Supara Leechasan,M.D Hematologist Bangkok Hospital 12 September 2016

Transcription

1 Supara Leechasan,M.D Hematologist Bangkok Hospital 12 September 2016

2 From Greek meaning without blood Insufficient RBC mass to adequately deliver Oxygen to peripheral tissue Anemia is not a disease but a consequenceof another acquired or genetic abnormality

3 WHO defines Anemia as Hemoglobin level < 13 g/dl in Men < 12 g/dl in Women

4 The reduced inspired Oxygen tension associated with altitude exacerbates the effects of anemia. Anemia is usually mild and picked up at blood testing for periodic flying medical examination. Symptomatic anemia is rare.

5 Applicants should with Hb < 13 g/dl in Men => be < 12 g/dl in Women investigated Fit to fly depend on: o o Hemoglobin level (Mild,Moderate,Severe) Onset of Anemia (Acute, Chronic)

6 Severe anemia Not fit to Fly ( Hb < 7.5g/dl) Patients with long standing Anemia (eg. Chronic renal failure) often have good cardiovascular compensation and experience few problems with travel.

7 History taking Physical examination Laboratory tests

8 Hb.( g/dl) Hct (%) Children Male Female ( ) Female ( > 50 ) Pregnant women

9 General : age,sex,occupation Inadequate intake :Vegetarian Blood loss : Blood donation, period, hemorrhoid, melena, hematemesis Malabsorption : Diarrhea Comorbid diseases : CRF,Liver cirrhosis, SLE, Hypothyroidism,TB, Cancer, MM, AIDS Drug history : Herb, Drug : induce PU, hemolysis in G-6 PD def Family history :Thalassemia

10 Onset of anemia : acute, chronic History of blood transfusion dark urine (G-6 PD def,pnh) sore tongue(glossitis) Precipitating : fever -> anemia,dark urine,jaundice

11 Dyspnea on exertion Palpitations Angina pectoris Intermittent claudication Headache Syncope anorexia Dizziness/vertigo Nausea Cold intolerance Amenorrhea Decrease libido/impotence

12 Vital signs: Postural hypotension (acute bl. loss) Hypertension (CRF) Fever (Infection, leukemia, SLE) Bradycardia (hypothyroidism)

13 GA : Jaundice (hemolysis, liver dis), Thalassemic facies Edema (CRF, CHF) ; myxedema koilonychia (Fe def), Glossitis (Fe, B12 def ), premature grey hair (B12 def) malar rash / DLE / oral ulcer / polyarthritis (SLE) oral thrush / OHL / PPE (HIV) petechiae (thrombocytopenia); signs of chronic liver disease

14 Splenomegaly (extravascular hemolysis, portalhypertension,infection,leukemia,lymphoma) Lymphadenopathy (HIV, neoplasm, SLE,TB) PR - melena, rectal shelf, hemorrhoids, prostate gland Neuro proprioception defect (B12 def), Slow relaxation of reflex

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18 For all: CBC &peripheral smear Size of red blood cells: (small/ normal/ big) Abnormal cells on microscopic examination Status of leukocytes and platelets Reticulocyte count ability of marrow to respond to anemia

19 For some: Hemoglobin typing - Thalassemia disease Serum ferritin, Iron study serum B12 level, folate level LDH, Bilirubin, haptoglobin - hemolysis Coombs test - AIHA Calcium, globulin, BUN/Cr, Urine Bence Jones,SPEP, BM study, bone survey (MM) BUN / Cr, urine exam CRF TFT - hypothyroidism Bone marrow study stem cell disorders, myelophthisis

20 Onset Acute Subacute to chronic Pathogenesis Disorders of erythrocyte production Hemolysis Bleeding MCV Microcytic (MCV < 80 fl) Normocytic (MCV fl) Macrocytic (MCV > 100 fl)

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22 Microcytic anemia Iron deficiency anemia Thalassemia anemia of chronic disease (บางราย) sideroblastic anemia anemia from other cause +Underlying thalassemia

23 Normocytic anemia Primary marrow disorders anemia of chronic disease CRF Mild iron deficiency acute bleeding hemolysis (except thalassemia) endocrine disorders

24 Macrocytic anemia Megaloblastic anemia Non-megaloblastic reticulocytosis, autoagglutination liver disease alcoholism primary marrow disorders: AA, MDS Drugs (AZT, hydroxyurea, chemotherapy) hypothyroidism

25 History Physical examination CBC, MCV Blood smear Reticulocyte count Clinical diagnosis & decision making & initial management Further investigation

26 Iron deficiency anemia Thalassemia Megaloblastic anemia

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