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Anemia
- 2. Clinical presentation
Asymptomatic in majority
Malaise, fatigue, DOE, pica
Palpitation, angina, CHF when severe
Amenorrhea/menorrhagia
Pallor, jaundice, koilonychia
Tachycardia, wide pulse pressure, flow
murmurs, cardiomegaly
Splenomegaly
- 3. Evaluation
CBC- Hb, TLC/DLC, platelets, MCV
PBS examination
Reticulocyte count
Ferritin
RFT- creatinine, LFT, TFT
Stool- occult blood
Bone marrow examination
Other- Coomb’s test, Hb electrophoresis,
vitamin B12/RBC folate levels
- 4. Poikilocytes
Abnormally shaped RBC
Types-
Acanthocyte- spur cell- abetalipoproteinemia, liver disease
Codocyte- target cell- thalassemia, HbC disease,
post-splenectomy
Echinocyte- burr cell- uremia
Ovalo/elliptocyte- hereditary ovalo/elliptocytosis
Spherocyte- hereditary spherocytosis, AIHA
Drepanocyte- sickle cell- sickle cell anemia
Dacrocyte- tear-drop cell- myelofibrosis
Schistocyte- fragmented, irregular RBC- MAHA
- 5. Causes
Blood loss
Acute- trauma, GI bleed
Chronic- GIT, menstrual, urinary
Decreased production
Iron deficiency
Vitamin B12/FA deficiency
BM defect- aplastic, myelophthisic
Increased destruction
Hemolytic anemia- AIHA, SCD, thalassemia
- 6. Morphologic classification
Microcytic- MCV<80
Iron deficiency
Thalassemia
Sideroblastic
Macrocytic- MCV>100
Vitamin B12/FA deficiency
Drugs- methotrexate, zidovudine
CLD, alcoholism, hypothyroidism
Normocytic- MCV 80-100
Hemolytic
Aplastic/Myelophthisic
Anemia of chronic disease
Acute blood loss
- 8. Chronic hyperproliferative BM
MDS-
myelodysplastic
syndrome
RA- refractory
anemia
RAEB
Sideroblastic
anemia
CMML
MPD-
myeloproliferative
disorders
Polycythemia vera
CML
Essential
thrombocythemia
Myelofibrosis
- 9. Aplastic anemia
Typically pancytopenia
(PRCA- anemia only)
Causes- autoimmune, chloramphenicol,
carbamazepine, radiation, benzene
s/s- of pancytopenia
Dx- bone marrow examination- biopsy
Rx- ATG/ALG with Cyclosporin-in
elderly or HSCT-in young
- 10. HSCT
Hematopoietic stem cell transplantation
BMT or PBSCT (preferred) or cord blood
Indications-
Multiple myeloma
AML in remission, ALL in second remission, CML
Relapsed lymphoma
Aplastic anemia
MDS
Congenital storage disorders, immunodeficiencies,
hemoglobinopathies
Collagen vascular disease
Autologous or Allogeneic
- 11. HSCT considerations
Cost
HLA matched donor (allogeneic)
Complications-
Infections
Mucositis
Hepatic veno-occlusive disease
GVHD (allogeneic)- acute or chronic
Mortality- 10-20%