Diagnostic Approaches to Anemia

Diagnostic Approaches To Anemia

1. Is the patient anemic ?

2. How severe is the anemia ?

3. What type of anemia ?

4. Why is the patient anemic?

5. What should be done ?

1- IS THE PATIENT ANAEMIC

Visual diagnosis of anemia; observation of paler.

Measurement of Hb & HCT

MCV = HCT/RBCs X 10 ( 85-95)

MCH = Hb/RBC X 10 (29-31)

MCHC= Hb/HCT X 10 ( 33% ± 2)

CLASSIFICATON OF ANAEMIA According To Cell Indices

*Normocytic ; MCV 85-95fl

MCH 28-32pg

MCHC 27-35g/dl

*Macrocytic MCV > 100

MCH > 34

MCHC 31-32

*Microcytic MCV < 70

MCH < 25

MCHC < 28

2-How Severe Is The Anemia?

Severity of anemia depend on ;

1. Hb level & HCT

2. Rapidity of onset

Mild ;Hb > 9g/dl

Moderate ;Hb 6-9g/dl

Severe ;Hb< 6g/dl

Compensatory Mechanism In ANAEMIA

1.Cardiac Output.

2. 2,3Diphosphoglycerate

3-WHAT TYPE OF ANAEMIA?

1- Is the anemia accompanied by alteration in WBC orPlatelet ?

2-Is it the result of reduced red cell production or increased cell destruction?

* RETICULOCYTE COUNT( corrected )

1.High= increase cell destruction.

2.LOW=reduce cell destruction.

Information Gained From Clinical Examinations

1- Pallor of mucosa; anaemia

2-Enlarged lymph node ; systemic disease

3- Hepatosplenomegaly; systemic disease, chronic hemolysis

4-Bruises; Bleeding disorder

5-Jaundice; Hemolysis

Simple Laboratory Test To Evaluate Anemia

1.Hb, PCV(HCT), MCHC.

2.WBC count & differential.

3.Peripheral Smear.

4.Reticulocyte count.

5. Urinalysis.

6.Occult Blood In Stool.

7.Serum Iron ,Total Iron Binding Capacity(TIBC).

8.Serum vitamin B12, Folic acid level.

9.Indirect bilirubin.

10.Haptoglobin leve.

11.Direct Coob`s test.

12.Sickle Cell Preparation.

13.Hb- electrophoresis.

14.Hb A2 %.

15.Hb F.

16.Osmotic Fragility.

17.Autohemolysis.

18.Red Cell Enzyme Assay.

19.Heinz bodies.

20.Acid lysis.

21.Platelet Count.

22.Bone Marrow Biopsy & Aspiration.

4- Why Is The Patient Anemic?

*Anemia due to decrease production of RBC

1-Lack of necessary nutrient;

a.Iron deficiency

b. Folic acid deficiency

c. Cobalamine deficiency

d.Combined deficiency

2-Bone Marrow defect;* Generalized

a. Primary Aplastic Anemia. b. Replacement.

* Limited to RBC

a. Congenital

b Acquired

*Anemia Due to Excessive Destruction Of RBC

1.Formation of abnormal RBC

A.Hb defect; Thalassemia.

B.Hereditary Spherocytosis.

C.Metabolic defect; Pyruvate kinase deficiency , other enzyme defect

2- Formation of RBC hypersensitive to hemolysis;

A. G6PD deficiency

B. Certain Hbpathies.

3- Presence of extracorpuscular factors

a.Immune hemolytic anemia .b. Cold agglutinin c.Hemolytic uremic syndrome d. Anemia of acute infection

e. Hypersplenism f. Anemia of collagen disease.

5-What ShouldBe Done?

# Treatment of the cause, once recognized;

1- Available modality of treatment;

Iron, Folic acid , B12, B6, Steroid.

2- Splenectomy ; Indication

a. RBC coated by antibody.

b.Hereditary Spherocytosis.

c.Pyruvate Kinase deficiency.

3- Blood Transfusion ; Indication

a. Anaemia +CHF

b.Sickle cell anemia,Thalassemia

c. Failure of all logic approaches

d.Hb < 4 gm/dl.

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