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Diagnosis Anemia:

Following information required:


Age
Anamnesis
Physical examination
Inspection of blood smear
Above will make diagnosis likely in
95 % of patient
Important Anamnesis data :
• Sudden, Slow  Onzet of pallor
• Constitutional symptoms :
- Weight
- Night sweats
• Underlying disease :
- Peptic ulcer
- Liver disease
- Nutritional deficiency
Physical examination :
• Pallor ( not detectable unless Hb < 8 gr%)
• Jaundice ( Icterus )
• Petechie, brusing
• Hepatomegaly
• Splenomegaly
• Significant lymphadenopaty
Stained Blood Film Provides Data
On:

• Significant RBC changes


• Adequacy of trombocytes
• Estimate of WC count ( 500 )
• Abnormality of Leucocytes
Haemoglobin Estimate :
• Done on machine: ( do not trust unless
machine standardized )
• Machine requires : calibration and
standardazation
• Costly automated machines are not
essential for accurate haemoglobin
measurements
Anemia can be classified:

• Inspect blood smear :


- microcytic, hypochromic
- normocytic, normochrome
- macrocytic
- mixture of the above
Investigation of microcytic
hypochromic anemia :
• Serum iron, TIBC not reliable
• Serum ferritin useful ( expensive )
• Erythrocyte proporphyrin useful ( not available in
Indonesia )
• Determine possible causes of blood loss, eliminate then.
• Therapeutic trial with oral iron
• For suspected haemoglobinopathy :
-Unstable Hb determination, Hb EGG.
- Foetal Hb determination
- Genetic counselling( in Australia after genetic probe
analysis).
Microcytic Hypochromic anemia:
• Iron deficiency:
- blood loss
- nutritional
• Haemoglobulinopathy
• Other causes are uncommon :
- sideroblastic
- familial
- atransferinaemi
Normocytic,normochromic
anaemia::
• Investigatios:
- Aplasia : all cell lines depressed
- Leukemia,lymphoma : usually changes in 2-3
cell lines ( RBC, WC, Thromb )
- Chronic inflamation ( infections, arthritis):
clinical supportive evidence + marked rouleax
on blood film.
- Chronic liver, renal disease : clinical supprtive
evidence.
- Haemolys : regenerative RBC cahnges (
polychromasia +++ ) without leukocyte, pletelet
abnormalitiies on film
Investigation of Macrocytic
anaemia:
• With oval macrocytes and hypersegmented
neutrophils : bone marrow aspration to exclude
megaloblastosis ( B 12, folat lack )
• Due to medication ( sulpha
drugs,anticonvulsan), or organic chemicals
• Chronic liver disease ( in Australia commonly
due to alkoholism : not megaloblastic.
• Leukemia, tumors ?
Iron deficiency anaemia treatment :
• Chronic anaemia is always compensated
emergency transfusion rarely needed
remember: treat patient, not Hb. Level oral iron
therapy is as speedy and as effective as
parenteral treatment, it is also not dangerous.
• Prefered treatment:
- children : 6 mg elemental iron/kg/day orally for
3 month
- adults : 60 mg elemental iron/day orally for 3
months.
* Treament of acute anaemia of blood loss : to be
diiscussed later
Acute Haemorrhage
• When should blood tranfusion be given ?
• How much blood ?
• For how long ?
BLOOD TRANFUSION THERAPY:
• Never curative form of treatment
• May be life saving ( until definitive treatment succesful )
• Carries potentially grave risks ( disease transmission,
sensitization, etc )
• Is contraindicated unless essential for life support
• When given,must be in appropiate amounts ( single unit
transfusins are not rational )
Use of fresh blood
• What is fresh blood ?
• What is super fresh blood ?
• Is blood stored for day fresh blood?
Quality of blood at 14 days :
Conclusion : there is not much therapeutic
diffference between 1 day and 14 day
stored blood
Common problems in hospital :

• Who and how should make request for


blood?
• Who : is responsible for giving blood(
circulatory overload, for example )
• Who is renponsible for reviewing both
benefits and reactions to blood ( for
example: fever, urticaria,clots )
• How can blood shortages be best avoided
?