1. Approach to anemia

5. Case1: 24 years old woman with fatigue

6. what to do? R/O IDA do Hb electrophoresis
if HbA2 more than % indicates beta thalassemia minor
MCV is rarely more than 75 and the Htc is rarely less than 30-33%
should avoid empirical iron therapy

7. Case2: 34 years old asymptomatic woman

8. what to do? The firs step in evaluating anemia is checking Retic count
check: serum iron , TIBC, Ferritin
search the cause of blood loss : menorrhagia, GI obscure bleeding in males and postmenopausal women

10. IDA treatment
the first step is oral iron therapy; 200 mg of elemental iron per day usually 3-4 tablets till 6-12 months after correction of the anemia
the usual response; retic rise within 4-7 days, correction of anemia within 3 months

12. IDA treatment parenteral treatment: unable to tolerate oral
acute need for correction
ongoing blood loss
products available:
Venofer Amp 100mg
Ferrinject Amp 500 mg
(2.3*BW*(15-Hb))

14. Case4: a 67 years old diabetic man with DOE

15. what to do? Check serum cobalamin level : under 100ng/L
Increase MMA and Homocysteine level in B12 deficiency
Test for PA (increase gastrin, decrease pepsinogen I, IF Ab)
PBS for hyper segmented neutrophil
Serum folate by ELIZA( Nl 2-15 microg/L)
RBC folate( Nl microg/L)
Test for celiac

16. Treatment:
1000 microg hydroxocobalamin 6 doses every 3-7 days( more frequent in neuropathy) and then every 1-3 months for maintenance.
Folic acid 5-15 mg/d for about 4 months after R/O or correction of B12 deficiency
Thrombocytosis may be seen within 1-2 weeks, aspirin may be required if Plt count reach more than 800,000