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Classification of AnaemiaClassification of Anaemia
Prof Roger PoolProf Roger PoolDepartment of HaematologyDepartment of Haematology
University of PretoriaUniversity of Pretoria
MEASUREMENT OF HAEMATOCRIT
The haematocrit ratio (Hct) is the proportion of blood made up of red blood cells.
bloodsample
centri-fuge
plasma
buffy coat
red cells
1.0
0.5
0
After centrifugation the heavier red cells settle to the bottom of the tube. The straw-coloured plasma remains at the top. The two layers are separated by a ‘buffy coat’ of white cells and platelets.
Normal values for Ht range between 0.42 - 0.47, generally higher in men than women.
Red Cell IndicesRed Cell Indices
MCVMCV haematocrit haematocrit <80, 80<80, 80--100, >100 fl100, >100 flRBC countRBC count
MCHCMCHC haemoglobinhaemoglobin <32, 32<32, 32--36, >36 g/dl36, >36 g/dlhaematocrithaematocrit
MCHMCH haemoglobinhaemoglobin 2727--31 pg31 pgRBC countRBC count
�� Macrocytic (MCV > 100)Macrocytic (MCV > 100)
�� MegaloblasticMegaloblastic�� Vit B12 or folate deficiencyVit B12 or folate deficiency
�� NonNon--megaloblasticmegaloblastic�� Alcohol, liver disease, hypothyroidism, aplastic anaemiaAlcohol, liver disease, hypothyroidism, aplastic anaemia
�� Normocytic (MCV 80Normocytic (MCV 80--100)100)
�� Haemolytic anaemiaHaemolytic anaemia�� Renal failureRenal failure�� Mixed deficiencies Mixed deficiencies �� Acute blood lossAcute blood loss�� Aplastic anaemia (bone marrow failure)Aplastic anaemia (bone marrow failure)
�� Microcytic (MCV < 80)Microcytic (MCV < 80)
�� Iron deficiencyIron deficiency�� ThalassaemiaThalassaemia�� Anaemia of chronic diseaseAnaemia of chronic disease�� Sideroblastic anaemiaSideroblastic anaemia
Low Hb=AnaemiaMCV
Low=microcytic Normal=normocytic High=macrocytic
Ferritin
Fe deficient Fe normal
Establishcause
Anaemia ofchronic diseaseorhaemoglobinopathy
Reticulocyte count
high low Anaemia of chronic diseaseRenal failureMarrow failure
Haemolysisor blood loss
Measure B12 + folate
Low -Establish cause
Normal
Obvious cause
Cause not obviousConsider bone marrow
Iron distribution in the bodyIron distribution in the body
Figure 9.1 Haematology at a Glance
Causes of iron deficiencyCauses of iron deficiency
Chronic blood lossChronic blood loss–– Menorrhagia, parasites, aspirin, haemorrhoids, Menorrhagia, parasites, aspirin, haemorrhoids,
carcinomacarcinoma
MalabsorptionMalabsorption–– PostPost--gastrectomygastrectomy, gluten , gluten enteropathyenteropathy
Inadequate diet Inadequate diet –– Unusual in developed countriesUnusual in developed countries
Increased demandsIncreased demands–– PrematurityPrematurity, adolescence, pregnancy, adolescence, pregnancy
Clinical featuresClinical features
General features of anaemiaGeneral features of anaemia–– Shortness of breathShortness of breath–– TirednessTiredness–– HeadacheHeadache–– PallorPallor
KoilonychiaKoilonychia (spoon shaped nails)(spoon shaped nails)
GlossitisGlossitisPica (abnormal appetite)Pica (abnormal appetite)Hair thinningHair thinningPharyngeal web Pharyngeal web (Paterson(Paterson--Kelly/PlummerKelly/Plummer--Vinson Vinson syndrome)syndrome)
KoilonychiaKoilonychia
GlossitisGlossitis
Plummer Vinson SyndromePlummer Vinson Syndrome
Laboratory findingsLaboratory findings
Hypochromic, microcytic anaemiaHypochromic, microcytic anaemiaElevated platelet count (Elevated platelet count (thrombocytosisthrombocytosis))Serum iron and ferritin reducedSerum iron and ferritin reducedBone marrowBone marrow–– Absent iron storesAbsent iron stores–– Erythroid hyperplasiaErythroid hyperplasia
Treatment of iron deficiencyTreatment of iron deficiency
Oral ferrous Oral ferrous sulphatesulphate (67mg Fe/tablet)(67mg Fe/tablet)3X/day before meals3X/day before mealsSide effects Side effects –– nausea, abdominal painnausea, abdominal painReticulocyte response within 7 daysReticulocyte response within 7 daysContinue treatment for 6 monthsContinue treatment for 6 monthsPoor responsePoor response–– NonNon--compliancecompliance–– MalabsorptionMalabsorption–– Ongoing blood lossOngoing blood loss–– Incorrect diagnosisIncorrect diagnosis
Intravenous ironIntravenous iron
Oral iron not toleratedOral iron not toleratedMalabsorptionMalabsorptionRapid filling of iron stores required e.g. Rapid filling of iron stores required e.g. late pregnancylate pregnancyAnaphylaxis may occur Anaphylaxis may occur –– always always administer a test doseadminister a test dose
Iron overload Iron overload -- causescauses
Primary haemochromatosis Primary haemochromatosis –– hereditary hereditary condition leading to condition leading to �� iron absorptioniron absorptionAfrican iron overload African iron overload –– use of iron utensilsuse of iron utensilsExcess dietary ironExcess dietary ironIneffective erythropoiesis with Ineffective erythropoiesis with �� iron iron absorptionabsorptionRepeated blood transfusionsRepeated blood transfusions
Iron overload Iron overload -- clinical featuresclinical features
Heart failureHeart failureRetarded growthRetarded growthExcessive skin pigmentationExcessive skin pigmentationRecurrent infectionsRecurrent infectionsSymptoms are caused by organ Symptoms are caused by organ dysfunction secondary to iron depositiondysfunction secondary to iron deposition
Iron overload Iron overload –– laboratory featureslaboratory features
Raised serum ferritinRaised serum ferritinIncreased iron in liver and bone marrowIncreased iron in liver and bone marrow
TreatmentTreatment
Iron chelation using subcutaneous Iron chelation using subcutaneous desferrioxamine by infusion pumpdesferrioxamine by infusion pump
Management of iron overloadManagement of iron overload
Sideroblastic anaemiaSideroblastic anaemia
Refractory anaemiaRefractory anaemiaMay present with hypochromic, microcytic May present with hypochromic, microcytic indicesindicesMay be congenital or due to:May be congenital or due to:–– Drugs (INH)Drugs (INH)–– Toxins (alcohol, lead)Toxins (alcohol, lead)–– MyelodysplasiaMyelodysplasia
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