Diagnosis Anemia:

Following information required: Age Anamnesis Physical examination Inspection of blood smear Above will make diagnosis likely in 95 % of patient

Important Anamnesis data :

Sudden, Slow Onzet of pallor Constitutional symptoms : - Weight - Night sweats Underlying disease : - Peptic ulcer - Liver disease - Nutritional deficiency

Physical examination :
Pallor ( not detectable unless Hb < 8 gr%) Jaundice ( Icterus ) Petechie, brusing Hepatomegaly Splenomegaly Significant lymphadenopaty

Stained Blood Film Provides Data On:

Significant RBC changes Adequacy of trombocytes Estimate of WC count ( 500 ) Abnormality of Leucocytes

Haemoglobin Estimate :
Done on machine: ( do not trust unless machine standardized ) Machine requires : calibration and standardazation Costly automated machines are not essential for accurate haemoglobin measurements

Anemia can be classified:

Inspect blood smear : - microcytic, hypochromic - normocytic, normochrome - macrocytic - mixture of the above

Investigation of microcytic hypochromic anemia :

Serum iron, TIBC not reliable Serum ferritin useful ( expensive ) Erythrocyte proporphyrin useful ( not available in Indonesia ) Determine possible causes of blood loss, eliminate then. Therapeutic trial with oral iron For suspected haemoglobinopathy : -Unstable Hb determination, Hb EGG. - Foetal Hb determination - Genetic counselling( in Australia after genetic probe analysis).

Microcytic Hypochromic anemia:

Iron deficiency: - blood loss - nutritional Haemoglobulinopathy Other causes are uncommon : - sideroblastic - familial - atransferinaemi

Normocytic,normochromic anaemia::
Investigatios: - Aplasia : all cell lines depressed - Leukemia,lymphoma : usually changes in 2-3 cell lines ( RBC, WC, Thromb ) - Chronic inflamation ( infections, arthritis): clinical supportive evidence + marked rouleax on blood film. - Chronic liver, renal disease : clinical supprtive evidence. - Haemolys : regenerative RBC cahnges ( polychromasia +++ ) without leukocyte, pletelet abnormalitiies on film

Investigation of Macrocytic anaemia:

With oval macrocytes and hypersegmented neutrophils : bone marrow aspration to exclude megaloblastosis ( B 12, folat lack ) Due to medication ( sulpha drugs,anticonvulsan), or organic chemicals Chronic liver disease ( in Australia commonly due to alkoholism : not megaloblastic. Leukemia, tumors ?

Iron deficiency anaemia treatment :

Chronic anaemia is always compensated emergency transfusion rarely needed remember: treat patient, not Hb. Level oral iron therapy is as speedy and as effective as parenteral treatment, it is also not dangerous. Prefered treatment: - children : 6 mg elemental iron/kg/day orally for 3 month - adults : 60 mg elemental iron/day orally for 3 months. * Treament of acute anaemia of blood loss : to be diiscussed later

Acute Haemorrhage
When should blood tranfusion be given ? How much blood ? For how long ? BLOOD TRANFUSION THERAPY: Never curative form of treatment May be life saving ( until definitive treatment succesful ) Carries potentially grave risks ( disease transmission, sensitization, etc ) Is contraindicated unless essential for life support When given,must be in appropiate amounts ( single unit transfusins are not rational )

Use of fresh blood

What is fresh blood ? What is super fresh blood ? Is blood stored for day fresh blood? Quality of blood at 14 days : Conclusion : there is not much therapeutic diffference between 1 day and 14 day stored blood

Common problems in hospital :

Who and how should make request for blood? Who : is responsible for giving blood( circulatory overload, for example ) Who is renponsible for reviewing both benefits and reactions to blood ( for example: fever, urticaria,clots ) How can blood shortages be best avoided ?