasedsliver diseaseds - hypothyroidism- Alcohol- Pregnancy- Pregnancy

NormocyticNormocytic anemiaanemiaNormocyticNormocytic anemiaanemia

•Normocytic anaemia occurs when the overall hemoglobin levels are always decreased, but

Mean corpuscular the red blood cell size () remains normal. Causes include:volumeblood lossAcute -

Anemia of chronic disease- Anemia of chronic disease•(bone marrow failure) Aplastic anemia-

Hemolytic anemiaHemolytic anemia-

Dimorphic anemiaDimorphic anemiaDimorphic anemiaDimorphic anemiaWhen two causes of anemia act simultaneously, y,

hookworm, due to hypochromice.g., macrocytic

and ironinfestation leading to deficiency of both

bloodor following afolic acidor12vitamin B blood or following a folic acidor 12vitamin B

more than one abnormality of red transfusion y

cell indices may be seen. Evidence for multiple

causes appears with an elevated RBC

distribution width (RDW) which suggests adistribution width (RDW), which suggests a

wider-than-normal range of red cell sizes.

AnemiaHistory and Exam

Anemia• History and Exam

• Reticulocyte county

• Blood film

• MCV

Ferritin • Ferritin

• WBC, diff, platelets, , p

1st TestRETICULOCYTE

COUNT

MCVlow/MCHlow

ReticulocyteReticulocyte

Normal/low High

Hb. electrophoresis

Thalassemia

Other abnormal hemoglobin

Normal/low

S iSerum iron

Low High

•Ferritin

Low Normal/high BM iron

•IDA ACD Sideroblastic anemia

MCV Normal/MCH normal

Reticulocyte count

1 Low/normal1-Low/normal

BM morphology

Normal Abnormal

Hypoplastic Infiltration/fibrosis 2nd anemia Aplastic anemia leukemia-Inflammations metastases

•- renal disease myelobibrosis

-Liver diseaseEndocrine def.

2- Reticulocyte count high

Acute blood loss hemolysis rather than ThalassemiaThalassemia

MCV high Reticulocyte count

High Norma/Low

BM morphology

•Megoloblastic Non megaloblasticMegoloblastic Non megaloblasticVit B12 def Alcohol Folate def Liver diseaseFolate def Liver disease

hypothyroidism MDSMDS

•AIHA

Figure 1-3. Overview of anemia diagnostic work-up using WHO anemia definitions.