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Slide 2 Prof. Aziz-ur-Rehman Slide 3 Very common problem Subtle or no symptoms, usually incidental finding Various causes; ID is the commonest Simple iron replacement is not the solution Investigate before starting treatment Slide 4 Nutrition Chronic blood loss Menorrhagia GI blood loss Liver disease Worm infestation Transfusions Family history Slide 5 Pallor Koilonychia Splenomegaly Purpura Lympadenopathy Routine features Serious problem? Slide 6 Routine CBC; Hb%, Hct, RBC indices Specilised Iron studies Hb. Electrophoresis Reticulocyte count Peripheral smear Bone marrow Other haematological Non haematological Slide 7 RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15 Slide 8 RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15 Slide 9 RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15 Slide 10 HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35 Slide 11 Slide 12 Slide 13 HCMC ANAEMIA-1 Slide 14 Very common; diagnosis by default Chronic blood loss, malnutrition Total iron depletion Various lab tests, serum ferritin best Slide 15 ParameterEffect Hb & HctReduced MCV, MCH, MCHCReduced FerritinReduced IronReduced TIBC/TSIncreased BM ironAbsent Retic countLow Slide 16 1. Identify and treat the cause 2. BT hardly ever indicated 3. Oral iron; various form, FeSO4 best 4. Parenteral iron 5. Good nutrition (meat, fish & poultry) Slide 17 HCMC ANAEMIA-2 Slide 18 Family history Mild to severe anaemia Splenomegaly HCMC anaemia (ID excluded) Hb electrophoresis: Hb A2 & Hb F levels high: beta thalassaemia Hb A2 & Hb F levels normal: alpha thalassaemia DNA analysis Slide 19 None Counseling BMT/SCT Iron contraindicated Desferrioxamine Slide 20 Macrocytic Anaemia Slide 21 Inherited disorder Intrinsic factor deficiency Vit. B12 not absorbed Slide 22 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCIncreased, Normal, Reduced Vit B12low Folatelow Retic countLow; prompt rise after treatment BM examinationMegaloblastic picture Slide 23 NCNC anaemia-1 Slide 24 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal TLClow Plateletslow DLCReversed P/L ratio Retic countLow BM examinationAplastic picture Slide 25 NCNC anaemia Pancytopenia Bone marrow biopsy Slide 26 Immunosuppressant BMT/SCT Blood transfusions Slide 27 NCNC ANAEMIA-2 Slide 28 ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal to slightly increased Haptoglobinlow BilirubinIncreased (unconjugated) Retic countHigh, polychromasia HaemoglobinaemiaPresent Hemoglobinuriapresent BM examinationHyperplastic picture Slide 29 Steroids Splenectomy BT BMT/SCT Slide 30 Rare disease Mixed pattern Partially treated Blood transfusion Slide 31 Anaemia is a common and treatable problem History, PE & CBC gives important clues to the diagnosis IDA is the commonest type, oral iron replacement is the treatment of choice BT needed rarely Slide 32 Aziz-ur-Rehman