Transcript Dr.Azarm

ANEMIA
anemia has been defined as a reduction in one
or more of the major red blood cell (RBC)
measurements: hemoglobin concentration,
hematocrit, or RBC count:
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signs and symptoms
 The signs and symptoms induced by anemia
are dependent upon the degree of anemia
and the rate at which it has evolved, as well
as the oxygen demands of the patient.
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 Weakness , dyspnea , chest pain ,especially
on exertion
 pallor
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 Hg = 12.7 , MCV = 90 , MCH = 27 , MCHC =
32
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Special populations
 high altitude
 smoker
 degree of environmental air pollution
 The elderly
 Athletes
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History
 Familial Hx
 Hx of medical disease
 Hx of drugs
 Chronologic Hx
 ethnicity and country of origin
Physical examination
 Pallor
 Jaundice
 lymphadenopathy, hepatosplenomegaly, and
bone tenderness, especially over the sternum
 petechiae due to thrombocytopenia,
ecchymoses,
LABORATORY EVALUATION
 CBC with platelets, WBC differential, and
reticulocytes.
 PBS
MICROCYTIC ANEMIA
 iron deficiency ,thalassemia, and the anemia
of chronic disease
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Microcytic anemias
TREATMENT OF IRON
DEFICIENCY
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identify and treat the cause of the deficiency (eg, blood loss, poor iron
absorption) as well as the administration of iron
Oral iron usually provides a safe, cheap and effective means of restoring iron
balance.
Iron is absorbed best from the duodenum and proximal jejunum. Therefore, the
more expensive enteric coated or sustained release capsules, which release
iron further down in the GI tract, are counterproductive.
Iron salts should not be given with food because the phosphates, phytates, and
tannates in food bind the iron and impair its absorption
Iron should be given two hours before, or four hours after, ingestion of antacids.
Patients with persistent gastric intolerance may tolerate ferrous sulfate elixir,
which provides 44 mg of elemental iron per 5 mL. Patients can titrate the dose
up or down to the level at which the gastrointestinal symptoms become
acceptable
Gastrointestinal tract symptoms (eg, abdominal discomfort, nausea/vomiting,
diarrhea/constipation) suffered by some patients seem to be directly related to
the amount of elemental iron ingested. Thus, the reported low incidence of side
effects for some preparations can be explained by their low elemental iron
content. For example, a 325 mg tablet of ferrous gluconate contains 36 mg of
elemental iron, or 55 percent of the amount of elemental iron in a 325 mg tablet
of ferrous sulfate.
 Ferrous fumarate — 106 mg elemental iron
 Ferrous sulfate — 65 mg elemental iron/tablet
 Ferrous gluconate — 28 to 36 mg iron/tablet
Side effects
 Approximately 10 to 20 percent of patients
may complain of nausea, constipation,
epigastric distress and/or vomiting after
taking oral iron preparations
 smaller dose of elemental iron
 switch from a tablet to a liquid preparation
 , increase the dose from one tablet per day to
the recommended three to four times per day,
as tolerated.
 taken with meals
PARENTERAL IRON
 rare patient who is unable to tolerate even
modest doses of oral iron
 in patients whose level of continued
gastrointestinal bleeding exceeds the ability
of the gastrointestinal tract to absorb iron
 Occasional patients with inflammatory bowel
disease and iron deficiency may give a
history of severe intolerance to oral Fe,
making therapy with parental iron necessary.
Macrocytic anemias
 alcoholism, liver
disease, folic acid and
vitamin B12 deficiency
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 The evaluation of such patients should begin with a
focused history including the extent of alcohol abuse,
exposure to antimetabolites and other medications,
nutritional status (especially in the elderly and
alcoholics), and the possible presence of liver
disease.
 examination of the blood smear, reticulocyte count,
and analysis of serum for cobalamin, folate, thyroid
stimulating hormone (TSH), tests of liver function,
and protein electrophoresis for the rare case of
multiple myeloma
 use of high concentrations of EDTA
 Osmotic swelling of RBCs within the counting
apparatus can occur following an episode of
hyperglycemia in diabetic patients
 Cold or warm agglutinins in the patient, activated by
temperature changes either in the sample prior to
counting or to heating/cooling of the RBC solution
within the apparatus itself, will cause RBCs to pass
through the counter in small groups, rather than one
by one, and will be counted as macrocytic cells.
 Vitamin B12 and/or folate deficiency should be suspected in
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patients with one or more of the following clinical or laboratory
findings :
Macrocytic red blood cells (ie, mean corpuscular volume >100
fL), and/or macro-ovalocytic red blood cells on the peripheral
blood smear, with or without anemia
The presence of hypersegmented neutrophils on the peripheral
blood smear
Pancytopenia (ie, the combination of anemia,
thrombocytopenia, and neutropenia) of uncertain cause
Unexplained neurologic signs and symptoms, especially
dementia (seen only with Cbl deficiency) Special populations,
such as the elderly, alcoholics, and patients with malnutrition