Hemoglobin below the normal reference level for the age and sex of the individual
Reference range:
1-3 days: 14.5 - 22.5g/dl 6 months to 2 years: 10.5 - 13.5g/dl Adult Men: 13-18 g/dl Adult Women: 11.5-15.5g/dl
Prevalence:
South East Asia 70% National Health Survey Pakistan children < 5 years 60% Adolescent 47% Adult women 43% Adult men 19%
Clinical Features
(symptoms):
Infants Irritability, restlessness Anorexia, sleepiness Behavioral changes
School going children
Clinical Features
(symptoms):
Common Fatigue/Muscle weakness Headache/Lack of concentration Faintness/dizziness
Exertional dyspnoea/palpitation
Angina/intermittent claudication
Clinical Features
(signs):
Non-specific pallor pucat, tacycardia, flow mummer Specific koilonychia, angular stomatitis, glossitis neuropathy gangguan saraf, dementia pusing, paraplegia
History:
Physiological
animia yang bukan penyakit mis pada wanita hamil Inadequate intake kurang asupan
Comorbids
Children with Hb < 10g/dl have reduced pengurangan cognitive kecerdasan & psychomotor keterampilan function despite a return to normal hematological status
MCV < 80 fL
MCV > 100 fL MCV 80 100 fL
Macrocytic Normocytic
Microcytic Anemia
Iron deficiency
Hemoglobinopathy penyakit
If no obvious cause
Serum Ferritin:
< 15ug/l : Normal or : Increased Iron deficiency Serum Iron / Total Iron binding capacity(TIBC)
Apabila ditemukan mikrositik pada hapusan darah maka dilakukan pemeriksaan serum
Evaluation continued..
Serum Iron TIBC Iron Decreased deficiency Thallasemi a
Increased karena hematopoesis inefektif sehingga meningkatkan absorsi besi di saluran cerna
Peripheral smear
Hypochromic
Target cells
Basophilic stippling
Sideroblast
Chronic disease
Normal
Diamorphic
Decreased akibat makrofag menimbun dan menahan besi sehingga eritrosit kekurangan besi. Alasan makrofag menahan besi adalah untuk menghambat pertumbuhan bakteri sebab bakteri dapat tumbuh subur jika
Evaluation continued..
Thallesemia
Mentzer index: MCV/RBC count. <13 Hb Electrophoresis pemeriksaan uji hemoglobin. Segala hemoglinopati dapat dideteksi melalui pemeriksaan ini
Sideroblastic anemia
Bone marrow exam
Rx of iron deficiency:
Adults
Ferrous sulphate/gluconate/fumarate Iron polymaltose complex Elemental iron 200mg/day
Parental Iron
Normal Hb/PatientHbXwt(kg)X2.2
Fruits
Dried fruit Juices Most fresh fruits
Grains
Iron-fortified breads Dry cereals Oatmeal cereal
High reticulocyte
hemolysis, bleeding or nutritional response to folate/B12/iron
Evaluation continued...
Macrocytes present
With megaloblast MCV>120
B12 deficiency, Folic acid deficiency Drugs (cytotoxic, anticonvulsant, antibiotic)
Intramuscular:1000 mcg alternate days to a total of 3-5 mg 1000 mcg every 3 months Intranasal: Nascobal
Oral folate I mg/day reduces artherosclerosis if associated with elevated homocysteine levels
Normocytic anemia
(evaluation):
CBC, Peripheral smear & Retic count Normal retic and mild anemia >9gm/dl
chronic disease
Conclusion:
Evaluation based on MCV Microcytosis is due to iron deficiency unless proven otherwise Megaloblast help in differentiating cause of macrosytosis CBC and reticulocyte count essential for normocytic anemia