HYP CHR MIC ANEMIA

PRESENTER - ASHWIN GOBBUR

Definition

• Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal.

(Hypo - less, chromic - color.)

ETIOLOGIC CLASSIFICATION

1. IRON DEFICIENCY ANEMIA

2. NON-IRON DEFICIENCY ANEMIA

Sideroblasic anemia

Thalassaemia

Anemia of chronic diseases

Lead poisoning

IRON DEFICIENCY ANEMIA

i. LOW INTAKE -

ii. DECREASED ABSORPTION -

iii.BLOOD LOSS -

iv. DRUGS -

v. TRANSPORT DEFECT -

CLINICAL APPROACH

HISTORY :

• Age at presentation –

thalassamia by 4-6 months

• History of repeated blood transfusion

• Diet – poor intake of grean leafs, meat

• Recurrent diarrhea

• Passing worms …

Continued…

• Dysphagia

• PICA

• Drug intake: NSAID

• Surgery of stomach

• Recurrent upper resp. tract infection

• Consanguinity : Thalassemia

• Poor concentration (enzyme co-factor)

SYMPTOMS

CLINICAL APPROACH

EXAMINATION :GENERAL PHYSICAL

• pallor• koilonychia• platonychia• hemolytic facies• cirrhotic features

Examination contd…

SYSTEMIC :

Per abdomen –

• Firm spleno-hepatomegaly – hemolytic anemia – thalassaemia

• Evidence of cirrhosis – spider naevi, oedema, splenomegaly

CVS –

• Physiological murmr

INVESTIGATION

I. FINDING THE CAUSE • USG • Endoscopy - site of bleed ( portal

hypertension, hemorrhoids, worms … )• Occult blood in stool (Benzidine test)–

GI bleed• Stool examination –

Ova (hook/round)

Investigation contd…II. Evaluating the severity• Hb estimation • Serum iron• Serum ferritin –

Normal: 50-150 mic/dl high in NIDA low in IDA

• Serum TIBC • MCV, MCHC• RDW * 14-16 – N, >16 – IDA, <13 – Th. minor• RBC count : high NIDA

low chronic organ / disease.

Contd…

• Peripheral smear examination

o microctic hypochromic anemia

o IDA - poikilocytosis

o Thalassaemia - nucleated RBC,

target cells

o Sideroblastic anemia – Bone marrow

(ring sideroblasts)

PS examination

Normocytic Normochromic

Macrocytic – Megaloblastic anemia

Microcytic Hypochromic – IDA

Microcytic Hypochromic –Thalassemia (Target cells, NRs)

TREATMENT

I. Treat underlying cause

II. Treat iron deficiency state

Ferrous sulphate – gold standerd. 3-5 mg/kg (20% absorbable)

(ideally empty stomach, with food if GI upset)

Ferrous fumerate

Ferrous gluconate

Ferrous ascorbate

Ferrros EDTA

Rx contd …

• Ferric preparations available

good compliance, poor efficacy (<10%)

Ferric ammonium citrate

Ferric hydroxide

Colloidal iron …

Rx contd…

• Parenteral iron – mg =

2.4 x body wt kg x Hb deficit + 500mg

Iron sucrose

Iron polymaltose

Sideroblastic – give pyridoxinesupplement (5-10 mg/kg)

CRF – injection erythropoietin

Rx contd…

• BLOOD

Intolerance to oral and parenteral iron

Severe anemia

CRF – packed cell ( PCV 10ml/kg)

*5ml/kg packed cell Hb by 2g

RESPONSE 24 hr – appetite

concentration smiling child

1 week – reticulocyte count – 10-15%Hb slowly increases

(1-2g/dl at the end of 1 month) IF NO RESPONSE REVISE DIAGNOSIS