anemia for chronic
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7/21/2019 Anemia for Chronic
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ANEMIA
BY: ASAL
GHARIB
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Objectives
Learn about iron defciency anemia
Learn about anemic o chronic disease
istin!uish bet"een iron defciency anemiaand anemia o chronic disease
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#hat is Anemia$
Anemia is defned by reduction in H!%oncentration& Hct %oncentration or RB% count
Or defned as ' standard deviations be(o" themean
#HO criteria is H! ) *+ in men and H! ) *' in"omen
Revised #HO criteria or ,atient-s "ithma(i!nancy H! ) *. in men and H! ) *'
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Sym,toms
/0ertiona( dys,nea and ys,nea at /0ertion
Headaches
1ati!ue
Boundin! ,u(ses and Roarin! in the /ars
2a(,itations
2I%A
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2hysica( 3aniestation : 4S,oon
5ai(s6 in Iron efciency
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7inetic A,,roach
ecreased RB% ,roduction
Lac8 o nutrients 9B*'& o(ate& iron
Bone 3arro" isorder
Bone 3arro" Su,,ression
Increased RB% destruction
Inherited and Ac;uired Hemo(ytic Anemias
B(ood Loss
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3or,ho(o!ica( A,,roach
3icrocytic 93%< ) =>
Reduced iron avai(abi(ity
Reduced heme synthesis
Reduced !(obin ,roduction
5ormocytic 9 => ) 3%< ) *>>
3acrocytic 93%< ? *>>
Liver disease& B*'& o(ate
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Labs
Inormation can be !(eaned rom !ood history ta8in!and a ,hysica( e0am 9,a((or& jaundice& etc
%B% #ith i@ Leu8o,enia "ith anemia may su!!est a,(astic anemia Increased 5eutro,hi(s may su!!est inection Increased 3onocytes may su!!est 3ye(odys,(asia hrombocyto,enia may su!!est hy,ers,(enism& marro"
invo(vement "ith ma(i!nancy& autoimmune destruction&o(ate defciency
Reticu(ocyte %ount
2eri,hera( Smear
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Iron efciency Anemia
Lo" Retic %ount
Hi!h R#
Lo" iron (eve(
Hi!h IB%
Lo" erritin
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e!rees o Iron efciency
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5orma( 2eri,hera( Smear
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Iron efciency Anemia:
2eri,hera( Smear
3icrocytosis & Hy,ochromic RB%s
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Reticu(ocyte %ount
Reticu(ocyte count is the ,ercent o immature RB%s9re(eased ear(ier in anemia rom the marro"
5orma( (eve(s >CDE*CDF or non anemic sta!es
)*F means Inade;uate 2roduction
?e;ua( to * means increased ,roduction 9hemo(ysis
%orrected reticu(ocyte count com,ares anemic to
nonEanemic counter,arts to assess res,onse asreticu(ocyte count may overestimate res,onse
%orrected Reticu(ocyte %ount F Retic H%.D
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Reticu(ocytes
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Reticu(ocyte %orrection 1actor
R2I F reticu(ocytes H%.D *%orrection 1actor
5orma( R2I *
R2I ) ' Hy,o,ro(ierative
R2I !reater thane;ua( ' Hy,er,ro(ierative isorder
Hematocrit Correction
Factor
.>E.D *
+DE+J *CD
'DE+. '
*DE'. 'CD
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So no" that it-s iron
defciencyKC #hat %auses Iron efciency$
B(ood Loss 9occu(t or overt: 2& iverticu(osis&%o(on %ancer
ecreased Iron Absor,tion: ach(orhydria&atro,hic !astritis& ce(iac disease
1oods and 3edications: ,hytate& ca(cium& soy,rotein& ,o(y,heno(s decrease iron absor,tion
ncommon causes: intravascu(ar hemo(ysis&,u(monary hemosiderosis& /2O& !astric by,ass
ecreased Inta8e 9rare
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#ho needs a GI "or8Eu,$
A(( men& a(( "omen "ithout menorrha!ia&"omen !reater than D> "ith menorrha!ia
I GI sym,toms& /G
I asym,tomatic& co(onosco,y
#omen (ess than D> ,(us menorrha!ia:consider GI "or8u, based u,on sym,toms
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Go(d Standard or ia!nosis
Bone 3arro" Bio,sy
2russian B(ue stainin! sho"s (ac8 o iron inerythroid ,recursors and macro,ha!es
Ho"ever& it is invasive and cost(y
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reatment O,tions
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Anemia o %hronic isease
/2O ,roduction inade;uate or the de!ree oanemia observed or erythroid marro"res,onds inade;uate(y to stimu(ation
%auses: inMammation& inection& tissue injury&cancer
Lo" serum iron& increased red ce(( ,or,hyrin&
transerrin *DE'>F& norma( to increased erritin
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2atho,hysio(o!y
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AI% vsC Iron efciency
So(ub(e ranserrin Rece,tor: e(evated in caseso iron defciency
1erritin: e(evated in anemia o chronic disease
I a(( e(se ai(s& Bone 3arro" Bio,sy
In anemia o chronic disease: macro,ha!escontain norma( increased iron erythroid
,recursors sho" decreasedabsent amounts oiron
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Anemia o %hronic isease
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reatment
reat the under(yin! cause
reat the under(yin! cause
And reat the nder(yin! %auseN
%onsider coEe0istent iron defciency as "e(( I under(yin! disease state re;uires it& consider
/2O injection
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Summary
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Reerences
Harrison-s 2rinci,(es o Interna( 3edicine Adamson #C %ha,ter *>+C Iron efciency and Other
Hy,o,ro(ierative AnemiasC In: Lon!o L& 1auci AS& 7as,er L& HauserSL& ameson L& Losca(Po & edsC Harrison's Principles of InternalMedicineC *=th edC 5e" Yor8: 3cGra"EHi((Q '>*'Chtt,:"""CaccessmedicineCcomcontentCas,0$aIJ**''+CAccessed ecember & '>**
#ians& 1CHC and rban /C 4iscriminatin! bet"een Anemia o %hronicdisease sin! raditiona( Indices o Iron Status vC ranserrin!Rece,tor %oncentration6C '>>*C American ourna( o %(inica(2atho(o!yC <o(ume **DC
,toate Schrier& SLC A,,roach to the adu(t ,atient "ith anemiaC In: ,oate&
Landa"& SA9/C ,toate& #a(tham& 3AC '>*'C
Schrier& SLC %auses and dia!nosis o anemia due to iron defciencyC In:,oateC Landa"& SAC9/C ,todate& #a(tham& 3AC '>*'C
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