Anemia resident survival guide: Difference between revisions
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{{familytree | | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | | | | G04 | | | | | | | | | | G05 | | | | | | | | | | | | | | | |G01=*Bone marrow disorder <br>[[Inflammation]]<br>*[[Autoimmune disease]]<br>*[[Chronic renal disease]]<br>*Critical illness<br>*Chronic endocrine disorders<br>*[[Aplastic anemia]]<br>*Pure red cell aplasia|G02=*[[Iron deficiency]]<br>*Chronic disease<br>*[[Thalassemia]] (Hemoglobinopathies)<br>*[[Sideroblastic anemia ]]<br>*[[Lead toxicity]]|G03=*Folate, B12 deficiency ([[Megaloblastic Anemia]]) <br>* Drug effect <br> *Excessive alcohol use <br> *[[Hypothyroidism]]|G04= '''Suggests hemolytic process'''<br>*Metabolic defect <br>*[[Hemoglobinopathies]] (eg, | {{familytree | | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | | | | G04 | | | | | | | | | | G05 | | | | | | | | | | | | | | | |G01=*Bone marrow disorder <br>[[Inflammation]]<br>*[[Autoimmune disease]]<br>*[[Chronic renal disease]]<br>*Critical illness<br>*Chronic endocrine disorders<br>*[[Aplastic anemia]]<br>*Pure red cell aplasia|G02=*[[Iron deficiency]]<br>*Chronic disease<br>*[[Thalassemia]] (Hemoglobinopathies)<br>*[[Sideroblastic anemia ]]<br>*[[Lead toxicity]]|G03=*Folate, B12 deficiency ([[Megaloblastic Anemia]]) <br>* Drug effect <br> *Excessive alcohol use <br> *[[Hypothyroidism]]|G04= '''Suggests hemolytic process'''<br>*Metabolic defect <br>*[[Hemoglobinopathies]] (eg, | ||
[[sickle cell]])<br>*Autoimmune destruction<br>*Splenic sequestration<br>*[[RBC membrane defect]]<br>*[[Intravascular hemolysis]]<br> See [[Hemolytic Anemia]] |G05=Suspect hemorrhage and acute blood loss}} | [[sickle cell]])<br>*Autoimmune destruction<br>*Splenic sequestration<br>*[[RBC membrane defect]]<br>*[[Intravascular hemolysis]]<br> See [[Hemolytic Anemia]] |G05=Suspect hemorrhage and acute blood loss<ref name="Salisbury-2011">{{Cite journal | last1 = Salisbury | first1 = AC. | last2 = Reid | first2 = KJ. | last3 = Alexander | first3 = KP. | last4 = Masoudi | first4 = FA. | last5 = Lai | first5 = SM. | last6 = Chan | first6 = PS. | last7 = Bach | first7 = RG. | last8 = Wang | first8 = TY. | last9 = Spertus | first9 = JA. | title = Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. | journal = Arch Intern Med | volume = 171 | issue = 18 | pages = 1646-53 | month = Oct | year = 2011 | doi = 10.1001/archinternmed.2011.361 | PMID = 21824940 }}</ref> | ||
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Revision as of 21:03, 18 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Chetan Lokhande, M.B.B.S [2]
Definition
Anemia is defined as a decrease in oxygen-carrying capacity of the blood . It is measured in unit volume concentrations of hemoglobin (Hb), red blood cell volume (MCV), red blood cell number (RBC count).
Causes
Life Threatening Causes
- Aplastic crisis
- Sickle cell crisis
- Severe Hemorrhage
Most Common Causes
Inadequate production
- Iron deficiency anemia
- Thalassemia
- Megaloblastic anemia ( Vit B12 , Folate )
- Hypothyroid
- Chronic renal disease
- Bone marrow suppression
- Pregnancy
Hemolysis
- Autoimmune hemolytic anemia
- Hemoglobinopathies
- RBC membrane defect
- Splenic sequestration
- Sickle cell anemia
Management
| INDICATIONS FOR TESTING Fatigue, weakness, pallor, dizziness, fainting | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check routine Labs, CBC , smear and reticulocyte count and index | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnosed as anemia if Hgb in males < 13g / dl and in females if Hgb < 12g / dl[1][2][3] Check whether corrected reticulocyte index ≥ 2.5 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If No Check RBC indices | If Yes then | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal MCV / MCHC Normocytic Normochromic | Low MCV / MCHC Microcytic Hypochromic | High MCV Macrocytic | Check peripheral smear | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↓ EPO production or improper response to EPO[4][5] | Maturation defect | Maturation defect | Fragmented cells on peripheral smear | No fragmented cells on peripheral smear | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| *Bone marrow disorder Inflammation *Autoimmune disease *Chronic renal disease *Critical illness *Chronic endocrine disorders *Aplastic anemia *Pure red cell aplasia | *Iron deficiency *Chronic disease *Thalassemia (Hemoglobinopathies) *Sideroblastic anemia *Lead toxicity | *Folate, B12 deficiency (Megaloblastic Anemia) * Drug effect *Excessive alcohol use *Hypothyroidism | Suggests hemolytic process *Metabolic defect *Hemoglobinopathies (eg, sickle cell) *Autoimmune destruction *Splenic sequestration *RBC membrane defect *Intravascular hemolysis See Hemolytic Anemia | Suspect hemorrhage and acute blood loss[6] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abnormal peripheral smear | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If yes then work up based on smear bone marrow biopsy may be necessary | If no | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ORDER Iron and Iron Binding Capacity and Ferritin check B12, Folate levels | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Start Vit B12,Folate If low | Low / normal TIBC Normal / high ferritin Low / normal iron | High TIBC Low iron Low ferritin | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inflammation / Chronic Disease Consider Biopsy in this case | Iron Deficiency anemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abbreviations and Formula
MCV = mean cell volume MCHC = mean cell hemoglobin concentration TIBC = total iron binding capacity
Reticulocyte correction for anemia:
Retic Count % x Hgb / Htc x Maturation time correction
Do's
Dont's
References
- ↑ "Nutritional anaemias. Report of a WHO scientific group". World Health Organ Tech Rep Ser. 405: 5–37. 1968. PMID 4975372.
- ↑ Rodgers, GM.; Becker, PS.; Bennett, CL.; Cella, D.; Chanan-Khan, A.; Chesney, C.; Cleeland, C.; Coccia, PF.; Djulbegovic, B. (2008). "Cancer- and chemotherapy-induced anemia". J Natl Compr Canc Netw. 6 (6): 536–64. PMID 18597709. Unknown parameter
|month=ignored (help) - ↑ Beutler, E.; Waalen, J. (2006). "The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?". Blood. 107 (5): 1747–50. doi:10.1182/blood-2005-07-3046. PMID 16189263. Unknown parameter
|month=ignored (help) - ↑ Gomes, ME.; Deinum, J.; Timmers, HJ.; Lenders, JW. (2003). "Occam's razor; anaemia and orthostatic hypotension". Lancet. 362 (9392): 1282. doi:10.1016/S0140-6736(03)14572-2. PMID 14575973. Unknown parameter
|month=ignored (help) - ↑ Perera, R.; Isola, L.; Kaufmann, H. (1995). "Effect of recombinant erythropoietin on anemia and orthostatic hypotension in primary autonomic failure". Clin Auton Res. 5 (4): 211–3. PMID 8520216. Unknown parameter
|month=ignored (help) - ↑ Salisbury, AC.; Reid, KJ.; Alexander, KP.; Masoudi, FA.; Lai, SM.; Chan, PS.; Bach, RG.; Wang, TY.; Spertus, JA. (2011). "Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction". Arch Intern Med. 171 (18): 1646–53. doi:10.1001/archinternmed.2011.361. PMID 21824940. Unknown parameter
|month=ignored (help)