1 / 17

Introduction to Haematology!

Introduction to Haematology!. Starting with anaemias !. Elliot Catchpole PCMD. Objectives. To be able to define what an anaemia is To describe the symptoms of classical anaemia

clive
Télécharger la présentation

Introduction to Haematology!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Introduction to Haematology! Starting with anaemias! Elliot Catchpole PCMD

  2. Objectives • To be able to define what an anaemia is • To describe the symptoms of classical anaemia • To identify the different aetiologies of anaemia and how to differentiate between them (which investigations to perform) • To be able to select an appropriate course of management for anaemia based on the aetiology.

  3. Lets begin... • What is in blood?

  4. CELLS Platelets Plasma WBC RBC ROTEINS P E N LECTROLYTES UTRIENTS

  5. ERYTHROBLAST KIDNEY • What is in blood? • Red blood cells? EPO RETICULOCYTE RBC RBC RBC RBC RBC

  6. ANAEMIA • “A reduction in haemoglobin, either through a decreased RBC mass or increased plasma volume” • Measuring RBC activity • Haematocrit (or PCV)= % concentration of RBC’s in blood Males = 45(13-18Hb) Females = 40 (11.5-16Hb)

  7. MCV • Mean Cell Volume = The size of each RBC MACROCYTIC >96 Normocytic 76-96 Microcytic <76 Haemolysis Non-Megaloblastic • -IRON deficiency • Thalassaemias • Sideroblastic -Alcohol -Liver Disease -G6PD Deficiency -Hereditary spherocytosis -Paroxysmal Nocturnal Haemoglobinurea -Autoimmune Haemolysis -Sickle Cell Megaloblastic B12andFolate Chronic Disease

  8. Presentation • All present the same! Severity based on HCT Fatigue Pallor >30 = Asymptomatic 25-30 = Fatigue 20 -25 = Dyspnoea, confusion <20 = MI ANAEMIA Light-headedness

  9. Iron Deficiency • CAUSES = 1) Bleeding 2) Diet (incl. Vit C) • *PRESENTATION* = Spoon nails, angular stomatitis (chronic) • *INVESTIGATIONS* = RDW • TREATMENT = 1) Ferrous Sulphate (PO) 2) Blood Transfusion (IM Fe if cannot tolerate infusion)

  10. Thalassaemia • CAUSES: Genetics (Major=homozygote, minor/trait=heterozygote) • *PRESENTATION* = (minor) MCV, minor symptoms • INVESTIGATIONS – smear – ‘Target cells’ *Electrophoresis* • TREATMENT - Trait = No active treatment Major = Lifelong transfusions

  11. Sideroblastic Anaemia • CAUSES = Genetic, Alcohol, Lead, Medications, Vit B6 deficiency • INVESTIGATIONS = *Prussian Blue stain* • TREATMENT = Genetic/deficiency: Pyridoxine OTHER: Remove cause

  12. Chronic Disease • Caused by many chronic diseases • Treat the underlying cause

  13. Questions • A 54 year old women comes to the clinic due to fatigue. FBC shows a decreases HCT (30) and an MCV of 68.What is the most likely dfiagnosis when the following additional features are described? • Elevated Red-cell distribution of width and high platelets • Low Iron, low TIBC, low reticulocytes. A history of rheumatoid arthritis • A very low MCV with few symptoms and an elevated red-cell count. Normal Iron studies.

  14. Questions • A 23 year old woman has been feeling tired and lethargic for the past 18 months. She occasionally feels dizzy on standing and is generally weak. Otherwise, she is well. FBC showed:Hb – 9.5mgMCV – 69fl • Which is the single most appropriate further investigation to confirm the diagnosis? • a) Hb electrophoresisb) HBA2 levelc) Serum Iron + Ferritind) Thyroid function testse) Vitamin B12 + Folate levels

  15. Questions • A pale 60 year old man presents with feelings of tiredness and light-headedness. MCV – 60flHCT – 30 • His Faecal occult blood test is negative 3 times. What is the next best step in the management of this patient? • a) Start iron replacement therapyb) Electrophoresisc) Transfused) Colonoscopye) Peripheral Blood smear

  16. D) Colonoscopy • There is such a high incidence of microcytic anaemia in colonic malignancy that excluding GI malignancy is very important in this age group.Faecal occult blood is not sensitive enough to exclude colon cancer.

More Related