COMMON ANEMIAS Haematology Dr. Janis Bormanis

Common anemias 4 Iron deficiency 4 Megaloblastic anemias 4 Secondary anemias to chronic diseases Anemia of chronic disease 4 Hemolytic anemias Spherocytic fragmentation

RELATIVE FREQUENCY IRON OVERLOAD DEFICIENCY IDAIDWA HC BODY IRON IN THE POPULATION INC STR

STAGES OF IRON DEPLETION Loss of body stores Fall in serum iron Anemia develops Microcytosis Hypochromasia

ASSESSMENT OF IRON STATUS 4 Identify high risk groups 4 Children 4 Menstruation 4 Pregnancy - Lactation 4 Frequent Blood Donors 4 Chronic GI loss 4 Malabsorption 4 Diet

SOURCES OF IRON ; Heme Iron –Meat –10-15% absorbed ; Non-Heme –Vegetables, Fruit, Cereal –Major source in Third World

IRON BALANCE ; Ingest mg. per day ; Absorb 1-3 mg. per day ; Lose 1 + mg per day –menstrual loss ml ; Total iron mg/kg ; Stores 1 gram ; Easy to achieve negative balance

Dx of IRON DEFICIENCY ; Symptoms and signs ; CBC - Anemia - microcytosis - Hypochromia ; Blood Film - Oval - pencil - Tear ; Serum Fe and TIBC Fe low TIBC high ; Serum Ferritin ; Cause of Iron Deficiency

Microcytic, hypochromic

INVESTIGATION OF CAUSE ; Investigate when cause not Clear ; Symptoms of cause often unreliable ; Upper GI cause higher Yield ; If upper GI lesion found then a colonic lesion unlikely ; TESTS - Radiologic, Endoscopic Biopsy, Angiographic.

THERAPY Replace iron

Anemia of Chronic disease 4 Usually mild to moderate anemia 4 normocytic normochromic 4 low retic count 4 Low serum Fe and low TIBC sat % Ferritin normal or high 4 A responsible disease is present 4 Usually a systemic disorder

Megaloblastic Anemias Vitamin B12 Folic Acid

Reasons for measuring B12 4 Investigation of macrocytic anemia 4 Investigation of any anemia 4 Investigation of fatigue 4 Routine Geriatric Screen 4 Investigation of neurologic symptoms

Symptom Complex 4 Classic presentation uncommon 4 Often a screen in older patients 4 Memory loss prominent 4 Neuropathy 4 Changes in evoked potential 4 Non specific symptoms of anemia

Causes Pernicious anemia 4 10 % of all cobalamin deficiencies 4 Majority are due to malabsorption

Causes of Low Serum B12 Malabsorption of free cobalamin 4 Pernicious anemia 4 Post gastrectomy state 4 Small bowel diseases

Causes of Low Serum B12 Malabsorption of food cobalamin 4 Atrophic gastritis 4 Postgastrectomy state 4 Chronic nonspecific gastritis (H pylori ?) 4 H2 receptor blocking agents

Tests 4 CBC - RBC indices –Most are macrocytic 4 Blood film –Macro-ovalocytes - hypersegmented polys 4 Biochemical abnormalities –LDH bilirubin 4 Serum B12 4 Schilling test

Oval Macrocytes Hypersegmented neutrophils

Folic acid deficieny 4 Dietary source is vegetables 4 Absorption no specific carrier 4 Deficiency mainly dietary. 4 Alcoholism a risk 4 Anemia macrocytic 4 No neurologic symptoms 4 Measure RBC folate

Therapy Replace B12 - folic acid

Hemolytic anemias 4 History of jaundice and anemia 4 May have splenomegaly 4 May have a family history 4 anemia with reticulocytosis 4 specific morphologic changes 4 serum bilirubin and LDH as markers 4 Specific tests follow morphology

Spherocytosis

G6PD deficiency - Oxidative hemolysis

Fragmentation Prosthetic heart valves

Which anemia is this ?

Hemoglobinopathies and Thalassemias

These are just some of the anemias which illustrate principles of diagnosis

Approach to anemia 4 Anemia is not a disease 4 There is usually a cause 4 investigation should be logical 4 Start with CBC and Blood film 4 Leads to other tests –non specific –specific 4 Guides therapy