Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Approach To A Patient With Anemia
1. Approach To A Patient With Anemia
Dr. Mohammad Usman Shaikh
Assistant Professor,
Aga Khan University Hospital.
2. Hematology
• Study of blood forming tissue and circulating blood
component
• Clotting factors
• Blood groups
• CBC and smear examination regardless of specialty
• Accessible, close proximity to tissues, often provide
some information
• Important for accurate diagnosis and therapeutics
choices
3. Manual Versus Automation
Feasibility:
Workload:
• Depend on number of samples per day
• Less than 20 samples, prefer manual method
• Tertiary care hospital setting in western hospitals,
CBC is mandatory for consultation.
• Rapid analysis
• Require only an appropriate blood sample.
• Measure 8-25 variables, no equivalent manually.
5. Electrical Impedance
Detection & measurement of changes in
electrical resistance produced by cells as
they passes via a small aperture
Electrical resistance between two electrodes,
or impedance in current leads to the formation of
pulses
6. A stream of cells passes through aperture across which
electrical current is applied. Each cell that passes alters
electrical impedance and can thus be counted and
sized.
Good Pulse
Diluent stream
7. Sensing Zone
Red Blood
Cells
Electrical Impedance
Oscilloscope
Oscilloscope
Each time a cell passes a
pulse is produced.
The pulse height is
proportional to Cell
volume
Animation by M.A.Ghauri
8. Light Scattering
O-3 deg
(relative size)
Light Scatter estimates relative
cell size based on forward
scatter - that is a measurement
of cross-sectional diameter
Laser
9. Hemogram/ Histogram
• Visual representation of what was counted at the
aperture.
• Verify a count that has a typical pattern according to
the reference ranges
• Alert for possible interfering particles and
abnormalities
10.
11. Hematological Variables on Automation
RBC
Hb, HCT, MCV, MCH, MCHC, RBC count, RDW
WBC
Total count, differential and absolute count
Platelet
Total count
Others: Nucleated RBC, reticulocyte count
flags
13. Anemia
• Laboratory data is more informative when
considered in the context of history and physical
examination
14. Approach to Anemia
• History:
– Family history– inherited causes such as
thalassemia, sickle cell anemia, G6PD deficiency
and hereditary spherocytosis.
– In most of these cases morphological findings of
smear are diagnostic
• B symptoms
• Systemic or other chronic disorders
15. History
• Drug history:
• History of blood loss
• Clinically: Degree of pallor, with or without
icterus, angular stomatitis and
glossitis, koilonychia, lymphadenophathy and
hepatoslenomegaly
24. Classification of Anemia on the Basis of MCV
Less than 76fl --- microcytic
Iron deficiency
Thalassemia
Anemia of chronic disease
Sideroblastic anemia and lead poisoning
MCV between 76 to 96 fl
Anemia of chronic disease
Acute blood loss
Chronic renal failure
Anemia due to infiltration
Aplastic anemia
25. Classification of Anemia on the Basis of MCV
• MCV more than 96fl
– Macrocytic anemia
• Megaloblastic: B12 and folate deficiency
• Non megaloblastic:
– Hemolysis
– MDS
– Hypothyroidism
– Liver disease
26. Etiological Classification of Anemia:
• Increase destruction
1-Hemolytic anemia
inherited and acquired
• Impaired Production
2-Anemia due to bone marrow failure states
3-Nutritional deficiencies
4-Anemia due to infiltrative disorders
5-Anemia of chronic disorders
60. Reticulocyte
• Reticulocyte: larger than
normal RBC
• RNA and Golgi remnants,
Ribosome, maturation take
another 24 to 48 hours in
the blood circulation
61.
62.
63. Conclusions
• Peripheral blood smear examination and reporting is one
of the most important aspect of hematology.
• It is diagnostic in many hematological and non
hematological disorders.
• It is cost effective and non invasive and helps the
clinicians in further diagnostic workup