Anemia

Anemia

1. low mcv <80fl

   • iron deficiency
     • brittle nails,koilonychia,atrophic glossitis, angular cheilosis
     • causes
       • GI blood loss-esophagitis, esophageal cancer, gastric cancer,beg gastric ulceration, NSAID and aspirin use, colonic carcinoma malsabsoption-celiac diseas, gastrectomy, gastric resection, h pylori non gi- menorrhagia,epistaxsis,hematuria pregnancy, prematurity, diet
       • microcytic,hypochromic, low ferritin
         • ida+dyspepsia- urgent refer gastroscopy/speciliast man &lt;11 and nmw (10 fail- h pylori,celiac disease,blood loss,non compliacen,wrong diagnosis,mixed anemia
         • ferou sulphate 200mg bd ascorbic acid 250-500 mg bd
           • constipation.black stool-reduce dose/ferrous fumarate
             • check response after 2-3 wks 1g/dl/wk continu for 3 more mo
   • thalessemia-AR
     • asymptomatic-hetreo a or b&nbsp; homo a+&nbsp; mild anemia confused with IDA. MCV will be very low ferritin will be normal and no response to fe tt hyochrmic,microcytic,target cells,nucleated RBCs
     • B thal-marrow prolif/mongoloid facies/frontal bossing,thing long bones,progessive spleno
       • iron chelation
     • a thal- homo a0-barts hydrops fetal death at 38wks
       • Hb h- a0 and a+ mode anemia/splenome, 4 b chains
   • lead poisoning
     • dec Hb synthesis, dec life span of eryth
       • acute-lethargy,encephalo,dec apetitie,abdominal pain vomiting
       • chronic-autonomic dysfuntion/hearing loss/agression/constipation
       • blue gums,anemia,cog dysfunction,child irrtable,restless,insomnia,
         • micro hypo basophillic stippling, ingestion- abd xray-radio opaque flecks encephalopathy- CT/MRI&nbsp;
         • Iv/im ca diNa edetate mild <45 micro/dl remove exposure, mild-moderate-consider oral chelation

2. low mcv

   • sideroblastic anemia
     • body cant incoporate fe into Hb
       • accumulation of fe in mitochondria rbc
         • heredirary/acquired heredity-defect in aminolevulinic acid synthase/vit b6 metabloism acquired-lead poisoning,choramphenicol,alcohol
         • ring sideroblasts on bone marrow exam. prussian blue stain of rbs mcv normal inc or dec high fe trasferrin saturation dimorphic population normal and hypochromic rbcs
         • rbc transfusion for symptomatic anemia desfuroxamine after 20-25 u of rbcs avoid alcohol/vit c&nbsp; hereditary-pyridoxine allogenic peripheral stem cell transplant&nbsp;
   • anemia of chronic disease
     • old age,DM,leg ulcers,low egfr
       • exclude,fe,transferrin,ferritin,ldh,gluco,LFT,EGFR

3. normal mcv (80-100)

   • high retics >2-3%
     • hemolysis
       • inherited-scd,thal,SPHERP,G6PD
       • acquired-immune,malaria,drugs
     • bleeding gu,gi