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An intelligent approach to the diagnosis and treatment of Anaemia

An intelligent approach to the diagnosis and treatment of Anaemia. Prof. Aziz-ur-Rehman. Introduction. Very common problem Subtle or no symptoms, usually incidental finding Various causes; ID is the commonest Simple iron replacement is not the solution Investigate before starting treatment.

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An intelligent approach to the diagnosis and treatment of Anaemia

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  1. An intelligent approach to the diagnosis and treatment ofAnaemia

    Prof. Aziz-ur-Rehman
  2. Introduction Very common problem Subtle or no symptoms, usually incidental finding Various causes; ID is the commonest Simple iron replacement is not the solution Investigate before starting treatment
  3. History Nutrition Chronic blood loss Menorrhagia GI blood loss Liver disease Worm infestation Transfusions Family history
  4. Physical Examination Pallor Koilonychia Splenomegaly Purpura Lympadenopathy Routine features Serious problem?
  5. Lab Evaluation Routine CBC; Hb%, Hct, RBC indices Specilised Iron studies Hb. Electrophoresis Reticulocyte count Peripheral smear Bone marrow Other haematological Non haematological
  6. Interpretation of CBC: 3 steps RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
  7. Hypochromicmicrocyticanaemia RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
  8. Macrocyticanaemia RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
  9. NCNC picture; Aplasticanaemia TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35 HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36
  10. Classification
  11. Differential Diagnosis of HCMC anaemia
  12. HCMC ANAEMIA-1 IRON DEFICINCY ANAEMIA (IDA)
  13. IRON DEFICINCY ANAEMIA Very common; diagnosis by default Chronic blood loss, malnutrition Total iron depletion Various lab tests, serum ferritin best
  14. Investigations of IDA
  15. Treatment of IDA Identify and treat the cause BT hardly ever indicated Oral iron; various form, FeSO4 best Parenteral iron Good nutrition (meat, fish & poultry)
  16. HCMC ANAEMIA-2 Thalassaemia
  17. Diagnosis of thalassaemia Family history Mild to severe anaemia Splenomegaly HCMC anaemia(ID excluded) Hb electrophoresis: Hb A2 & Hb F levels high: beta thalassaemia Hb A2 & Hb F levels normal: alpha thalassaemia DNA analysis
  18. Treatment of thalassaemia None Counseling BMT/SCT Iron contraindicated Desferrioxamine
  19. MacrocyticAnaemia Pernicious Anaemia
  20. Pernicious Anaemia Inherited disorder Intrinsic factor deficiency Vit. B12 not absorbed
  21. Investigations of Macrocytic Anaemia
  22. NCNC anaemia-1 Aplastic anemia
  23. Investigations of Aplastic Anaemia
  24. diagnosis NCNC anaemia Pancytopenia Bone marrow biopsy
  25. Treatment of Aplasticanaemia Immunosuppressant BMT/SCT Blood transfusions
  26. NCNC ANAEMIA-2 Haemolyticanaemias
  27. Investigations of Haemolytic Anaemia
  28. Treatment of haemolyticanaemia Steroids Splenectomy BT BMT/SCT
  29. Difficult cases Rare disease Mixed pattern Partially treated Blood transfusion
  30. Summery Anaemia is a common and treatable problem History, PE & CBC gives important clues to the diagnosis IDA is the commonest type, oral iron replacement is the treatment of choice BT needed rarely

  31. Thank you

    Aziz-ur-Rehman
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