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Approach to Anemia
Important to remember
• Anemia is a clinical sign of disease
• It is not a single disease by itself
• Need to look for the underlying cause !
• Will we ignore a fever with out investigation ?
• Its diagnosis is not that simple !! We'll make it
• Its very common and imp. in our practice
• Drug Rx. depends on the cause
Definition of Anaemia
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Pro Erythroblast
No definite nucleus
Reticulum of RNA
Deep blue staining
Light blue cytoplasm
Cell size about 10 µ
Normal Red Cells
Normal Red Cell
No nucleus, Enzyme packets
Biconcave discs – Haem + Gl
Center 1/3 pallor
Pink cytoplasm (Hb filled)
Cell size 7 - 8 µ - capill. 2 µ
EM pathway, HMP
Negative charge – no phago
Na less, K more inside
100-120 days life span
The Factory – Bone Marrow
• 57% Plasma
MCV C ÷ A x 10 = 90 fl
MCH B ÷ A x 10 = 30 pg
MCHC B ÷ C x 100 = 33%
Causes of Anaemia
RETICULOCYTE COUNT %
• 'RBC to be' or Apprentice RBC
• Fragments of nuclear material
• RNA strands which stain blue
Normal
Less than
2%
Reticulocytes
Supravital Leishman's
Reticulocyte Production Index
Hypoproliferative Hemolytic
MCV
MCV
TIBC
HIGH N or ↓
- BM Fe +
Iron Deficiency Anaemia Not IDA, Other Mi
IDA A
IDA – Special Tests
• 25-96% of alcoholics
• MCV elevation usually slight (100-110 fl)
• Minimal or no anemia
• Macrocytes round (not oval)
• Neutrophil hyper segmentation absent
• Folate stores normal
Smoking increases the Red Cell Mass
Megaloblastic Hematopoiesis
• Chronic disease
• Early IDA
• Hemoglobinopathies
• Primary marrow disorders
• Combined deficiencies
• Increased destruction
• Anaemia of investigations -ICU
Anaemia of Chronic Disease
1. Liver Disease
2. Thalassemia
3. Hb D Disease
4. Post splenectomy
Tear Drop Cells
1. Myelofibosis
2. Infiltration of BM
3. Tumours of BM
4. Thalassemia
Hair on end - Thalassemia Major
Drepanocytes - SS
Sickle Cell Anaemia
Autosplenectomy - SS
Normal spleen is 8 to 12 cm
Hemolytic Anaemia
• Reticulocyte count
• Combined with serial Hb
• Serum LDH
• Serum bilirubin
• Haptoglobin
• Urine hemosiderin
• Hemoglobinuria
Findings in Hemolytic Anaemia
1. Liver Disease
2. Acute Alcoholism
3. H Stomatocyosis
4. Malignancies
Echinocytes
Evenly distributed spicules > 10
1. Uremia
2. Peptic ulcer
3. Gastric Ca
4. PK-D
Called Burr Cells
Acanthocytes
5-8 spikes of varying length, irregular intervals
Called Spur Cells, Occur in A H A
Shistocytes
Fragmented, Helmet or triangle shaped RBC
1. MAHA
2. Prosthetic valves
3. Uremia
4. Malignant HT
Leukoplakia - Aplastic Anaemia
1. Chloramphenicol
2. Neomercazole
3. Sulfonamides
4. Analgin
5. Phenytoin
6. Butazolidin group
7. Anti Ca drugs
Normal BM High Power
E:G=1:3
Shift in E : G Ratio
E:G=2:1
BM - Aplastic Anaemia
Myelofibrosis
Post transfusion - CBC
Howell-Jolly Bodies
Absence of Splenic function; Nuclear chromatin in RBC
Pelger-Huet Anomaly
• Inherited condition
• PMN - Spectacles
• Heterozygous
• Homozygous fatal
• Neutrophil Bands ↑
• Normal WCC
• No e/o infection
Anaemia Diagnosis -Algorithm
Anaemia Suspected