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Anemia

Anemia. Paolo Aquino PGY-I January 2005 VA Hospital. Definition. Anemia is a reduction of hemoglobin or volume of red blood cells from normal limits Variation due to age, gender Decreased production Increased loss. History. Signs of blood loss Onset- rapid vs. gradual Family history

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Anemia

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  1. Anemia Paolo Aquino PGY-I January 2005 VA Hospital

  2. Definition • Anemia is a reduction of hemoglobin or volume of red blood cells from normal limits • Variation due to age, gender • Decreased production • Increased loss

  3. History • Signs of blood loss • Onset- rapid vs. gradual • Family history • Exposures • Diet • History of infection • PMH- cancer, renal, endocrine

  4. Physical exam • Appearance • Vital signs • HEENT • Heart • Abdominal

  5. Laboratory studies • Hemoglobin and hematocrit • Mean corpuscular volume • Reticulocytes • Peripheral smear

  6. Microcytic anemia • Most common cause: iron-deficiency anemia • Thalassemia • Lead poisoning • Sideroblastic anemia • Anemia of chronic disease

  7. Normocytic anemia • Marrow hypoplasia • Marrow infiltration • Myelofibrosis • Renal insufficiency • Anemia of chronic disease • Mild iron deficiency • Mixed microcytic/macrocytic

  8. Approach • History and physical • Hemoglobin, hematocrit • Reticulocytes decreased production, increased loss • Remember to correct the retic count for the anemia

  9. Approach • If reticulocytes low, check MCV • Low MCV: check iron studies, examine peripheral blood smear, hemoglobin electrophoresis • Normal MCV: check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration

  10. Peripheral smear • Normal RBC size equal to nucleus of a mature lymphocyte • Shape • Spherocytes • Sickle cell • Helmet cells • Tear drop cells

  11. Peripheral smear • Color • Hypochromasia • Iron deficiency • Sideroblastic • Hyperchromasia • Megaloblastic anemia • Spherocytosis

  12. Peripheral smear • Morphology • Howell-Jolly bodies • Basophilic stippling • Heinz bodies • Requires supravital stain • Cabot ring • Nuclear remnants

  13. Peripheral smear • Morphology • Rouleaux formation • Parasites • Nucleated RBCs • Target cells

  14. Summary • Once anemia is established • Check reticulocyte count • Correct count for anemia • Increased retic count indicates RBC loss- hemolysis or bleed • Decreased retic count indicates decreased RBC production • Check MCV

  15. Summary • Decreased reticulocyte count • Normocytic • check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration • Microcytic • check iron studies, examine peripheral blood smear, hemoglobin electrophoresis

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