02. Clinical and laboratory diagnostics of anemias.ppt

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Clinical laboratory diagnostics of anemias

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Actuality of theme: Anemia is very often met in 20% women of the developed countries and in 50% women of the non-developed countries; More than 50% patients with chronic diseases and tumors; Considerably worsens quality of life and capacity.

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Anemia - is the decreasing of hemoglobin and red blood cells level in the unit of blood volume Reduction in one or more of the major red blood cell (RBC) measurements: Hemoglobin concentration Hematocrit RBC count From data of WHO: a hematocrit less than 40 in men and 37 in women, or hemoglobin less than 130 g/l in men and less than 120 g/l in women.

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Anemia • Decrease in the number of circulating red blood cells • Most common hematologic disorder by far • Almost always a secondary disorder • As such, critical for internist to know how to evaluate/determine cause

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Anemia Symptoms Because a low red blood cell count decreases oxygen delivery to every tissue in the body, anemia may cause a variety of signs and symptoms. It can also make almost any other underlying medical condition worse. If anemia is mild, it may not cause any symptoms. If anemia is slowly ongoing (chronic), the body may adapt and compensate for the change; in this case there may not be any symptoms until the anemia becomes more severe.

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Signs of anemia : Black and tarry stools (sticky and foul smelling) Maroon, or visibly bloody stools Rapid heart rate Rapid breathing Pale or cold skin Yellow skin called jaundice Low blood pressure Heart murmur Enlargement of the spleen Signs and symptoms

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Symptoms of anemia may include the following: Fatigue Chest pain Abdominal pain Weight loss Weakness Dizziness and passing out, especially upon standingSigns and symptoms

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Anemia Symptoms Fatigue decreased energy weakness lightheadedness palpitations (feeling of the heart racing or beating irregularly) looking pale

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Symptoms of severe anemia may include:chest pain, angina, or heart attack dizziness fainting or passing out rapid heart rate

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Symptoms of severe anemia may include:Change in stool color, including black and tarry stools (sticky and foul smelling), maroon-colored, or visibly bloody stools if the anemia is due to blood loss through the gastrointestinal tract. rapid heart rate low blood pressure rapid breathing pale or cold skin yellow skin called jaundice if anemia is due to red blood cell breakdown heart murmur enlargement of the spleen with certain causes of anemia  

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Depending on the level of hemoglobin in the blood anemia is divided on: - mild degree (Hb 110-90 g/l), - moderate degree (Hb 89-70 g/l), - severe degree (Hb less than 69 g/l). Depending on the size of RBC and their saturation by hemoglobin (from data of colour index - CI) anemia is divided on: - Normocytic anemia (can be normochromic anemia: colour of RBC is normal and CI is 0,86-1,1); - Microcytic anemia (can be hypo- or normochromic): microcytosis , anizopoykilocytosis, hypochromia, CI < 0,7; - Macrocytic anemia: macrocytosis, megalocytosis, CI > 1,1.

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Approaches to AnemiaKinetic approach Decreased RBC production Increased RBC destruction Blood loss Morphologic approach Macrocytic Normocytic Microcytic

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Decreased RBC ProductionNutrient deficiency Dietary, malabsorption Bone marrow disorders/suppression Anemia of chronic diseases Low levels of trophic hormones Epo, thyroid hormone, androgens

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Increased RBC Destruction

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Blood Loss Most common cause of anemia Fe deficiency almost always due to blood loss Obvious bleeding Occult bleeding Induced bleeding Operative blood loss

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Clinical classification of anemia is based on morphological prinsiple - determination of mean corpuscular volume (MCV) of red blood cells MСV- is determined by automatic laboratory analyzers or by such formula: MСV = (hematocrit x10) / amount of RBC (in mln/l).

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Definition of MEAN CORPUSCULAR VOLUME : the volume of the average red blood cell in a given blood sample that is found by multiplying the hematocrit by 10 and dividing by the estimated number of red blood cells—abbreviation MCV

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First use size (MCV) to sort the Differential Dx

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Normocytic anemia (MCV - 80-100) A loss or destruction of RBC is increased Acute bleeding Early iron deficiency - Hemolytic anemia - Hypersplenism Decreasing of RBC synthesis -Anemia of chronic diseases (most commonly) Endocrine dysfunctions Renal insufficiency Pathology of bone marrow (for example, action of medications, infection, aplastic anemia, myelodysplastic syndrome, multiple myeloma and other infiltrative diseases).

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Anemia of Chronic Disease•Common • Develops over 1 to 2 months • Non-progressive • Usually mild to moderate – but hematocrit < 0.20 occasionally • 30% mildly microcytic • WBC, platelets normal or increased

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ANEMIA OF CHRONIC DISEASE • Thyroid disease • Collagen Vascular Disease – Rheumatoid Arthritis – Systemic Lupus Erythematosus – Polymyositis – Polyarteritis Nodosa • Inflammatory Bowel Disease – Ulcerative Colitis – Crohn’s Disease • Malignancy • Chronic Infectious Diseases – Osteomyelitis – Tuberculosis • Familial Mediterranean Fever • Renal Failure

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Normocytic Anemia (MCV 80-100 fl)

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Hemolytic Anemia• Anemia of increased destruction normochromic anemia – Shortened RBC survival – Reticulocytosis - Response to increased RBC Destruction

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Hemolytic Anemia

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Last Updated: 8th March 2018

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