anemia

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anemia the minestry of the health of the republik of uzbekistan fergana public health medical intitute t-26 prepare by safaxonov______ murtozaxon reseived by_____azzamova gulasal anemia pas 654 august 30, 2005 robert d. hadley, phd, pa-c anemia is a laboratory diagnosis men women hemoglobin (g/dl) 14-17.4 12.3-15.3 hematocrit (%) 42-50% 36-44% rbc count (106/mm3) 4.5-5.9 4.1-5.1 reticulocytes 1.6 ± 0.5% 1.4 ± 0.5% wbc (cells/mm3) ~4,000-11,000 mcv (fl) 80-96 mch (pg/rbc) 30.4 ± 2.8 mchc (g/dl of rbc) 34.4 ± 1.1 rdw (%) 11.7-14.5% sites of absorption of iron and vitamin b12 if secretion symptomology is poorly related to absolute lab values patients with gradual onset may be asymptomatic with quite low hb/hct acute onset can cause symptoms with relatively less anemia presentation/history higher hb/hct: patients living at high altitudes smokers and patients living in air pollution areas endurance athletes have increased hct lower hb/hct: african-americans have 0.5 to 1 g/dl …

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problems, or other problems ineffective erythropoiesis most commonly due to chronic bleeding and erythropoiesis limited by iron stores that have been depleted may be dietary (pica, lack of meat/ vegetables, other) iron balance is very close in menstruating women, so fe++ deficiency is not uncommon with no other source of bleeding fe++ deficiency anemia iron and ferritin will be low tibc (total iron binding capacity) will be high, since iron stores are not saturating their binding sites on transferrin reduced rbc counts (definition of anemia) microcytosis & hypochromia are hallmarks, but early fe++ may be normocytic (± hypochromic) usually, mch and mchc will both be low (whereas in macrocytic anemia, the mch may be normal while the mchc is low, because of the larger cell size) labs most practitioners would agree that if a patient has microcytic hypochromic anemia with a low reticulocyte count, it would be reasonable to use …

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n, and liver disease may also contribute to macrocytosis b12 deficiency deficiency results in damage to dorsal columns (sensory) and lateral columns (motor) of spinal cord decreased vibration sense and position sense of joints detectable, and may affect gait, etc. may have positive romberg’s test severe effects may include ataxia and dementia neurological effects folate and b12 levels schilling test may be useful to establish etiology of b12 deficiency assesses radioactive b12 absorption with and without exogenous if other tests if pernicious anemia is suspected anti- parietal cell antibodies, anti-if antibodies secondary causes of poor absorption should be sought (gastritis, ileal problems, etoh, etc.) labs correct or manage underlying disease when possible may need epo injection ($$$$) epo is the treatment of choice for anemia of renal failure in bone marrow deficiency/malignancy, treat if possible, remove precipitating drugs, may require bmt treatment increased reticulocyte count acute blood loss very acutely, …

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sensitive to oxidative stress (infection, certain drugs) treatment: avoid triggers if possible, especially inciting drugs special cases of hemolytic anemia more in pas 658 african background abnormal hemoglobin causes change in rbc shape, resulting in constant rbc destruction by the spleen, functional asplenia, susceptible to infection arterial occlusion leads to infarcts, pain crises, acute chest syndrome, stroke, mi keep hydrated, treat pain, take infection seriously also sickle-c and sickle-b-thalassemia sickle cell disease anemia case study #1 a 72 year old male has the cbc findings shown. peripheral rbcs are hypochromic & microcytic. anemia case study #1 what test would you order for this patient? a-hemoglobin electrophoresis b-retic count c-stool for occult blood d-b12 assay e-bone marrow biopsy two questions: what is your diagnosis? what is the next step for this patient? anemia case study #1 answers question 1 likely iron deficiency anemia question 2 colonoscopy anemia case study #1 anemia …

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and lateral columns). anemia case study #2 normal size & hb content large size & normal hb content decreased hb/hct reticulocytes? low/normal (decreased/ineffective production) increased (destruction/loss) red cell indices morphology small size & decreased hb content membrane defects hemoglobinopathies enzymopathies environmental

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anemia the minestry of the health of the republik of uzbekistan fergana public health medical intitute t-26 prepare by safaxonov______ murtozaxon reseived by_____azzamova gulasal anemia pas 654 august 30, 2005 robert d. hadley, phd, pa-c anemia is a laboratory diagnosis men women hemoglobin (g/dl) 14-17.4 12.3-15.3 hematocrit (%) 42-50% 36-44% rbc count (106/mm3) 4.5-5.9 4.1-5.1 reticulocytes 1.6 ± 0.5% 1.4 ± 0.5% wbc (cells/mm3) ~4,000-11,000 mcv (fl) 80-96 mch (pg/rbc) 30.4 ± 2.8 mchc (g/dl of rbc) 34.4 ± 1.1 rdw (%) 11.7-14.5% sites of absorption of iron and vitamin b12 if secretion symptomology is poorly related to absolute lab values patients with gradual onset may be asymptomatic with quite low hb/hct acute onset can cause symptoms with relatively less …

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