Anemia

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Anemia
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• iron deficiency anemia,
• thalassemia,
• Autoimmune hemolytic anemia (AIHA)
• aplastic anemia (AA)
• G-6-PD deficiency

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Recommended book

• Blood physiology and pathology Chris
  Pallister. 1994
• Williums Text book of hematology 5 th ed. 1995
• Wintrobe Text book of hematology 9 th ed. 1993
• ???????????????????????? ??. 2539
• Short note in medicine ??. 2543
• ?????????????? ??????? ????????? ??. 2537
• http//chittima.mykku.net

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Anemia
Acute
Chronic
( gt 2 Months )
( lt 7 Days )
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Acute anemia
Acute hemolysis
Acute blood loss

• History of
• dark urine
• jaundice

• History of
• GI bleeding
• hypermenorrhea

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Acute anemia
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Chronic anemia
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• Iron deficiency anemia
• Thalassemia
• Autoimmune hemolytic anemia
• Aplastic anemia
• G-6-PD deficiency anemia

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Iron deficiency anemia
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Dietary iron 1-2 mg/day
Slough mucosal cell 1-2 mg/day
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Iron depletion
normal
depletion
deficiency
erythrocyte
Iron stores
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?????????????????????????????? Iron deficiency
anemia

• ??????
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• ?????????? ???? ??????? ????????? ??? PICA

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Diagnosis

• Clinical manifestation

• CBC, blood smear

• Red cell indices-

If Hct gt30 - normal RBC morphology
Hypochromic microcytic red cells
thalassemia ACD/ACI
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Diagnosis

• serum ferritin

Normal 40-200 ng/ml
lt 30 ng/ml sens 92, spec 98
Inflammatory state ?ferritin threefold
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Diagnosis

• serum iron and transferrin (TIBC)

High accuracy
ACD - low serum iron, low TIBC normal or low
Tf saturation
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Treatment

• treat underlying disease
• iron supplement
• oral (ferrous salt)
• parenteral (iron dextran)

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Thalassemia

• ??????????????????????????????????
• ?????????????????????? autosomal recessive

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Thalassemia

• - a thalassemia
• - b thalassemia
• - hemoglobinopathy

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a thalassemia
a1 trait _ _ /aa
a2 trait _ a/aa
a1 a2 _ _ / _ a
a1 a1 _ _ / _ _
a2 a2 _ a/ _ a
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b thalassemia
b0
b
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Thalassemia

• ???????????????? 2 ???
• ??????? (thalassemic disease)
• ???????? (thalassemic carrier)

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Thalassemic carrier
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Thalassemic disease
Mongoloid facies
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Thalassemia disease
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Thalassemia disease
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Clinical manifestation
- Mongoloid facies
- Anemia
- Jaundice
- Hepatosplenomegaly
- Growth retardation
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Diagnosis

• CBC
• Red cell indicies
• Blood smear
• Hb typing

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Management of thalassemia

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Management of thalassemia

• Stem cell transplantation

• Blood transfusion iron chelation

• Splenectomy

• Folic acid supplement

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cardiomyopathy
cirrhosis
DM
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Iron chelation
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Autoimmune hemolytic anemia (AIHA)
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Autoimmune hemolytic anemia
??????

• ?????????????
• ?? (quinidine, methyldopa, penicillin)
• ??????????? (HIV, TB)
• connective tissue diseases- SLE
• ?????? (lymphoma, ovarion tumor)

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Diagnosis

• CBC
• Blood smear
• Saline agglutination test
• Coombs test

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Investigation

• Identify secondary cause of AIHA
• HIV
• UA, LE, ANA
• Ultrasonography
• Before giving corticosteroid
• BS
• Stool exam
• CXR

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????????

• ???????????
• corticosteroid prednisolone
• cyclophosphamide, azathioprine
• IV Ig

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G-6-PD deficiency anemia

• X-linked recessive
• ??? ??????????????
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  ???????????????????
• ???????????????

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Investigation

• CBC, blood smear
• Wet smear inclusion bodies
• UA- hemoglobinuria
• BUN/Cr, electrolyte

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Heinz body
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?????????????? (aplastic anemia)
Criteria

• Peripheral criteria
• Hb lt 10 g/dL, Hct lt 30
• WBC lt 3500/mm3, N lt 1500 /mm3
• Platelet lt 100,000 /mm3

Bone marrow criteria bone marrow biopsy-
hypo-cellular, normo-cellular, or hyper-cellular
marrow marrow with decreased megakaryocyte
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Severe aplastic anemia
Criteria

• Peripheral criteria
• Corrected reticulocyte count lt 1
• N lt 500 /mm3
• Platelet lt 20,000 /mm3

Bone marrow criteria bone marrow biopsy-
cellularity lt 20
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Clinical manifestation
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Treatment

• Bone marrow transplantation
• pack red cell and platelet transfusion
• androgenic hormone
• oxymetholone