COMMON ANEMIAS Haematology Dr. Janis Bormanis Common anemias 4 Iron deficiency 4 Megaloblastic anemias 4 Secondary anemias to chronic diseases Anemia

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  • COMMON ANEMIASHaematologyDr. Janis Bormanis

  • Common anemiasIron deficiencyMegaloblastic anemiasSecondary anemias to chronic diseases Anemia of chronic diseaseHemolytic anemias Spherocyticfragmentation


  • STAGES OF IRON DEPLETIONLoss of body storesFall in serum ironAnemia develops MicrocytosisHypochromasia

  • ASSESSMENT OF IRON STATUSIdentify high risk groupsChildrenMenstruationPregnancy - LactationFrequent Blood DonorsChronic GI lossMalabsorptionDiet

  • SOURCES OF IRONHeme IronMeat10-15% absorbedNon-HemeVegetables, Fruit, CerealMajor source in Third World

  • IRON BALANCEIngest 10-20 mg. per dayAbsorb 1-3 mg. per dayLose 1 + mg per daymenstrual loss 30-50 mlTotal iron 35-50 mg/kgStores 1 gramEasy to achieve negative balance

  • Dx of IRON DEFICIENCYSymptoms and signsCBC - Anemia - microcytosis - HypochromiaBlood Film - Oval - pencil - TearSerum Fe and TIBC Fe low TIBC highSerum FerritinCause of Iron Deficiency

  • Microcytic, hypochromic

  • INVESTIGATION OF CAUSEInvestigate when cause not ClearSymptoms of cause often unreliableUpper GI cause higher YieldIf upper GI lesion found then a colonic lesion unlikelyTESTS - Radiologic, Endoscopic Biopsy, Angiographic.

  • THERAPYReplace iron

  • Anemia of Chronic diseaseUsually mild to moderate anemianormocytic normochromiclow retic countLow serum Fe and low TIBC sat % 15-20Ferritin normal or highA responsible disease is presentUsually a systemic disorder

  • Megaloblastic AnemiasVitamin B12Folic Acid

  • Reasons for measuring B12Investigation of macrocytic anemiaInvestigation of any anemiaInvestigation of fatigueRoutine Geriatric ScreenInvestigation of neurologic symptoms

  • Symptom ComplexClassic presentation uncommonOften a screen in older patientsMemory loss prominentNeuropathyChanges in evoked potentialNon specific symptoms of anemia

  • Causes Pernicious anemia10 % of all cobalamin deficiencies

    Majority are due to malabsorption

  • Causes of Low Serum B12Malabsorption of free cobalaminPernicious anemiaPost gastrectomy stateSmall bowel diseases

  • Causes of Low Serum B12Malabsorption of food cobalaminAtrophic gastritisPostgastrectomy stateChronic nonspecific gastritis (H pylori ?)H2 receptor blocking agents

  • TestsCBC - RBC indicesMost are macrocyticBlood filmMacro-ovalocytes - hypersegmented polysBiochemical abnormalitiesLDH bilirubinSerum B12Schilling test

  • Oval Macrocytes Hypersegmented neutrophils

  • Folic acid deficienyDietary source is vegetablesAbsorption no specific carrierDeficiency mainly dietary.Alcoholism a riskAnemia macrocyticNo neurologic symptomsMeasure RBC folate

  • TherapyReplace B12 - folic acid

  • Hemolytic anemiasHistory of jaundice and anemiaMay have splenomegalyMay have a family historyanemia with reticulocytosisspecific morphologic changesserum bilirubin and LDH as markersSpecific tests follow morphology

  • Spherocytosis

  • G6PD deficiency - Oxidative hemolysis

  • Fragmentation Prosthetic heart valves

  • Which anemia is this ?

  • Hemoglobinopathies and Thalassemias

  • These are just some of the anemias which illustrate principles of diagnosis

  • Approach to anemiaAnemia is not a diseaseThere is usually a causeinvestigation should be logical Start with CBC and Blood filmLeads to other testsnon specificspecificGuides therapy