Definition: Red Blood Cell Count (RBC), or other laboratory parameters (HGB, PCV) are lower than normal.
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1 ANEMIAS
2 Anemia is usually a symptom, that is associated with another disease, e.g. with chronic inflammation or with malignancy. Definition: Red Blood Cell Count (RBC), or other laboratory parameters (HGB, PCV) are lower than normal. Male: RBC: < 4.4 T/l HGB: < 135 g/l PCV: < 0.40 l/l Female: RBC: < 3.8 T/l HGB: < 120 g/l PCV: < 0.37 l/l
3 Classification of Anemias I. II. III. BLOOD LOSS: a. acute: traumatic shock, b. chronic: gynecological or gastrointestinal diseases. HEMOLYTIC ANEMIAS: a. intrinsic (intracorpuscular) abnormalities: 1. abnormalities of cytoskeleton, 2. enzyme deficiencies, 3. disturbances of hemoglobin synthesis. b. extrinsic (extracorpuscular) abnormalities: 1. antibody mediated, 2. mechanic traumas of RBCs, 3. infections. ABNORMAL RBC DEVELOPMENT
4 Thalassemia Peripheral Blood
5 Classification of Anemias Size of RBC (MCV) Normocytic Hb Content of HypoRegenerative RBC Aregenerative Anemias Anemias (MCH) Normochromic Aplastic Anemias Hemolytic anemias Anemia due to Acute Blood Loss Microcytic Hypochromic Iron deficiency Anemia Macrocytic Hyperchromic Megaloblastic Anemias
6 Laboratory Diagnosis of Anemias RBC: T/l MCV: fl WBC: 4-10 G/l PLT: G/l MCH: pg MCHC: g/l HGB: g/l PCV: l/l Reticulocyte count (relative to RBC): %
7 Blood Chemistry Serum Iron: μmol/l TIBC: μmol/l Transferrin saturation: (Quotient of serum iron and TIBC) Haptoglobin concentration: 6-28 μmol/l (its level decreases during hemolysis)
8 Examinations Medical history, Symptoms and Findings: a. Medical History: nutritional habits, dyscoloration of urine and stool, gynecological history, previous diseases: chronic inflammation, malignancy. b. Symtoms: weakness, fatigue, short of breath, palpitation, angina pectoris, headache, sleeping problems, flattened nails, dry skin, hair loss, digestive disorders, motivelessness (DD: depression). c. Findings: pallor (conjunctiva, nail bed), systolic murmur, tachycardia, jaundice, splenomegaly, paresthesia, glossitis. Symptoms and findings depend on the type of anemia and its duration.
9 Laboratory examinations I. Basic: Blood test, thrombocyte- and reticulocyte count, BSR, Urine test, Serum: creatinine, bilirubin, LDH, iron, ferritin, haptoglobin, hemopexin, Blood in stools. If cause of anemia is not clear: Gastroscopy, colonoscopy, gynecological examination, Special laboratory tests: Schilling-test, direct and indirect Coombs test, Hgb-electrophoresis in thalassemia and sickle cell anemia, Bone marrow smear.
10 Laboratory examinations II. In vivo examinations: 1.) Schilling test, 2.) Life span of RBCs. In vitro examinations: 1.) serum ferritin level, 2.) serum vitamin B12 level, 3.) serum and RBC folic acid level, 4.) erythropoietin level.
11 Laboratory Diagnosis of Hypochromic Anemia MCHC Anemia due to Iron deficiency Anemia Chronic Inflammation or Malignancy Decreased, depending At the lowest level on the severity of anemia of the normal range or decreased Serum iron decreased decreased TIBC elevated decreased MCV MCH Bone marrow empty iron storages normal
12 Iron Deficiency Anemia Peripheral Blood
13 Causes of Iron Deficiency Anemia 1. Chronic Blood Loss gynecological bleeding, gastrointestinal bleeding rarely hematuria, hemoglobinuria. 6. Increased Needs preterm neonates, puberty, pregnancy. 11. Nutritional Habits 13. Malabsorption gastrectomy, celiac disease.
14 Causes of Vitamin B12 Deficiency 1. Nutritional: vegetarianism 2. Malabsorption: a. Gastric origin: lack of IF, pernicious anemia, gastrectomy. b. Bowel origin: diverticulosis, blind loop syndrome, bowel resection, inflammatory bowel diseases.
15 Folic acid deficiency 1. Nutritional: alcoholism, starvation, elderly patients, nutritional habits. 2. Malabsorption: gastrectomy, bowel resection, inflammatory bowel diseases, celiac disease. 3. Increased consumption: pregnancy, brest feeding, preterm neonates, inflammatory diseases: rheumatoid arthritis, psoriasis, hematological diseases, malignant diseases. 4. Medical treatment antiepileptics, 5. Others: active liver disease, heart failure.
16 Megaloblastic Anemia Peripheral Blood
17 Megaloblastic Anemia Bone Marrow
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Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name
Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve