COMMON ANEMIAS

Haematology

Dr. Janis Bormanis

Common anemias

Iron deficiency Megaloblastic anemias Secondary anemias to chronic diseases

Anemia of chronic disease Hemolytic anemias

Spherocytic

fragmentation

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IRON OVERLOADDEFICIENCY

IDA IDWAHC

BODY IRON IN THE POPULATION

INCSTR

STAGES OF IRON DEPLETION

Loss of body storesFall in serum ironAnemia develops MicrocytosisHypochromasia

ASSESSMENT OF IRON STATUS

Identify high risk groups Children Menstruation Pregnancy - Lactation Frequent Blood Donors Chronic GI loss Malabsorption Diet

SOURCES OF IRON

Heme Iron– Meat

– 10-15% absorbed

Non-Heme– Vegetables, Fruit, Cereal– Major source in Third World

IRON BALANCE

Ingest 10-20 mg. per day Absorb 1-3 mg. per day Lose 1 + mg per day

– menstrual loss 30-50 ml

Total iron 35-50 mg/kg Stores 1 gram Easy to achieve negative balance

Dx of IRON DEFICIENCY

Symptoms and signs CBC - Anemia - microcytosis -

Hypochromia Blood Film - Oval - pencil - Tear Serum Fe and TIBC Fe low TIBC high Serum Ferritin Cause of Iron Deficiency

Microcytic, hypochromic

INVESTIGATION OF CAUSE

Investigate when cause not Clear Symptoms of cause often unreliable Upper GI cause higher Yield If upper GI lesion found then a colonic

lesion unlikely TESTS - Radiologic, Endoscopic Biopsy,

Angiographic.

THERAPY

Replace iron

Anemia of Chronic disease

Usually mild to moderate anemia normocytic normochromic low retic count Low serum Fe and low TIBC sat % 15-20 Ferritin normal or high A responsible disease is present Usually a systemic disorder

Megaloblastic Anemias

Vitamin B12

Folic Acid

Reasons for measuring B12

Investigation of macrocytic anemia Investigation of any anemia Investigation of fatigue Routine Geriatric Screen Investigation of neurologic symptoms

Symptom Complex

Classic presentation uncommon Often a screen in older patients Memory loss prominent Neuropathy Changes in evoked potential Non specific symptoms of anemia

Causes

Pernicious anemia 10 % of all cobalamin deficiencies

Majority are due to malabsorption

Causes of Low Serum B12

Malabsorption of free cobalamin Pernicious anemia Post gastrectomy state Small bowel diseases

Causes of Low Serum B12

Malabsorption of food cobalamin Atrophic gastritis Postgastrectomy state Chronic nonspecific gastritis (H pylori ?) H2 receptor blocking agents

Tests

CBC - RBC indices– Most are macrocytic

Blood film– Macro-ovalocytes - hypersegmented polys

Biochemical abnormalities– LDH bilirubin

Serum B12 Schilling test

Oval Macrocytes Hypersegmented neutrophils

Folic acid deficieny

Dietary source is vegetables Absorption no specific carrier Deficiency mainly dietary. Alcoholism a risk Anemia macrocytic No neurologic symptoms Measure RBC folate

Therapy

Replace B12 - folic acid

Hemolytic anemias

History of jaundice and anemia May have splenomegaly May have a family history anemia with reticulocytosis specific morphologic changes serum bilirubin and LDH as markers Specific 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 anemia

Anemia is not a disease There is usually a cause investigation should be logical Start with CBC and Blood film Leads to other tests

– non specific– specific

Guides therapy