2. COMMON ANEMIAS Haematology Dr. Janis Bormanis

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

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

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

6. 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

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

8. IRON BALANCE ; Ingest 10-20 mg. per day ; Absorb 1-3 mg. per day ; Lose 1 + mg per day –menstrual loss 30-50 ml ; Total iron 35-50 mg/kg ; Stores 1 gram ; Easy to achieve negative balance

9. 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

10. Microcytic, hypochromic

11. 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.

12. THERAPY Replace iron

13. 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 % 15-20 4 Ferritin normal or high 4 A responsible disease is present 4 Usually a systemic disorder

14. Megaloblastic Anemias Vitamin B12 Folic Acid

15. 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

16. 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

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

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

20. 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

21. 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

22. Oval Macrocytes Hypersegmented neutrophils

23. 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

24. Therapy Replace B12 - folic acid

25. 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

26. Spherocytosis

27. G6PD deficiency - Oxidative hemolysis

28. Fragmentation Prosthetic heart valves

29. Which anemia is this ?

30. Hemoglobinopathies and Thalassemias

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

32. 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