anemia; clinical approachiacld.ir/dl/co/15/laboratory and clinic anemias/anemia... ·...
TRANSCRIPT
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A.H.Emami MD.
Associate professor of TUMS
Medical Oncologist- Hematologist
ANEMIA; CLINICAL APPROACH
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DEFINITION
• Anemia can be rigorously defined as a reduced
absolute number of circulating red blood cells
• In practice, however, a low hemoglobin concentration
or a low hematocrit is most widely employed for this
purpose.
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• Anemia is defined as values that are more than two
standard deviations (SD) below the mean
• ….. have proposed different lower limits of normal for
the hemoglobin level, ranging from 13.0 to 14.2 g/dL for
men and 11.6 to 12.3 g/dL for women
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• The revised WHO/National Cancer Institute's criteria for
anemia in men and women are <14 and <12 g/dL,
respectively
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• These "normal" ranges may not apply to certain
populations:
• Athletes
• Living at high altitude
• Smokers
• African-Americans
• Presence of chronic disease
• Older adults
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CAUSES OF ANEMIA
• kinetic approach
decreased RBC production
increased RBC destruction
blood loss
morphologic approach
microcytic
macrocytic
normocytic
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HISTORY• Is there a recent history of loss of appetite, weight loss, fever,
and/or night sweats that might indicate the presence of infection
or malignancy?
• Is there a history of, or symptoms related to, a medical condition
that is known to result in anemia (eg, tarry stools in a patient
with ulcer-type pain, significant blood loss from other sites,
rheumatoid arthritis, renal failure)?
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HISTORY• Is the anemia of recent origin, subacute, or lifelong? Recent
anemia is almost always an acquired disorder, while lifelong
anemia, particularly if accompanied by a positive family history,
is likely to be inherited
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• The patient's ethnicity and province of origin may be
helpful: Thal. SS. Sβ. …
• The use of medications, both prescribed and over-the-
counter, should be examined in some detail. Specific
questions should be asked about the use of alcohol
opium, aspirin, and nonsteroidal antiinflammatory drugs
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HIJAMA
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BLOOD DONATION
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DIET
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• Is there evidence for increased red blood cell (RBC)
destruction (either intravascular or extravascular)?
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PHYSICAL EXAMINATION
• evaluation for jaundice and pallor is a standard part of the
physical examination
• The major aim of physical examination is to find signs of organ
or multisystem involvement and to assess the severity of the
patient's condition.
• Thus, the presence or absence of tachycardia, dyspnea, fever,
or postural hypotension should be noted
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PALLOR
• The sensitivity and specificity for pallor in the palms, nail beds,
face, or conjunctivae as a predictor for anemia varies from 19 to
70 percent and 70 to 100 percent, respectively
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• Jaundice may be difficult to detect under artificial (nonfluorescent) lighting conditions . Even under optimal conditions, it may be missed.
• As an example, in a double blind study involving 62 medical observers at various levels of training, the presence of scleralicterus was detected by 58 percent at a total serum bilirubinconcentration of 2.5 mg/dL (42.8 micromol/L) and by only 68 percent at a bilirubin concentration of 3.1 mg/dL (53.0 micromol/L) .
• False positives were mostly attributable to medical students, while false negatives were not related to the level of training
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KOILONYCHIA
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• lymphadenopathy,
• hepatosplenomegaly,
• bone tenderness
• signs of other hematologic abnormalities, including petechiae
due to thrombocytopenia, ecchymoses,
• signs and symptoms of recurrent infections secondary to
neutropenia or immune deficiency states.
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LEAD LINE
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