approach to patient with anemia

7/31/2019 Approach to Patient With Anemia

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6/5/12

APPROACH TO PATIENT

WITH ANEMIAdr. Srie Harti Soelistio


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Definition

in RBC mass

men : Ht < 41 % or Hb < 13.5 g/dl

Women : Ht < 36% or Hb < 12g/dl


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CLINICAL MANIFESTATION


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SIGN

O2 delivery

pallor (skin & mucous membranes)

tachycardia orthostatic hypotension


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SYMPTOMS

O2 delivery

Fatigue

Malaise Fever

weight loss

night sweats


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OTHER FINDINGS

jaundice (hemolysis)

splenomegaly (thalassemia,

neoplasm, chronic hemolysis) petechiae/purpura (bleeding

disorder)

glossitis (iron, folate, vit B12 defic.) koilonychia (iron defic.)


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DIAGNOSTIC EVALUATION


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HISTORY

Is the patient bleeding?

Actively? In past? Is there evidence for increased RBC

destruction?

Is the bone marrow suppressed? Is the patient nutritionally deficient?

Pica?

PMH including medication review, toxinexposure


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RIVIEW THE SYMPTOMS

Decreased oxygen delivery to tissues

Exertional dyspnea

Dyspnea at rest

Fatigue

Signs and symptoms of hyperdynamic state

Bounding pulses

Palpitations Life threatening: heart failure, angina,

myocardial infarction

Hypovolemia

Fatiguablitiy, postural dizziness, lethargy,


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LABORATORY EVALUATION

Bleeding

Serial HCT or HGB

Iron Deficiency

Iron Studies

Hemolysis

Serum LDH, indirect bilirubin, haptoglobin,coombs, coagulation studies

Bone Marrow Examination

Others-directed by clinical indication

hemo lobin electro horesis


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DIFFERENTIAL DIAGNOSIS

Classification by Patophysiology

Blood Loss

Decreased Production Increased Destruction

Classification by Morphology

Normocytic

Microcytic

Macrocytic
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Blood Loss

Acute

Traumatic

Variety of sources Melena, hematemesis, menometrorrhagia

Chronic

Occult bleeding Colonic polyp/carcinonma
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Decreased Production

Infectious

Neoplasm

Endocrine Nutritional Deficiency

Anemia of Chronic Disease


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Increased Destruction

M ti
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MacrocyticAnemia

MCV > 100

Megaloblastic: Abnormalitiesin nucleic acid metabolism

B12, Folate

Non megaloblastic:AbnormalRBC maturation

Myelodysplasia

liver dz, hypothryroidism,chemotherapy/drugs
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Microcytic Anemia

MCV


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Microcytic Anemia


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Microcytic AnemiaREDUCED IRON AVAILABILTY Iron Deficiency

Deficient Diet/Absorption

Increased Requirements

Blood Loss

Iron Sequestration

Anemia of Chronic Disease

Low serum iron, low TIBC, normal serum ferritin

MANY!!

Chronic infection, inflammation, cancer, liver disease


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Microcytic AnemiaREDUCED HEME SYNTHESIS

Lead poisoning

Acquired orcongenitalsideroblasticanemia

Characteristicsmear finding:Basophylicstippling

croc c nem a


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crocy c nem aREDUCED GLOBIN

PRODUCTION Thalassemias Smear

Characteristics

Hypochromia

Microcytosis

Target Cells

Tear Drops

a es s


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a es sof iron deficiency of

increased severity
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Normositic Anemia

Sideroblastic anemia

Anemia of chronic disorders

Anemia of chronic inflamation Renal failure epo

Edocrine deficiencies

Hypometabolism Pure red cell aplasia

Ineffective erythropoiesis


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TREATMENT


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Iron deficiency

Fe supplementation

6 weeks to correct anemia

6 month to replete Fe stores


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Thallasemia

Folate

Tranfusion + deferoxamine ( oral ionchelator)

Splenectomy if > 50% intranfusions


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Anemia of chronicinflamation

Treat the underlying disease

Erythropoietin


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Sideroblastic anemia

Treat reversible causes

Supportive transfusion for severeanemia

High doses pyridoxine for someheriditery cases


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Folate deficiencies

Folate 1-5 mg po qd


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Vit B12 deficiencies

1 mg B12 IM qd for 7 days

1 mg B12 IM once a week untill 4-8weeks

1 mg B12 IM once a month for life

Neurologic abnormalities are

refersible if treated with in 6 months Folate can reverse hematologic

abnormalities of B12 deficiencies but

not neurologic changes


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Sickle cell anemia

Supportive care

Follic acid

hydration, oksigen and analgesia Simple change transfusion


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THANK YOU

approach to patient with anemia

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