Clinical laboratory diagnostics of anemias Anemia

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Clinical laboratory diagnostics of anemias

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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 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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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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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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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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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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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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Equired hemolytic anemia Reticulocytosis

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Equired hemolytic anemia Reticulocytosis

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Hereditary disordersinclude erythrocyte membrane and enzymatic defects and hemoglobin abnormalities. Some hereditary disorders include the following:G6PD deficiency Herediditary spherocytosis Sickle cell anemia Thalassemia

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Acquired hemolytic conditionscan be due to immune disorders, toxic chemicals and drugs, antiviral agents (eg, ribavirin) physical damage, and infectionsAutoimmune hemolytic anemia (AIHA) may result from warm or cold autoantibody types; rarely, mixed types occur. Most warm autoantibodies are immunoglobulin (Ig) G and can be detected with the direct Coombs test, which is also known as the direct antiglobulin test (DAT)

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Acquired hemolytic conditionsAutoimmune hemolytic anemia and hereditary spherocytosis are classified as examples of extravascular hemolysis because the red blood cells are destroyed in the spleen and other reticuloendothelial organs. Intravascular hemolysis occurs in hemolytic anemia due to prosthetic cardiac valves, G6PD deficiency, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, and paroxysmal nocturnal hemoglobinuria (PNH).

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Peripheral blood smear with sickled cells

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Last Updated: 8th March 2018