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Prof. Aziz-ur-Rehman
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Very common problem Subtle or no symptoms, usually incidental finding Various causes; ID is the commonest Simple iron replacement is not the solution Investigate before starting treatment
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Nutrition Chronic blood loss Menorrhagia GI blood loss Liver disease Worm infestation Transfusions Family history
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Pallor Koilonychia Splenomegaly Purpura Lympadenopathy Routine features Serious problem?
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Routine CBC; Hb%, Hct, RBC indices Specilised Iron studies Hb. Electrophoresis Reticulocyte count Peripheral smear Bone marrow Other haematological Non haematological
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RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
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RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
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RBC= 4-5.5M HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 RDW 11-15
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HGB= 12-18 HCT= 37-52 MCV= 78-98fL MCH= 27-32pg MCHC= 31-36 TLC= 3.2 P= 30% L= 65% RBC= 2.5M PLT= 32 HGB= 10 HCT= 24 MCV= 82fL MCH= 29pg MCHC= 35
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HCMC ANAEMIA-1
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Very common; diagnosis by default Chronic blood loss, malnutrition Total iron depletion Various lab tests, serum ferritin best
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ParameterEffect Hb & HctReduced MCV, MCH, MCHCReduced FerritinReduced IronReduced TIBC/TSIncreased BM ironAbsent Retic countLow
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1. Identify and treat the cause 2. BT hardly ever indicated 3. Oral iron; various form, FeSO4 best 4. Parenteral iron 5. Good nutrition (meat, fish & poultry)
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HCMC ANAEMIA-2
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Family history Mild to severe anaemia Splenomegaly HCMC anaemia (ID excluded) Hb electrophoresis: Hb A2 & Hb F levels high: beta thalassaemia Hb A2 & Hb F levels normal: alpha thalassaemia DNA analysis
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None Counseling BMT/SCT Iron contraindicated Desferrioxamine
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Macrocytic Anaemia
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Inherited disorder Intrinsic factor deficiency Vit. B12 not absorbed
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ParameterEffect Hb, HCTReduced MCV, MCH, MCHCIncreased, Normal, Reduced Vit B12low Folatelow Retic countLow; prompt rise after treatment BM examinationMegaloblastic picture
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NCNC anaemia-1
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ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal TLClow Plateletslow DLCReversed P/L ratio Retic countLow BM examinationAplastic picture
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NCNC anaemia Pancytopenia Bone marrow biopsy
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Immunosuppressant BMT/SCT Blood transfusions
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NCNC ANAEMIA-2
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ParameterEffect Hb, HCTReduced MCV, MCH, MCHCNormal to slightly increased Haptoglobinlow BilirubinIncreased (unconjugated) Retic countHigh, polychromasia HaemoglobinaemiaPresent Hemoglobinuriapresent BM examinationHyperplastic picture
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Steroids Splenectomy BT BMT/SCT
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Rare disease Mixed pattern Partially treated Blood transfusion
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Anaemia is a common and treatable problem History, PE & CBC gives important clues to the diagnosis IDA is the commonest type, oral iron replacement is the treatment of choice BT needed rarely
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Aziz-ur-Rehman
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