Download Free Medical Lab interpretation Hemoglobin abnormalitiess PowerPoint Presentation

Lab interpretation Hemoglobin abnormalitiess PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : hemoglobin abnomralitites

Tags : cbc interpretation

Published on : Nov 09, 2019 | Views : 3662 | Downloads : 18

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Lab interpretation part 1 Hemoglobin abnormalities By: Dr. Mostafa Mahmoud Abdallah
Slide 2-

Case 1 46 year old male patient came asking for follow up of his lab investigations. The patient has no past medical history except for h.pylori gastritis diagnosed 6 months ago and treated with the triple regimen. He is asymptomatic except for mild heart burn that comes and goes with certain types of food. He is a business man and goes to the GYM daily and follow a healthy life style. General and abdominal examination is normal and the patient has a muscular body.
Slide 3-

Case 1 How to approach this case ?
Slide 4-

Case 1 History: Hyper viscosity symptoms. Thrombosis or bleeding . Symptoms associated with PV. Tumors. past history of cardio-pulmonary disease. Drug history. Social history. Family history.
Slide 5-

Examination: General. Cardio-pulmonary. Organomegaly.
Slide 6-

Polycythemia Polycythemia: an abnormal elevation of hemoglobin (Hgb) and/or hematocrit (Hct) in peripheral blood. Increased hemoglobin >16.5 g/dL (10.3 mmol/L) in men or >16.0 g/dL (10.0 mmol/L) in women. Increased hematocrit >49 percent in men or >48 percent in women
Slide 7-

polycythemia Relative Absolute Primary Secondary RBS count is 5.2 in men and 4.6 in females
Slide 8-

ppt slide no 8 content not found
Slide 9-

ppt slide no 9 content not found
Slide 10-

polycythemia Lab investigations for all patients : BMP Urinalysis Serum erythropoietin Pulse oximetry
Slide 11-

ppt slide no 11 content not found
Slide 12-

Case 1 Patient was taking daily high dose anabolic steroids with all his other tests are normal. Patient has absolute secondary polycythemia caused by the anabolic steroids. Follow up after 2 months of stopping the anabolic steroids his Hgb falls down to 16.
Slide 13-

Case 2 44 years old with no past medical illness came for follow up of her lab investigations She has no past medical history except for iron that was prescribed in 2018 as a diagnosis of IDA but she did not take it regularly Other than that there is no active complains Her renal and liver functions are normal and her CBC result as follows:
Slide 14-

How to approach this case ?
Slide 15-

Case 2 History Examination
Slide 16-

Normal level of Hgb
Slide 17-

Microcytic anemia Most common causes : IDA Thalassemia Anemia of chronic inflammation (chronic disease )
Slide 18-

Microcytic anemia Did you hear about Mentzer index ?
Slide 19-

Microcytic anemia
Slide 20-

Iron deficiency anemia IDA associated symptoms : pica , pagophagia , restless leg syndrome , atrophic glossitis , angular cheilitis , koilonychia
Slide 21-

Iron deficiency anemia Diagnosis of iron deficiency anemia requires laboratory-confirmed evidence of anemia, as well as evidence of low iron stores. In IDA you will find in the CBC : Low red blood cell (RBC) count Low hemoglobin and hematocrit Low absolute reticulocyte count Low mean corpuscular volume (MCV) and low mean corpuscular hemoglobin (MCH) The platelet count may increase High RDW
Slide 22-

Microcytic anemia Microcytic anemia
Slide 23-

Case 2 Iron profile and ferritin ordered and the following results came : Ferritin : 20 (N) Iron : 5.1 (L) TIBC : 93 (H) Fe saturation : 6 (L( What will you do next ?
Slide 24-

ppt slide no 24 content not found
Slide 25-

Management of iron deficiency anemia The recommended dose for iron replacement 150-200 elemental iron per day . If the treatment is adequate the hemoglobin deficit should be halved by approximately one month. Treatment should continued for 3 months after normalization of the hemoglobin level What is the first indicator of effective treatment ?
Slide 26-

Case 3 58 year old male patient came to the clinic for removal of a sebaceous cyst in the axilla the patient has no past medical history and is not taking any current medications. On reviewing of his lab results the following results was found ?
Slide 27-

Case 3 How to approach this case ?
Slide 28-

Case 3 History Examination What will you do next ?
Slide 29-

Causes of normocytic anemia Increased red blood cell loss or destruction Decreased red blood cell production Over expansion of the plasma volume What is the most common cause ?
Slide 30-

ppt slide no 30 content not found
Slide 31-

ppt slide no 31 content not found
Slide 32-

Normocytic anemia Patient with : Mild anemia Normal WBCs and platelets Normal RDW Known chronic illness Consider anemia of chronic illness
Slide 33-

Normocytic anemia If not ? Retic counts Peripheral smear
Slide 34-

Reticulocytes Normal retic percentage in a normal individual is 0.5 to 2.5 Absolute retic count = % retics * (pt's Hct / normal Hct). Retic index = absolute reticulocyte count / maturation factor. Retic index ≥2 adequate response.
Slide 35-

Case 3 The retic count was ordered and the results are as follows
Slide 36-

Peripheral smear Minor population of microcytic cells Minor population of macrocytic cells
Slide 37-

Peripheral smear Spherocytes (hereditary spherocytosis, autoimmune hemolysis, G6PD deficiency)
Slide 38-

Peripheral smear Elliptocytes hereditary elliptocytosis
Slide 39-

Peripheral smear Schistocytes microangiopathic hemolysis as TTP and DIC
Slide 40-

Peripheral smear Burr cells hemolytic uremic syndrome
Slide 41-

Peripheral smear Heinz bodies G6PD and hemolytic anemia
Slide 42-

Peripheral smear Howell jolly bodies asplenia or splenic dysfunction as sickle cell anemia
Slide 43-

ppt slide no 43 content not found
Slide 44-

Case 3 Peripheral smear :Mild normochromic normocytic anemia with marked anisopoikilocytosis including many spherocytes, moderate polychromasia, few howell jolly bodies, ovalocytes, occasional schistocytes, acanthocytes. Haptoglobin : below 10
Slide 45-

Case 3 Is the patient diabetic or not and how to confirm ??
Slide 46-

Case 4 63 year old male came complaining of 2 weeks H/O of numbness of both both lower limbs with unsteady gait. theres is also subjective loss of sensation on the soles with hotness sensation No other neurological signs No past medical history His lab investigations are as follows :
Slide 47-

How to approach this case ?
Slide 48-

Case 3 History Examination
Slide 49-

Classification of Macrocytic anemia Megaloblastic Non- megaloblastic Increased reticulocytes Normal reticulocytes
Slide 50-

Macrocytic anemia
Slide 51-

ppt slide no 51 content not found
Slide 52-

Macrocytic anemia How will you proceed ? Repeat the CBC Peripheral smear Retic count Vitamin b12 levels Folate level
Slide 53-

ppt slide no 53 content not found
Slide 54-

ppt slide no 54 content not found
Slide 55-

Case 4 Repeating the CBC came with the same result Peripheral smear shows megaloblastic anemia Retic count 1% Other results
Slide 56-

Vitamin b12 correction dose Children : 50 to 100 mcg parenterally once per week. Adult : oral 1000 mcg daily or parenteral 1000 mcg per week. Till when ?
Slide 57-

Special thanks to Dr/ Hassan Yousef Dr/ Mohamed Salem and Dr/ Nahed Ragab
Slide 58-

THANK YOU presented by Dr/ Mostafa Abdallah