anemia
DESCRIPTION
A practical approach to a common problemTRANSCRIPT
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Anemia
Low hemoglobinWomen<12 gm/dl; Men<13
gm/dl
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Clinical presentation Asymptomatic in majority Malaise, fatigue, DOE, pica Palpitation, angina, CHF when severe Amenorrhea/menorrhagia
Pallor, jaundice, koilonychia Tachycardia, wide pulse pressure, flow
murmurs, cardiomegaly Splenomegaly
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Evaluation CBC- Hb, TLC/DLC, platelets, MCV PBS examination Reticulocyte count Ferritin RFT- creatinine, LFT, TFT Stool- occult blood Bone marrow examination Other- Coomb’s test, Hb
electrophoresis, vitamin B12/RBC folate levels
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Poikilocytes Abnormally shaped RBC Types- Acanthocyte- spur cell- abetalipoproteinemia, liver
disease Codocyte- target cell- thalassemia, HbC disease,
post-splenectomy Echinocyte- burr cell- uremia Ovalo/elliptocyte- hereditary ovalo/elliptocytosis Spherocyte- hereditary spherocytosis, AIHA Drepanocyte- sickle cell- sickle cell anemia Dacrocyte- tear-drop cell- myelofibrosis Schistocyte- fragmented, irregular RBC- MAHA
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Causes Blood loss Acute- trauma, GI bleed Chronic- GIT, menstrual, urinary Decreased production Iron deficiency Vitamin B12/FA deficiency BM defect- aplastic, myelophthisic Increased destruction Hemolytic anemia- AIHA, SCD, thalassemia
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Morphologic classification Microcytic- MCV<80 Iron deficiency Thalassemia Sideroblastic Macrocytic- MCV>100 Vitamin B12/FA deficiency Drugs- methotrexate, zidovudine CLD, alcoholism, hypothyroidism Normocytic- MCV 80-100 Hemolytic Aplastic/Myelophthisic Anemia of chronic disease Acute blood loss
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Treatment
Correct underlying causePacked RBC transfusion
Replacement- iron, vitamin B12/FA
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Chronic hyperproliferative BM
MDS- myelodysplastic syndrome
RA- refractory anemia
RAEB Sideroblastic
anemia CMML
MPD- myeloproliferative disorders
Polycythemia vera CML Essential
thrombocythemia Myelofibrosis
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Aplastic anemia Typically pancytopenia
(PRCA- anemia only) Causes- autoimmune,
chloramphenicol, carbamazepine, radiation, benzene
s/s- of pancytopenia Dx- bone marrow examination- biopsy Rx- ATG/ALG with Cyclosporin-in
elderly or HSCT-in young
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HSCT Hematopoietic stem cell transplantation BMT or PBSCT (preferred) or cord blood Indications- Multiple myeloma AML in remission, ALL in second remission, CML Relapsed lymphoma Aplastic anemia MDS Congenital storage disorders, immunodeficiencies,
hemoglobinopathies Collagen vascular disease Autologous or Allogeneic
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HSCT considerations Cost HLA matched donor (allogeneic) Complications- Infections Mucositis Hepatic veno-occlusive disease GVHD (allogeneic)- acute or chronic Mortality- 10-20%