anemii feriprive cm engl - modificat

8/10/2019 Anemii Feriprive CM ENGL - Modificat

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Case presentationDr. Minodora Onisi


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Clinical complaints

- Male, 45 years-old

- 3 weeks before presentation

- shortness of breath

- fati!e, di""iness- #ery acti#e person, b!t with recent lack of appetite

and weiht loss

- chronic $%&'Ds cons!mer


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Clinical e(amination

- %kin pallor

- Dry skin

- $ails) breakin easily *friable+, at, thin, witho!t low

*koilonychia+- &trophy of the lin!al papillae, dysphaia *l!mmer-

inson sd+

- 'ntermitent peri-!mbillical pain

- $on-speci/c heart m!rm!r.


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0oilonychia


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1aboratory - C2C

- 2C 3.66.6667mm8

- 9b ,5 7dl

- 9tc :; ? MC 9tc*6 72C*mil7mm8+

- MC9C :5 7dl ? MC9C 9b*7dl+ ( >66 7 9t*6.;667mm8 *%-=:


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1aboratory tests

- retic!locytes >,6 6 E7dl *#.n. 56->56 E7dl+ F

-B'2C ;66 E7dl *#.n. :56-456 E7dl+ G

- %at!ration of transferin >.;< F %B e ( >667 B'2C *#.n. :6-;6


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$O@ @9&BH


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%IA'O D'JA%B'A B&CBA$DO%COK

%mall diaphramatic hernia


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'$A'O D'JA%B'A B&CBA$DO%COK

atient ref!ses


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9emoc!lt test

ositi#eL

Disc!ssion) diaphramatic herniaH

emember he was a chronic $%&'Ds cons!merL


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CB scan of the abdomen

%mall t!mor of the ascendin lare bowel, located onlyon the cecc!m.

$o sins of spreadin to s!rro!ndin tiss!es.

$o sins of metastases. $o enlared lymph nodes.


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'$A'O D'JA%B'A B&CBA$DO%COK

Bhe cecc!m presented an !lcerated t!mor with recentbleedin sins, with a malinant aspect.

$o risk of occl!sion *small t!mor+ hence the patientne#er presented diarrhea 7 constipation.

M!ltiple biopsies are taken.


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ositi#e dianosis


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ositi#e dianosis

'ron de/ciency anemia *'D&+ d!e tochronic diesti#e tract hemorrhae fromlare intestine neoplasia

- microcytic hypochromic anemia *9b, MC, MC9CF+ - non-reenerati#e * tc F+ - low ser!m iron F

- B'2C G , C%B F- ferritin F 2M

- so!rce of hemorrhae t!mor


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ositi#e dianosis

2O$A M&O@ 9AMO%'DA'$ - absent

*erls stainin+

ememberL

'D&is the only type of anemia with neati#e erls stainin in2M.

&ll other anemias) normal or increased 2M iron.

'D&is not a disease in itself, b!t an eNect and a sin ofanother condition.


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DiNerential dianosis

IDA is the main cause of hypochromic

microcytic anemia, but not the only cause


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DiNerential dianosis

TestTest IronIron

deficiencydeficiency

anemiaanemia

ThalasseThalasse

miamiaChronicChronic

anemiaanemiaSidero-Sidero-

blasticblastic

anemiaanemia

FeFe DecreasedDecreased Normal orNormal or

increasedincreased

DecreasedDecreased IncreasedIncreased

TIBCTIBC IncreasedIncreased NormalNormal DecreasedDecreased NormalNormal

FerritinFerritin DecreasedDecreased NormalNormal IncreasedIncreased IncreasedIncreased

HbA2HbA2 DecreasedDecreased IncreasedIncreased NormalNormal DecreasedDecreased


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Breatment

>+ 'ron therapy remarkably ecient? therape!tictest of dianosis

:+ %econdary)

- transf!sion in emerency cases, se#ereanemia, associated cardio#asc!lar patholoy,elderly patients

- the patient sho!ld not recei#e complementarytreatment with #itamin 2>:, folic acid, etc, withthe possible e(ception when malabsorbtion is the

ca!se of anemia and other de/cits are associated.- oral (safer and less expensive) or iv route

TREATMENT OF THE CAUSE


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Breatment oral iron

- ills, syr!p

- 'ron is absorbed as e

- e is red!ced in the d!oden!m to e

- A() erro-Jrad!met

, Bardyferon, !mafer, &scofer,Bothema, etc


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Breatmentdosae

>66-:66 m7day *3-4 times7day+ both d!rinmeals *in order to ameliorate tolerance+ andbetween meals *to increase absorption+?

associate #itamin C

&s the anemia is corrected, the absorptiondiminishes proressi#ely.

etic!locyte PcrisisQ) =->6 days

1ack of retic!locyte crisis misdianosisH 2addosaeH 1ack of absortionH


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Breatment

%ide eNects) na!sea, abdominal pain,diarrhea7constipation, black stool, headache, di""iness

Doses are adapted to indi#id!al tollerance red!cedoses 7 administration d!rin meals 7 etc


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Breatment

'.. 7 *'.M.+ - indications)

'ns!cient absorption of oral 'ron

Diesti#e intolerance

Bhe patient does not cooperate *e.. psychiatricdisorder+

apid treatment is necessary *e.. prenancy+


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Breatment

- 'M e() Maltofer

- ' e() enoferOnly in the hospital important risk of alleric reactions !p toanaphylactic shock.

Botal 'ron *m+ weiht *k+ ( *aimed 9b present 9b+*7l+ ( :.4

566 m


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ollow-!p

- Correction of anemia starts in >-: weeks, maylast for : months

- Correction of anemia is not s!cient? B'2C andferritin m!st also normali"e total time oftreatment in ; monthsLLL *after the ca!se iscorrected+

- ersistent anemia with correction of the

biochemistry another ca!se of anemia *e..)thalassemia+- ersistent anemia with the same biochemicpro/le lack of absorptionH Breatment is nottakenH Ca!se persistsH


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Breatment in this case

'.. 'ron 5 administrations

acked red cells transf!sion *pre-op+

%!rery the cecc!m is remo#ed alon with the t!mor,witho!t any incidents.

Bhe patient is referred to an oncoloist for f!rthertherapy and follow!p.


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roteina transportatoare a /er!l!i este )

a+ 9emosiderina

b+ eritina

c+ Bransferinad+ &lb!mina

e+ 9aptolobina


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e !n froti! de sane periferic se constatamicrocito"a si hipocromie importanta c! pre"entade an!locite. Care din !rmatoarele se pot asociaacest!i aspect hematoloic )

a+Disfaia

b+aloarea c! tenta icterica

c+%ideroblasti 5


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C! referire la anemia sideropenica dininfectiile cronice s!nt corecte a/rmatiile)

a+%ideroblastii inelari s!nt patonomonici

b+ier!l este pre"ent in macrofaelemed!lare

c+Microcito"a eritrocitara este !n semnconstant

d+ier!l #a / administrat n!mai pe caleparenterala

e+Bratament!l c! /er este contraindicat


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Care din !rmatoarele a/rmatii diferentia"ain mod cert anemia prin carenta de /er deanemia inamatorie p!ra H

a+$!mar!l de eritrociteb+$i#el!l feritinei

c+$i#el!l retic!locitelor

d+%ideremia sca"!tae+Mielorama


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Berapia parenterala c! e este indicata in)

a+ Malabsorbtia intestinala se#era

b+ Ilcer!l astric

c+ Jra#ide in primele do!a trimestre de sarcinad+ Donatorii de sane

e+ ierderi de sane necontrolate prin tratament!l oral


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De/cienta de /er la barbat!l ad!lt este ca!"ata , cel maiadesea de)

a+Carenta alimentara prel!nita

b+&clorhidria astrica

c+Malabsorbtia intestinala

d+9emoraia astro-intestinala

e+9emoraia tra!matica


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Care din !rmatoarele a/rmatii, c! referire laanemia feripri#a , $I s!nt corecte )

a+9emosiderina med!lara este absenta

b+%ideroblastii med!lari R>6< s!nt pre"entiintotdea!na

c+ Coef de sat!rare este S>;

anemii feriprive cm engl - modificat

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