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Lab interpretation Hemoglobin abnormalitiess PowerPoint Presentation

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Description : hemoglobin abnomralitites

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Published on : Nov 09, 2019 | Views : 4089 | Downloads : 18

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Lab interpretation part 1 Hemoglobin abnormalities By: Dr. Mostafa Mahmoud Abdallah
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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.
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Case 1 How to approach this case ?
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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.
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Examination: General. Cardio-pulmonary. Organomegaly.
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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
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polycythemia Relative Absolute Primary Secondary RBS count is 5.2 in men and 4.6 in females
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polycythemia Lab investigations for all patients : BMP Urinalysis Serum erythropoietin Pulse oximetry
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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.
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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:
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How to approach this case ?
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Case 2 History Examination
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Normal level of Hgb
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Microcytic anemia Most common causes : IDA Thalassemia Anemia of chronic inflammation (chronic disease )
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Microcytic anemia Did you hear about Mentzer index ?
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Microcytic anemia
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Iron deficiency anemia IDA associated symptoms : pica , pagophagia , restless leg syndrome , atrophic glossitis , angular cheilitis , koilonychia
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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
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Microcytic anemia Microcytic anemia
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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 ?
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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 ?
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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 ?
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Case 3 How to approach this case ?
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Case 3 History Examination What will you do next ?
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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 ?
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Normocytic anemia Patient with : Mild anemia Normal WBCs and platelets Normal RDW Known chronic illness Consider anemia of chronic illness
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Normocytic anemia If not ? Retic counts Peripheral smear
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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.
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Case 3 The retic count was ordered and the results are as follows
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Peripheral smear Minor population of microcytic cells Minor population of macrocytic cells
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Peripheral smear Spherocytes (hereditary spherocytosis, autoimmune hemolysis, G6PD deficiency)
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Peripheral smear Elliptocytes hereditary elliptocytosis
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Peripheral smear Schistocytes microangiopathic hemolysis as TTP and DIC
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Peripheral smear Burr cells hemolytic uremic syndrome
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Peripheral smear Heinz bodies G6PD and hemolytic anemia
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Peripheral smear Howell jolly bodies asplenia or splenic dysfunction as sickle cell anemia
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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
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Case 3 Is the patient diabetic or not and how to confirm ??
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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 :
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How to approach this case ?
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Case 3 History Examination
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Classification of Macrocytic anemia Megaloblastic Non- megaloblastic Increased reticulocytes Normal reticulocytes
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Macrocytic anemia
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Macrocytic anemia How will you proceed ? Repeat the CBC Peripheral smear Retic count Vitamin b12 levels Folate level
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Case 4 Repeating the CBC came with the same result Peripheral smear shows megaloblastic anemia Retic count 1% Other results
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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 ?
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Special thanks to Dr/ Hassan Yousef Dr/ Mohamed Salem and Dr/ Nahed Ragab
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THANK YOU presented by Dr/ Mostafa Abdallah