anemia
Post on 31-May-2015
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Anemia
Low hemoglobinWomen<12 gm/dl; Men<13
gm/dl
Clinical presentation Asymptomatic in majority Malaise, fatigue, DOE, pica Palpitation, angina, CHF when severe Amenorrhea/menorrhagia
Pallor, jaundice, koilonychia Tachycardia, wide pulse pressure, flow
murmurs, cardiomegaly Splenomegaly
Evaluation CBC- Hb, TLC/DLC, platelets, MCV PBS examination Reticulocyte count Ferritin RFT- creatinine, LFT, TFT Stool- occult blood Bone marrow examination Other- Coomb’s test, Hb
electrophoresis, vitamin B12/RBC folate levels
Poikilocytes Abnormally shaped RBC Types- Acanthocyte- spur cell- abetalipoproteinemia, liver
disease Codocyte- target cell- thalassemia, HbC disease,
post-splenectomy Echinocyte- burr cell- uremia Ovalo/elliptocyte- hereditary ovalo/elliptocytosis Spherocyte- hereditary spherocytosis, AIHA Drepanocyte- sickle cell- sickle cell anemia Dacrocyte- tear-drop cell- myelofibrosis Schistocyte- fragmented, irregular RBC- MAHA
Causes Blood loss Acute- trauma, GI bleed Chronic- GIT, menstrual, urinary Decreased production Iron deficiency Vitamin B12/FA deficiency BM defect- aplastic, myelophthisic Increased destruction Hemolytic anemia- AIHA, SCD, thalassemia
Morphologic classification Microcytic- MCV<80 Iron deficiency Thalassemia Sideroblastic Macrocytic- MCV>100 Vitamin B12/FA deficiency Drugs- methotrexate, zidovudine CLD, alcoholism, hypothyroidism Normocytic- MCV 80-100 Hemolytic Aplastic/Myelophthisic Anemia of chronic disease Acute blood loss
Treatment
Correct underlying causePacked RBC transfusion
Replacement- iron, vitamin B12/FA
Chronic hyperproliferative BM
MDS- myelodysplastic syndrome
RA- refractory anemia
RAEB Sideroblastic
anemia CMML
MPD- myeloproliferative disorders
Polycythemia vera CML Essential
thrombocythemia Myelofibrosis
Aplastic anemia Typically pancytopenia
(PRCA- anemia only) Causes- autoimmune,
chloramphenicol, carbamazepine, radiation, benzene
s/s- of pancytopenia Dx- bone marrow examination- biopsy Rx- ATG/ALG with Cyclosporin-in
elderly or HSCT-in young
HSCT Hematopoietic stem cell transplantation BMT or PBSCT (preferred) or cord blood Indications- Multiple myeloma AML in remission, ALL in second remission, CML Relapsed lymphoma Aplastic anemia MDS Congenital storage disorders, immunodeficiencies,
hemoglobinopathies Collagen vascular disease Autologous or Allogeneic
HSCT considerations Cost HLA matched donor (allogeneic) Complications- Infections Mucositis Hepatic veno-occlusive disease GVHD (allogeneic)- acute or chronic Mortality- 10-20%
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