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Dr.M.KULANDAIVEL MD DCH
Definition
Reduction in oxygen carrying capacity of blood as a result of : Red cell mass
Classification
Aetiological
Production: e.g. aplastic anemia Hemolysis: e.g. G6PD deficiency Hemorrhage: e.g. rectal polyp
Rate of onset
Acute: e.g. malaria with hemolysis Chronic: e.g. Iron deficiency anemia
Severity
Mild 10 gm % Moderate 7-10 gm% Severe < 7 gm%
Nutritional Anemia
Iron Folic acid Vit. B12 Others: Protein, Zinc, Copper, Vit. C Deficiency of any of these will lead to a chronic state of nutritional anemia
Anemia Global Problem Incidence WHO 1990 30% of world population 1500 million people
Region Children 0-4 yr Developed Region 1200 million Developing Region 3800 million World 5000 million 5-12 yr Mean Women 17- 40 yr Pregnant All
12 51 43
7 46 37
3 26 18
14 59 51
11 47 35
Preschool children - 70% Chakraborty et al 1990, Choudhary S.N. 1990 - ICMR - 1-3 yrs-63.2%, 3-5 yrs - 44%
Confirmatory tests
Anemia - History
Age / Sex / Inheritance Infections & Worms Drugs Diet, Pica Community
Diet: Lack of breast feeds, excess of milk based diet, bottle fed, poor weaning food, predominantly vegetarian diet, pure vegan (B12 def.)
Common Manifestations
Glossitis, Stomatitis, Angular cheilosis
Koilonychia, Platynychia usually in older children/adolescent females Plummer-Winson syndrome (Patterson Kelly syndrome)
Pica altered and perverted appetite
Common Manifestations
Loss of Papillae
Platynychia
Hyperpigmented knuckles
Laboratory Investigations
Screening tests
Hb, HCT
Red cell indices Reticulocyte count P.S. examination
Confirmatory tests
Thalassemia trait
Aplastic anemia
High
IDA
Chronic liver disease, Megalo. An., malignancies, Imm. Hem. myelofibrosis, An. myelotoxic drugs
Reticulocyte Count
Count 500 cells - supravital staining Normal : 1-2% corrected retic count
Low count: BM depression like aplastic anemia, BM infiltration, PRCA High count: Good BM response like in hemolysis, hemorrhage, post-treatment
Advantages of PS examination
Bedside, easily available
PS examination
Normocytic Normochromic
Morphological Classification
Blood Film
Normocytic
Microcytic
Macrocytic
MCV > 953
MCV 75-95 3
IDA
Hemoglobinopathies Anemia of chronic infections Sideroblastic Anemia Lead poisoning
Vicious Cycle
Top fed infant bottle Improper BF Poor weaning Cows milk Recurrent infections Worms, Malaria
Role of Iron
Hemoglobin 70% Myoglobin Enzymes Storage Iron
4-5% earths crust is iron Child 70 mg/kg Male 4.0 gms, Female 3.0 gms
Clinical Manifestations
Multisystemic disease Hematological Anemia Muscles, Cerebral Cortex, Epithelial tissues, Myocardium, Peri. nerves, Kidney, Liver, Immune system
Confirmatory tests :
Plasma/storage compartment S.Iron, TIBC, TS, S.Ferritin, B M iron staining
Treatment
Correct diagnosis Diet modification Treat the cause Iron supplementation Prevention
Monitoring of Response
Retic 8-10 % at day 7 Hb es by 0.1 gm/day Normal by 2-3 mo. PS mixed population Indices : 2-3 mo to normalise Imm. subjective well being Epithelial changes : 2-3 mo.
Investigations
CBC: Macrocytic anemia with high RDW PS: Macrocytic, ovalocytosis, basophilic stippling, polychromasia, Howell Jolly bodies Increased indirect bilirubin, high LDH Bone marrow: Megaloblastic changes
Treatment
Oral folic acid: 1-5 mg/day for 3-6 mo Oral B12: 10 mcg/Kg/day for 3-6 mo Give both folate and B12, B12 deficiency treated only with folate Hb will raise but CNS changes will worsen If pernicious anemia: Injectable B12 initially 1 mg daily IM for 2 weeks followed by 1 mg monthly life long Deworm, improve diet
Response to treatment
Bone marrow may totally revert in 24 hours Patient starts feeling well in days Retic response will peak at 5-7 days Hb starts rising after 1-2 weeks Hb normalizes by 3 months PS becomes normal after 1-2 months as old macrocytic RBCs will persist till their life
Prevention of Anemia
Diet modification Iron supplementation
Food fortification
Control infections, worms
Thank you