Anemia

Low hemoglobinWomen<12 gm/dl; Men<13

gm/dl

Clinical presentation Asymptomatic in majority Malaise, fatigue, DOE, pica Palpitation, angina, CHF when severe Amenorrhea/menorrhagia

Pallor, jaundice, koilonychia Tachycardia, wide pulse pressure, flow

murmurs, cardiomegaly Splenomegaly

Evaluation CBC- Hb, TLC/DLC, platelets, MCV PBS examination Reticulocyte count Ferritin RFT- creatinine, LFT, TFT Stool- occult blood Bone marrow examination Other- Coomb’s test, Hb

electrophoresis, vitamin B12/RBC folate levels

Poikilocytes Abnormally shaped RBC Types- Acanthocyte- spur cell- abetalipoproteinemia, liver

disease Codocyte- target cell- thalassemia, HbC disease,

post-splenectomy Echinocyte- burr cell- uremia Ovalo/elliptocyte- hereditary ovalo/elliptocytosis Spherocyte- hereditary spherocytosis, AIHA Drepanocyte- sickle cell- sickle cell anemia Dacrocyte- tear-drop cell- myelofibrosis Schistocyte- fragmented, irregular RBC- MAHA

Causes Blood loss Acute- trauma, GI bleed Chronic- GIT, menstrual, urinary Decreased production Iron deficiency Vitamin B12/FA deficiency BM defect- aplastic, myelophthisic Increased destruction Hemolytic anemia- AIHA, SCD, thalassemia

Morphologic classification Microcytic- MCV<80 Iron deficiency Thalassemia Sideroblastic Macrocytic- MCV>100 Vitamin B12/FA deficiency Drugs- methotrexate, zidovudine CLD, alcoholism, hypothyroidism Normocytic- MCV 80-100 Hemolytic Aplastic/Myelophthisic Anemia of chronic disease Acute blood loss

Treatment

Correct underlying causePacked RBC transfusion

Replacement- iron, vitamin B12/FA

Chronic hyperproliferative BM

MDS- myelodysplastic syndrome

RA- refractory anemia

RAEB Sideroblastic

anemia CMML

MPD- myeloproliferative disorders

Polycythemia vera CML Essential

thrombocythemia Myelofibrosis

Aplastic anemia Typically pancytopenia

(PRCA- anemia only) Causes- autoimmune,

chloramphenicol, carbamazepine, radiation, benzene

s/s- of pancytopenia Dx- bone marrow examination- biopsy Rx- ATG/ALG with Cyclosporin-in

elderly or HSCT-in young

HSCT Hematopoietic stem cell transplantation BMT or PBSCT (preferred) or cord blood Indications- Multiple myeloma AML in remission, ALL in second remission, CML Relapsed lymphoma Aplastic anemia MDS Congenital storage disorders, immunodeficiencies,

hemoglobinopathies Collagen vascular disease Autologous or Allogeneic

HSCT considerations Cost HLA matched donor (allogeneic) Complications- Infections Mucositis Hepatic veno-occlusive disease GVHD (allogeneic)- acute or chronic Mortality- 10-20%