Detection Of Anemia

Detection of anemia Co-ordinator:Dr.Nitin Raithatha Represented by:Jay patel,Alfaz lakhani Batch:26-50

Clinical Diagnosis • History • Clinical examination • Hematological Investigation • Other Investigation

Clinical symptoms

Easy fatiguability Palpitation Shortness of breath Decrease work or exercise tolerance

Acute and Chronic • Acute – Fatiguability – Breathlessnes s – Palpitation – Hypotension – Tachycardia

• Chronic – Koilonychia – Angular Cheilosis – Fainting – Compenseted: may have pulse and BP normal

History Age and Parity: Elderly and multifetal gestation are more prone

Hematuria suggest hemolytic anemia

Bruises, Petechial hemmorhage suggest platelet disorder

History • History of blood loss from bleeding gums or bleeding piles. • Family history: Hereditary hemolytic anemia,bleeding disorder • Dietry history: with respect to folic acid intake • Personal history: • Menstrual history: Heavy blood loss • Obstretic history:abortion,Child birth, Hemmorhage

Pallor

Conjuctival pallor

Koilonychia

Smooth Tongue

Angular Cheilosis

Clinical Examination • Features of anemia like facial pallor,pale conjuctiva,tongue,palmer creases and nail beds. • Tongue may have painful ulcers and necrotic lesions in mouth • Sternal tenderness near lower or middle third :acute leukemia

Clinical Examination • Palpation of liver and spleen and generalized lymphedenopathy:chronic infection and hemolytic anemia. • Hemic murmurs are common cardiac signs • Basal crepitation in lungs suggest congestive heart failure with severe anemia.

Laboratory investigation

Hemotological Investigation • CBC – – – – –

RBC COUNT,Hb RBC INDICES WBC COUNT PLATELET COUNT CELL MORPHOLOGY

• Reticulcyte count • Iron supply studies: Serum iron,TIBC,s.ferritin • Marrow examination

Other investigation • • • • • • •

Urine: Hematuria,pus cells,casts Urine culture: infection LFT Stool examination Xray chest Hemoglobinuria, Hemosiderinuria Serum Haptoglobin, S.bilirubin

Iron Deficiency anemia • Serum ferritin: <12ng/ml:IDA • Serum iron: <60μg/dl:IDA • Serum iron binding capacity: Normal:250-435 μg/dl. Increased in IDA. • Serum transferrin receptors, Free erythropoietin protoporphyrins, Nestroft test

Interpretation of plasma Iron Iron

TIBC

Ferritin

Iron deficiency anemia

Decrea Increas Decrea se e se

Anemia of chronic disease

Decrea Decrea Increas se se e

Pregnancy

Increas Increas Normal e e

B12 and folate deficiency • • • • •

Hypersegmented neutrophils Orthochromatic macrocytes Howell-Jolly bodies Nucleated red cells Bone marrow examination: megaloblastic and aplastic anemia, Serum VitB12 assay, Serum folate assay

Sickle cell anemia • Sickling test • PS : sickle cell, polychromatophil ia,basophilic stippling • Electrophoresis • Decrease ESR

Aplastic anemia • CBC and PS: neutropenia, lymphocytosis, thrombocytopenia • Blood test:electrophoresis • Serum transaminase, bilirubin, LDH,Coombs test, RFT • Bone marrow: Hypocellular with fatty replacement and plasma cells and mast cell

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