Approach to Anemia

52 Pages·2017·2.41 MB·English

Approach to Anemia: An
Interactive Discussion
Mark M. Udden, MD
Chief, Benign Hematology
Baylor College of Medicine
Disclosures
I didn’t do it.
You didn’t see me.
You have no evidence.
Consultant for Novartis
Co-Investigator for same
Free meals from Injectafer
people
Bart Simpson
Objectives: Develop an
Approach
• to evaluation of microcytic
anemia anemia
• to evaluation of microcytic
anemia
• to evaluation of iron
deficiency
• to anemia of chronic
disorders
• to anemia of renal disease
After the Hx and PE:
Peripheral Blood Smear Reticulocyte Count
Patient 1
A 25-year-old woman presents with
weakness, fatigue, and pallor. She reports
that she has had heavy periods for most of
her adult life and that she has three children,
the youngest of which is 10 months old.
Her CBC shows a Hct of 28 %, with an MCV
of 72 fL, and a platelet count of 540,000. The
WBC is normal.
Iron Deficiency Anemia
• History
– Bleeding
– Pica
– Restless Legs
– Subtle neurologic dysfunction
– Dysphagia
• Physical Exam
– Painless stomatitis
– Spoon nails
– Blue Sclera?
– Telangiectasia
Peripheral Blood Smear in Fe
Deficeincy
Peripheral Blood Smear in Fe
Deficeincy
Forms of Pica Reported in Association
with Iron Deficiency
• Pagophagia Ice
• Geophagia Clay, dirt
• Amylophagia Starch
• Geomelophagia Potatoes
• Gooberphagia Peanuts
Unnamed Forms of Pica
• Ash
• Baking Powder
• Card Board
• Paper
• Venetian Blind Dust
• Wood, Toothpicks