anemia for chronic

7/21/2019 Anemia for Chronic

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ANEMIA

BY: ASAL

GHARIB



Objectives

Learn about iron defciency anemia

Learn about anemic o chronic disease

istin!uish bet"een iron defciency anemiaand anemia o chronic disease



#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! ) *'



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



2hysica( 3aniestation : 4S,oon

5ai(s6 in Iron efciency



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



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



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



Iron efciency Anemia

Lo" Retic %ount

Hi!h R#

Lo" iron (eve(

Hi!h IB%

Lo" erritin



e!rees o Iron efciency



5orma( 2eri,hera( Smear



Iron efciency Anemia:

2eri,hera( Smear

3icrocytosis & Hy,ochromic RB%s



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



Reticu(ocytes



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



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



#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



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



reatment O,tions



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



2atho,hysio(o!y



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



Anemia o %hronic isease



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



Summary



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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