1. This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Approach to Anemia Reem Alashjaie 428203500

3. Approach to Anemia Important to Remember: Anemia is a symptom and not a disease Look for the Primary Cause!

4. Diagnosis: is a medical condition in which the red blood cell count or hemoglobin is less than normal. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml

5. False Anemia HB concentration: ش Normal ↓ True Anemia False anemia _pregnancy 2 nd trimester. _Large spleen

6. : History First Question: _Acute VS chronic _Hemodynamic stability _Previous CBC

7. SYMPTOMS: _Easy fatigue and loss of energy _Unusually rapid heart beat, particularly with exercise _Shortness of breath and headache, particularly with exercise _Dizziness _Pale skin

8. _ Tingling (pins and needles) sensation in the hands or feet. _(A blue-black line on the gums _abdominal pain (constipation_vomiting _Jaundice (yellow skin and eyes)-Brown or red urine _ Episodes of severe pain, especially in the joints, abdomen, and limbs _history of chronic disease (renal faliure _SLE_RE..)

9. What is the mean corpuscular volume ( MCV ) ? Classify chronic anemia as: 80) >) _Microcytic ( decreased MCV ) 80_99)) _Normocytic ( normal MCV ) 100)<) _Macrocytic ( increased MCV )

10. Microcytic anemia: _Microcytic anemias usually as result of defective hemoglobin synthesis _Differential diagnosis: Iron deficiency Thalassemia trait Anemia of chronic disease Sideroblastic anemia Lead poisoning

11. Microcytic anemia Ferritin lowFerritin normal or high Iron defeciency anemia Chronic disease electrophoresis +_ _Thalasemia _sidroblastic anemia _lead posining

12. Case Presentation 1: _women 60 y,complains of burning sensation over the tongue and oral mucosa, fatigue,weakness and dyspnea, dysphagia to solids only not liquid,no weight loss. Labs: _Hg 7.1 gm/dl _ Hct 23%, _WBC 5,400/mm3 _platelets 450,000/mm3 _(MCV) is 74 _(RDW) is 17.1%

14. Normocytic anemia: _Acute blood loss _Hemolysis ( acute/chronic) _Anemia of chronic disease: – chronic inflammation: RA, SLE – chronic infection: TB, SBE, abscess –malignancy _renal faliure

16. Case presentation 2: A 25-year-old male, Mediterranean taken anti-malarial prophylaxis for a trip to West Africa. Over the next week he develops increasing fatigue, back pain, SOB. On physical examination (jaundice),Lab studies show a HCT of 30%,hg 10 gm. Examination of his blood film shows RBCs with Heinz bodies. There is a family history of this disorder, with males, but not females, affected. What is the most likely diagnosis

17. Case presentation 3: A 78-year-old man presents with a three-year history of an elevated leukocyte count with recent fatigue and anemia. He has received two red blood cell transfusions in the past two months. His past medical history includes coronary artery disease and hypertension,. His physical examination is unremarkable

18. Lab result: (WBC)= 75,000/uL HG= 9.3 g/dL, and platelet =71,000/Ul MCV =88 Reticulocyte count =normal What next step?

19. Macrocytic Anemia: Differential diagnosis: Megaloblastic anemia – Vitamin B12, Folate deficiency – Chemotherapeutic drugs Myelodysplastic syndromes Liver disease Hypothyroidism

20. Macrocytic anemia : Rule out medication or alcohol Check vit.B12 and folate level Both normal _chronic liver disease _hypothyrodism _bone marrow disorder Low B12,normal folate Methylmalonic acid level Low folate,normal vit.B12 Consider folate deficency

21. Thank you