Susan Stegman, MD Medical Director AXA Equitable Life May 3, 2016
|
|
- Dortha Wood
- 5 years ago
- Views:
Transcription
1 Susan Stegman, MD Medical Director AXA Equitable Life May 3, 2016
2 Underwriting impact Anemia overview Classification of anemia Specific anemia topics Iron deficiency anemia Thalassemia Megaloblastic anemia Mixed anemias Myelodysplasia Case studies Conclusion
3 Mortality risk based on: Type and severity of anemia Speed of onset Acute vs chronic anemia Other impairments contributing to anemia Appropriate evaluation, treatment and follow-up Compliance with treatment Risk of recurrence Note if any co-morbid conditions aggravated by anemia and those that exacerbate anemia Most anemias detected in aps information CBC done only on fresh blood, not useful on insurance applicants except for Hb level
4 Definition: Reduction in red blood cell mass causes decreased RBC oxygen-carrying capacity Hemoglobin <13g/dL in men, <12g/dL in women Exceptions Baseline decreased hemoglobin: Pregnancy Heavy menses Baseline increased hemoglobin: High altitude Heavy smoker Polycythemia vera
5 Epidemiology: Broad range of demographics Incidence depends on type of anemia Diverse group of diseases Genetic causes occur among certain ethnic groups and in specific geographic areas Nutritional causes often occur with lower socioeconomic status, common in third-world countries
6 Normal RBC microanatomy: Biconcave disc with no nucleus Flexible to fit easily through capillaries Filled with iron-containing protein hemoglobin Normal RBC physiology: RBC production stimulated by erythropoietin released by kidney Bone marrow produces RBCs 2.4 million new erythrocytes produced per second Each RBC circulates for days 25% of cells in human body are RBCs Nearly 40-45% of human blood volume consists of red blood cells
7 Normal RBC morphology
8 Genetic/inherited anemias Sickle cell anemia Thalassemia Hereditary spherocytosis G6PD deficiency Acquired due to nutritional/dietary factors Folate, iron, thiamine, B-12 deficiency Alcoholism Acquired due to underlying medical conditions Malignancy Renal disease GI/uterine bleeding Hematologic disorders Anemia of chronic disease
9 Based on mechanism of decreased hemoglobin 1. Blood loss (acute or chronic): COMMON 2. Decreased/defective RBC production: COMMON 3. Increased RBC destruction: UNCOMMON Based on color/hemoglobin content 1. hypochromic (pale color due to low Hb content) 2. normochromic (normal color with Hb content) Based on mean corpuscular volume (MCV) 1. microcytic: small RBCs due to decreased MCV 2. normocytic: normal RBC size and MCV 3. macrocytic: large RBCs due to increased MCV
10 MCV: average volume of each red blood cell determined by: 1. Iron stores/ferritin: deficiency causes decreased hemoglobin production => decreased cytoplasm => smaller than normal RBCs => low MCV 2. B-12 and folate: low levels cause impaired DNA synthesis => no signal to progress from G2 growth stage to mitosis = cell growth without division => increased cytoplasm => larger than normal RBCs => elevated MCV
11
12
13 Red cell distribution width (RDW) Reported on all CBCs Measures the range of RBC volume variation Normal RDW 11-15% Distinguishes different types of anemias with same MCV High RDW reflects wide range of RBC sizes
14
15 Normal RDW Heterozygous beta thalassemia (beta thalassemia minor or trait) Anemia of chronic disease Elevated RDW Iron deficiency anemia Sickle thalassemia cell disease Thalassemia intermedia Alpha and beta thalassemia major
16 Normal RDW Aplastic anemia Chronic liver disease Chemotherapy Antiviral medications Alcohol dependence (formerly alcoholism) Elevated RDW Folate or B-12 deficiency Immune hemolytic anemia Cytotoxic chemotherapy Chronic liver disease Myelodysplastic syndrome
17 Elevated RDW/normal MCV: EARLY iron, vitamin B-12 or folate deficiency Dimorphic anemia (concurrent iron AND folate deficiency) Sickle cell disease Chronic liver disease
18 Focus on anemias that: 1. frequently seen in underwriting 2. not an outright decline 3. severity may warrant postpone or ratings 4. can have wide range of presentations and mortality risks
19 3 million cases in US annually Caused by decreased iron intake or absorption and/or chronic blood loss Not seen with acute blood loss (takes time to deplete iron stores from bone marrow) Affects nearly 1 billion persons worldwide 600 million cases of moderate IDA worldwide (8.8% of world population) 375 million more with mild IDA Causes 50% of anemia cases worldwide Leading cause is parasitosis
20 Laboratory findings Low serum iron, ferritin and MCV Elevated TIBC, transferrin and RDW Secondary thrombocytosis Peripheral blood smear: Hypochromia Microcytosis Poikilocytosis (variation in shape) Anisocytosis (variation in size causing elevated RDW) Nucleated RBCs Diagnosis often made based on laboratory findings, rarely BM biopsy with iron staining
21 Causes: Blood loss Decreased iron absorption Decreased iron intake Treatment Iron supplementation to correct depleted bone marrow ferritin stores Oral iron first-line IV iron when impaired iron absorption or when rapid supplementation needed Dietary adjustments to increase intake of heme iron (meat, eggs)
22 Mortality risk Lower in pregnancy and women of child-bearing ages unless Hb <9.5 Normal Hb levels can be of concern in those with baseline elevated Hb GI blood loss always a concern for underlying malignancy especially if age >50 Potentially higher risk in cases of: Young males Older men and post-menopausal women New-onset without apparent cause Hx anemia with marked decrease from usual Hb level
23 Microcytic, hypochromic anemia Autosomal recessive disorder that leads to deleted or dysfunctional hemoglobin Defective hemoglobin production leads to microcytosis Resultant improper O2 transport and destruction of RBCs (hemolysis) Decreased number of intact circulating RBCs leads to anemia
24 Why is this disorder so confusing? Need to understand basics of hemoglobin structure Protoporphyrin ring with iron in the center and 4 globin chains 2 alpha globin chains with 4 genes each 2 beta globin chains with 2 genes each Thalassemia occurs with either alpha gene deletions or beta gene defects MCV disproportionately low compared to degree of anemia (MCV in 60s)
25
26 Alpha thalassemia (αα/αα) Deletion of one or more of the 4 globin chain genes 1 deletion = silent carrier normal labs 2 deletions = alpha thalassemia trait/minor mild microcytosis and hypochromia with no anemia 3 deletions = alpha thalassemia intermedia/hb H disease compensated hemolytic state, transfusions needed 4 deletions = hydrops fetalis (Hb Barts) decompensated hemolytic state uniformly fatal
27 Beta thalassemia (ββ) Defect in one or both β globin chain genes 1 defect = heterozygous beta thalassemia SAME AS beta thalassemia trait SAME AS beta thalassemia minor 2 defects = homozygous beta thalassemia SAME AS beta thalassemia major SAME AS Cooley s anemia: most severe type of congenital hemolytic anemia 2 partial defects Beta thalassemia intermedia: less severe form than homozygous beta thalassemia can survive into adulthood without treatment
28
29 Treatment Alpha thalassemia Silent carrier: none Trait: none Hb H disease: periodic transfusions for severe (<7g/dL) or symptomatic anemia, chelation therapy for iron overload from transfusions Hydrops fetalis: supportive, uniformly fatal Beta thalassemia Minor/heterozygous/trait: none Intermedia: ranges from none to transfusion-dependent Major: transfusion therapy due to chronic hemolysis Splenectomy due to splenic sequestration Chelation therapy for transfusion iron overload BM transplantation
30 Increased mortality risk: Transfusion-dependent beta thalassemia Iron overload from chronic transfusion Progression of anemia from chronic hemolysis Alpha thalassemia intermedia/hb H Beta thalassemia intermedia No increased mortality risk: Alpha thalassemia silent carrier or trait/minor Beta thalassemia trait/minor
31 Due to vitamin B-12 or folate deficiency from inadequate intake or poor GI absorption B-12 deficiency Gastrectomy/gastric bypass surgery/pernicious anemia Ileal resection or bypass Malabsorption Chronic pancreatitis Fish tapeworm infection Crohn s disease involving terminal ileum Folate deficiency Alcoholism Pregnancy (increased demand for neural tube formation) Cirrhosis malabsorption
32 Laboratory: Low Hb Elevated MCV >99 Peripheral blood smear Oval-shaped macrocytic RBCs Anisocytosis Poikilocytosis Hypersegmented neutrophils Treatment Oral folate and/or IM B-12 injections Correct underlying cause(s) of deficiency
33 Normal neutrophils Hypersegmented neutrophils
34 Dimorphic anemia Two distinct forms of RBCs are circulating simultaneously Examples: IDA combined with folate and/or B-12 deficiency Idiopathic acquired sideroblastic anemia with folate and/or B-12 deficiency Red blood cell transfusions Hemolytic anemias Erythropoietin therapy Alcohol dependence with GI blood loss Laboratory findings Low Hb Normal MCV (equal amounts of low and high MCV cells) Elevated RDW (wide variation in cell sizes)
35
36 Ineffective production ( dysplasia ) of all blood cells Also known as myelodysplastic syndrome (MDS) Disorder of hematopoietic stem cells Causes irreversible decrease in number and quality of blood-forming cells Incidence increasing with aging US population Often an indolent course
37 Median age at diagnosis years old Rare under age 50 Males >females Causes Primary/de novo (unknown cause) Secondary or treatment-related MDS due to prior chemotherapy or radiation (younger ages) Cigarette smoke use or exposure Toxic chemical exposure (benzene) Pre-existing chromosomal abnormalities (Down Syndrome)
38 Laboratory findings: Anemia: high MCV and RDW hemolysis Thrombocytopenia: Platelet clumping causes spurious low count Megakaryocytes Leukopenia: Hyper-segmented and hyposegmented neutrophils on peripheral blood smear
39
40
41 Clinical signs: Recurrent infections Excess bleeding from unknown cause Diagnosis: High index of suspicion needed especially with mild pancytopenia Hb <13.0mg/dL males, <12.0mg/dL females Plt count <150,000 WBC <4.0mg/dL Other causes of pancytopenia need to be excluded BM biopsy required to confirm diagnosis and determined correct subtype
42 Treatment Tailored to patient s age, overall health, MDS subtype and prognostic score RBC transfusions to correct anemia Platelet transfusions to reduce excess bleeding Antibiotics to combat more frequent infections due to low WBC BM transplantation can be curative
43 Can go undetected for years in milder cases Primarily a disease of older persons Higher mortality risk with exposure to: Cigarette smoke Chemotherapy/radiation Toxic chemicals Watch for anemia of unknown cause associated with: Thrombocytopenia or normal platelet count with history of frequent bleeding Frequent infections High MCV and high RDW
44 37F Build Long hx heavy menses takes bcp to control excessive flow APS reports usual Hb 11.0mg/dL with MCV 85, iron studies consistant with IDA Hb 3 mos ago was 9.5mg/dL with MCV 79 Diagnosis? Mortality risk?
45 45M Build Works in sales, entertains clients, extensive domestic travel Father died from liver disease Hx GERD, takes PPI daily APS reports Hb ranging from for the last 5 years, MCV 90, RDW 18 LFTs: AST 74 ALT 65 GGT 102 Diagnosis? Mortality risk?
46 69M Build Hx HTN, high chol well-controlled on meds Mother died of stomach cancer at age 61 Annual Hb levels from APS records: 2011: 14.5mg/dL 2012: 14.2mg/dL 2013: 13.9mg/dL 2014: 13.3mg/dL 2015: 12.5mg/dL Diagnosis? Mortality risk?
47 21F Build Menses very light for years Recently traveled to Greece to visit grandparents CBC done for college physical 3 yrs ago Hb 11.8mg/dL MCV 66 Repeat CBC at recent gyn exam: Hb 12.1mg/dL MCV 67 Diagnosis? Mortality risk?
48 72F Build Hx HTN, GERD, DM, high chol Tob use ½ ppd x 40 yrs, quit 12 yrs ago Recurrent sinusitis x 5 yrs, pneumonia in 2015 Most recent labs from APS records: A1c 6.2% (baseline) WBC 3.3, Hb 9.4, MCV 108, plts 104K Normal folate and B-12 levels Normal iron studies Normal renal and hepatic functions Diagnosis? Mortality risk?
49 39M Lives in Colorado, very active lifestyle APS labs: 2009 Hb 17.2, MCV Hb 17.4, MCV Hb 16.5, MCV 89 Fatigue noted at OV in 3/2015 while training for a marathon Blood in stool noted 9/2015, noted hemorrhoids on exam Hb 14.8, MCV 82 Diagnosis? Mortality risk?
50 Anemia encompasses a broad, diverse group of disorder Always take into account WBC, plt count, MCV and RDW in any case of anemia Elderly with anemia have higher mortality risk compared to younger ages No increased mortality risk associated with: Alpha thalassemia silent carrier/minor/trait Beta thalassemia heterozygous/minor/trait Be wary of myelodysplasia when anemia occurs with: history of bleeding problems and/or frequent infections Look for alcohol abuse or dependence in any case of anemia (8% of US population)
Microcytic Hypochromic Anemia An Approach to Diagnosis
Microcytic Hypochromic Anemia An Approach to Diagnosis Decreased hemoglobin synthesis gives rise to microcytic hypochromic anemias. Hypochromic anemias are characterized by normal cellular proliferation
More informationI. Definitions. V. Evaluation A. History B. Physical Exam C. Laboratory evaluation D. Bone marrow examination E. Specialty referrals
I. Definitions II. III. Red blood cell life cycle Iron metabolism IV. Causes of anemia A. Kinetic approach 1. decreased production 2. increased destruction 3. blood loss B. Morphologic approach 1. normocytic
More informationGeneral Characterisctics
Anemia General Characterisctics Definition: anemia is a decrease in red blood cells. Happens due to underproduction, increased destruction or loss of red cells. Diagnosis of anemia: Hgb < 135 (men) Hgb
More informationFaculty of Medicine Dr. Tariq Aladily
Iron deficiency anemia The most common anemia worldwide Only 10% of ingested iron is absorbed Most dietary iron occurs in meat products Absorbed in duodenum Hepcidin By inhibiting ferroportin, hepcidin
More informationRed cell disorder. Dr. Ahmed Hasan
Red cell disorder Dr. Ahmed Hasan Things to be learned in this lecture Definition and clinical feature of anemia. Classification of anemia. Know some details of microcytic anemia Question of the lecture:
More informationAnemia In the Insurance Applicant What do the numbers mean?
Anemia In the Insurance Applicant What do the numbers mean? Lisa Duckett, M.D. Vice President and Medical Director September 12, 2017 Goals of the presentation Develop a consistent way to analyze Complete
More informationHAEMATOLOGICAL EVALUATION OF ANEMIA. Sitalakshmi S Professor and Head Department of Clinical Pathology St John s medical College, Bangalore
HAEMATOLOGICAL EVALUATION OF ANEMIA Sitalakshmi S Professor and Head Department of Clinical Pathology St John s medical College, Bangalore Learning Objectives Laboratory tests for the evaluation of anemia
More informationDeconstructing the CBC
Deconstructing the CBC Dr. Ann M. Wexler Solano Hematology Oncology September 10, 2017 What Are the Major Components of Blood? Red Blood Cells (also called erythrocytes) White Blood Cells (also called
More informationIn adults, the predominant Hb (HbA) molecule has four chains: two α and two β chains. In thalassemias, the synthesis of either the α or the β chains
Thalassaemias Thalassemia Thalassemia is an inherited autosomal recessive blood disease. Associated with absence or reduction in a or b globin chains. Reduced synthesis of one of the globin chains can
More informationGenetics of Thalassemia
Genetics of Thalassemia Submitted by : Raya Samir Al- Hayaly Sura Zuhair Salih Saad Ghassan Al- Dulaimy Saad Farouq Kassir Sama Naal Salouha Zahraa Jasim Al- Aarajy Supervised by : Dr. Kawkab Adris Mahmod
More informationYear 2003 Paper two: Questions supplied by Tricia
QUESTION 65 A 36-year-old man presents in a post-ictal state after an observed generalised seizure. Full blood investigation shows: haemoglobin 0 g/l [128-175] mean corpuscular volume (MCV) 106 fl [80-7]
More informationEvaluation of Anemia. Md. Shafiqul Bari Associate professor (Medicine) SOMC
Evaluation of Anemia Md. Shafiqul Bari Associate professor (Medicine) SOMC Definition Anemia is operationally defined as a reduction in one or more of the major RBC measurements Hemoglobin concentration
More informationINTERELATIONSHIP BETWEEN IDA AND VITAMIN D DEFICIENCY IS NOW ESTABLISHED
INTERELATIONSHIP BETWEEN IDA AND VITAMIN D DEFICIENCY IS NOW ESTABLISHED Rationale for Combining Iron & Vit-D Vit D deficiency and Iron deficiency Anaemia the two most menacing disorders - are inter-related
More informationAnemia 1: Fourth year Medical Students/ October/21/ 2015/ Abdallah Abbadi.MD.FRCP Professor
Anemia 1: Fourth year Medical Students/ October/21/ 2015/ Abdallah Abbadi.MD.FRCP Professor Email: abdalla.awidi@gmail.com Main Hematological diseases A- Benign Hematology 1- Anemias 2- Bleeding disorders
More informationThalassemia Maria Luz Uy del Rosario, M.D.
Thalassemia Maria Luz Uy del Rosario, M.D. Philippine Society of Hematology and Blood Transfusion Philippine Society of Pediatric Oncology What is Thalassemia Hereditary Hemoglobin disorder Hemolytic anemia
More informationAnemia s. Troy Lund MSMS PhD MD
Anemia s Troy Lund MSMS PhD MD lundx072@umn.edu Hemoglobinopathy/Anemia IOM take home points. 1. How do we identify the condtion? Smear, CBC Solubility Test (SCD) 2. How does it present clincally? 3. How
More informationAnaemia in Pregnancy
Anaemia in Pregnancy Definition :anaemia is a pathological condition in which the oxygen-carrying capacity of red blood cells is insufficient to meet the body needs. The WHO : haemoglobin concentration
More informationHematology Unit Lab 1 Review Material
Hematology Unit Lab 1 Review Material - 2018 Objectives Laboratory instructors: 1. Assist students during lab session Students: 1. Review the introductory material 2. Study the case histories provided
More informationTypes of Anaemias and their Management. S. Moncrieffe, Pharm.D., MPH, Dip.Ed., RPh. PSJ CE Mandeville Hotel April 27, 2014
Types of Anaemias and their Management S. Moncrieffe, Pharm.D., MPH, Dip.Ed., RPh. PSJ CE Mandeville Hotel April 27, 2014 Objectives At the end of the presentations participants should be able to: 1. Define
More information4 Jumana Jihad Dr. Ahmad Mansour Dr. Ahmad Mansour
4 Jumana Jihad Dr. Ahmad Mansour Dr. Ahmad Mansour Anemia Decreased blood production Increased blood loss Hemolytic Hemorrhage Extravascular Intravascular Hemolytic (Further classification( Extrinsic Intrinsic
More informationBONE MARROW PERIPHERAL BLOOD Erythrocyte
None Disclaimer Objectives Define anemia Classify anemia according to pathogenesis & clinical significance Understand Red cell indices Relate the red cell indices with type of anemia Interpret CBC to approach
More informationThe LaboratoryMatters
Laboratory Medicine Newsletter for clinicians, pathologists & clinical laboratory technologists. A Initiative. Complete Blood Count This issue highlights: CBC, while ubiquitous, is an excellent diagnostic
More informationAplastic anamia & Sideroblastic anemia
Hematology Lecture 7 كلية التقنيات الصحية والطبية قسم التحليالت المرضية Aplastic anamia & Sideroblastic anemia اإلعداد: ظفر جبار دهاق فؤاد APLASTIC ANEMIA What is Aplastic anemia? Aplastic anemia is a
More informationL4-Iron Deficiency Anemia (IDA) & Biochemical Investigations
L4-Iron Deficiency Anemia (IDA) & Biochemical Investigations 1 st Year-College of Medicine Hematology Module-Biochemistry Semester II Dr. Basil OM Saleh Objectives Identify stages in development of IDA
More information* imagine if the Hb is free ( e.g. hemolysis ) in the plasma what happens?
In this lecture we will talk about Some characteristics of RBC. Erythrpoiesis : * During fetal & adult life. * its regulation. RBCs : - Appear under the microscope as circular,unnucleated and biconcave
More informationHypochromic Anaemias
Hypochromic Anaemias Dr Mere Kende MBBS, MMED (Path), MAACB, MACTM, MACRRM LECTURER-SMHS Anaemia LOW HEMOGLOBIN Anaemia Definition: Hb
More informationApproach to a pale child
Approach to a pale child Dr. Dafalla Ahmed Babiker Jazan university objectives Definition of anemia Classification and causes Important points in history and physical examination Investigations. Definition
More informationQUESTIONS OF HEMATOLOGY AND THEIR ANSWERS
QUESTIONS OF HEMATOLOGY AND THEIR ANSWERS WHAT IS TRUE AND WHAT IS FALSE? Questions 1 Iron deficiency anemia a) Is usually associated with a raised MCV. b) The MCH is usually low. c) Is most commonly due
More informationInterpreting the CBC. Robert Miller PA Assistant Professor of Clinical Pediatrics and Family Medicine USC Keck School of Medicine Retired
Interpreting the CBC Robert Miller PA Assistant Professor of Clinical Pediatrics and Family Medicine USC Keck School of Medicine Retired The CBC 3 Cell Lines RBCs WBCs Platelets Assess general health Make
More informationAnemia 1: Fourth year Medical Students/ Feb/22/ Abdallah Awidi Abbadi.MD.FRCP.FRCPath Professor
Anemia 1: Fourth year Medical Students/ Feb/22/ 2018 Abdallah Awidi Abbadi.MD.FRCP.FRCPath Professor Email: abdalla.awidi@gmail.com Kidney EPO O2 Sensor Blood vessel Definition: Anemia is operationally
More informationTaking The Fear Out of Abnormal CBC s Problems of Production, Destruction or loss
Taking The Fear Out of Abnormal CBC s Problems of Production, Destruction or loss Joanne Eddington, MN, FNP, AOCN Providence Oncology and Hematology Care Clinic - Eastside Blood Cell Abnormalities Abnormalities
More informationSICKLE CELL DISEASE. Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH. Assistant Professor FACULTY OF MEDICINE -JAZAN
SICKLE CELL DISEASE Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN Objective: The student should be able: To identify the presentation, diagnosis,
More informationApproach to the child with anemia. Nittaya Wisanuyothin,MD. Pediatrics Department, Maharat Nakhonratchasima Hospital
Approach to the child with anemia Nittaya Wisanuyothin,MD. Pediatrics Department, Maharat Nakhonratchasima Hospital Definition of anemia Hb< 2 SD or P2.5 below the mean for a healthy of the same gender
More informationMoath Darwish. Waseem Alhaj. Tareq Adely
4 Moath Darwish Waseem Alhaj Tareq Adely Please refer to the slides for pictures. Iron deficiency anemia 1. Iron absorption and regulation a. only 10% of ingested iron are absorbed b. absorption of iron
More informationGuideline developed by Shelley Crary, MD, MS,* in collaboration with the ANGELS team. Last reviewed by Shelley Crary, MD, MS, January 19, 2017.
Microcytic Anemia Guideline developed by Shelley Crary, MD, MS,* in collaboration with the ANGELS team. Last reviewed by Shelley Crary, MD, MS, January 19, 2017. Dr. Crary is a member of the hemophilia
More informationDefinition Aetiology
Definition Anaemia is a fall in haemoglobin below the reference ranges for age and sex (adult female
More informationHEMOLYTIC ANEMIA DUE TO ABNORMAL HEMOGLOBIN SYNTHESIS
Hemolytic Anemia Due to Abnormal Hemoglobin Synthesis MODULE 19 HEMOLYTIC ANEMIA DUE TO ABNORMAL HEMOGLOBIN SYNTHESIS 19.1 INTRODUCTION There are two main mechanisms by which anaemia is produced (a) Thalassemia:
More informationChapter 28. Media Directory. Hematopoiesis. Regulation of Hematopoiesis. Erythropoietin. Drugs for Hematopoietic Disorders
Chapter 28 Drugs for Hematopoietic Disorders Slide 35 Media Directory Epoetin Alfa Animation Upper Saddle River, New Jersey 07458 All rights reserved. Hematopoiesis Figure 28.1 Hematopoiesis Process of
More informationCollect and label sample according to standard protocols. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE. Do not centrifuge.
Complete Blood Count CPT Code: CBC with Differential: 85025 CBC without Differential: 85027 Order Code: CBC with Differential: C915 Includes: White blood cell, Red blood cell, Hematocrit, Hemoglobin, MCV,
More informationIntroduction and Approach to Anemia
2 nd lecture in Hematology by Dr.Alaa Fadhil Alwan Introduction and Approach to Anemia Anemia is defined clinically as a blood hemoglobin or hematocrit value that is below the appropriate reference range
More informationnamib la UnIVERSITY OF SCIEnCE AnD TECHnOLOGY FACULTY OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES
namib la UnIVERSITY OF SCIEnCE AnD TECHnOLOGY FACULTY OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES QUALIFICATION: BACHELOR OF BIOMEDICAL SCIENCES QUALIFICATION CODE: SOBBMS LEVEL: 6 COURSE
More information2. Non- hemolytic anemias 3. Normocytic Normochromic Normocytic Normochromic Blood loss. (MCV<80 fl) (MCV fl) (MCV>100 fl)
Definition of Anaemia of Anaemias Approach for diagnosis of Red cell disorders any condition resulting from a significant decrease in the total body erythrocyte mass due to decrease of Hb and or RBCs Hemoglobin
More informationDiagnostic Approach to Patients with Anemia
J KMA Special Issue Diagnostic Approach to Patients with Anemia Seonyang Park, MD Department of Internal Medicine, Seoul National University College of Medicine E mail : seonpark@snu.ac.kr J Korean Med
More informationMyelodysplastic Syndrome: Let s build a definition
1 MDS: Diagnosis and Treatment Update Gail J. Roboz, M.D. Director, Leukemia Program Associate Professor of Medicine Weill Medical College of Cornell University The New York Presbyterian Hospital Myelodysplastic
More informationReport of Beta Thalassemia in Newar Ethnicity
Report of Beta Thalassemia in Newar Ethnicity Rajendra Dev Bhatt 1*, Surendra Koju 2, Prabodh Risal 1 Affiliations: 1 Department of Clinical Biochemistry, Dhulikhel Hospital, Kathmandu University Hospital
More informationHow to Write a Life Care Plan for a Child with Hemoglobinopathy
How to Write a Life Care Plan for a Child with Hemoglobinopathy Tamar Fleischer, BSN, MSN, CNLCP & Mona Yudkoff, RN, MPH, CRRN, CNLCP BalaCare Solutions March 2018 St. Peterburg, Florida What is Hemoglobinopathy?
More informationHematopoiesis, The hematopoietic machinery requires a constant supply iron, vitamin B 12, and folic acid.
Hematopoiesis, 200 billion new blood cells per day The hematopoietic machinery requires a constant supply iron, vitamin B 12, and folic acid. hematopoietic growth factors, proteins that regulate the proliferation
More informationMDS 101. What is bone marrow? Myelodysplastic Syndrome: Let s build a definition. Dysplastic? Syndrome? 5/22/2014. What does bone marrow do?
101 May 17, 2014 Myelodysplastic Syndrome: Let s build a definition Myelo bone marrow Gail J. Roboz, M.D. Director, Leukemia Program Associate Professor of Medicine What is bone marrow? What does bone
More informationYear 2003 Paper two: Questions supplied by Tricia
QUESTION 93 A 24-year-old woman, who has recently arrived in Australia from Vietnam, presents for evaluation of abnormal menstrual bleeding. There are no abnormalities on examination. Results of investigations
More informationHeme Questions and Derivatives for the USMLE Step One Exam. Winter Storm Skylar Edition
Heme Questions and Derivatives for the USMLE Step One Exam Winter Storm Skylar Edition Howard J. Sachs, MD Howard@12DaysinMarch.com www.12daysinmarch.com Patient presents for routine preoperative evaluation
More informationThalassemias. Emanuela Veras, M.D. 01/08/2006
Thalassemias Emanuela Veras, M.D. 01/08/2006 Structure and Function of normal Hemoglobin molecules: 2/3 1/3 β: increases from 6 th week of fetal life to 12 months of age At birth: HbF: 75-90% HbA: 10-25%
More informationMyelodysplastic Syndromes: Everyday Challenges and Pitfalls
Myelodysplastic Syndromes: Everyday Challenges and Pitfalls Kathryn Foucar, MD kfoucar@salud.unm.edu Henry Moon lecture May 2007 Outline Definition Conceptual overview; pathophysiologic mechanisms Incidence,
More informationAvoiding Early Cancer Claims. Presentation #4. Hank George, FALU
Avoiding Early Cancer Claims Presentation #4 Hank George, FALU Hematology and High Risk of Early Cancer Claims Mild Anemia in elders is underpriced by insurers most likely because of its high prevalence
More informationHemolytic anemias (2 of 2)
Hemolytic anemias (2 of 2) Sickle Cell Anemia The most common familial hemolytic anemia in the world Sickle cell anemia is the prototypical (and most prevalent) hemoglobinopathy Mutation in the β-globin
More informationExtra Notes 3. Warm. In the core (center) of the body, where the temperature is 37 C.
Extra Notes 3 *The numbers of the slides are according to the last year slides. Slide 33 Autoimmune hemolytic anemia : Abnormal circulating antibodies that target normal antigen on the RBC and cause lysis.
More informationIndication of peripheral blood smear exmination:
Indication of peripheral blood smear exmination: 1. For carried out differential WBC count. 2. For differential diagnosis of anemia. 3. For detection of parasites. 4. For diagnosis of leucemoid reaction.
More informationClassification of Anaemia
Classification of Anaemia Dr Roger Pool Department of Haematology NHLS & University of Pretoria MEASUREMENT OF HAEMATOCRIT The haematocrit ratio (Hct) is the proportion of blood made up of cells - mainly
More informationWhat is Thalassaemia?
What is Thalassaemia? Introduction The thalassaemias are a diverse group of genetic blood diseases characterized by absent or decreased production of normal hemoglobin, resulting in a microcytic anemia
More informationDiseases Of The Blood
Diseases Of The Blood DR. Associate Professor Of Pathology Faculty Of Medicine Ain Shams University Red Blood Cells and Anemia RBC=4-6 million/mm 2 Hb=12-18 g/dl Oxygen Carrying Molecule Hemoglobin Tetramer:
More informationMYELODYSPLASTIC SYNDROMES
MYELODYSPLASTIC SYNDROMES Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra university hospital, Isfahan university of medical sciences Key Features ESSENTIALS OF DIAGNOSIS Cytopenias
More informationManagement of anemia in CKD
Management of anemia in CKD Pierre Cochat, MD PhD Professor of Pediatrics Chair, Pediatrics & Pediatric Surgery Department Head, Center for Rare Renal Diseases Néphrogones Hospices Civils de Lyon & University
More informationLaboratory for diagnosis of THALASSEMIA
SCBM343 CLINICAL PATHOLOGY 2(1-2-3) Laboratory for diagnosis of THALASSEMIA PORNTHIP CHAICHOMPOO pornthip.chh@mahidol.ac.th Acknowledgements Dr. Pranee Winichagoon Fucharoen Ms. Pornnapa Khampan Thalassemia
More informationClinical implications for decreased lymphocytes (lymphopenia) o Corticosteroid therapy, adrenocortical hyperfunction, stress, shock
Learning Objectives At the completion of this program, the participants will be able to: 1. Identify the components of the CBC and Differential and their clinical implications. 2. Identify normal pediatric
More information(anemia) ก hemoglobin concentration, hematocrit deviation 1 1 ก hemoglobin, hematocrit mean corpuscular volume (MCV) 2
ก ก. ก ก.. ก (anemia) ก hemoglobin concentration, hematocrit ก ก ก 2 Standard deviation 1 1 ก hemoglobin, hematocrit mean corpuscular volume (MCV) 2 Hemoglobin hematocrit MCV (g/dl) (%) (fl) ( ) 0.5-1.9
More informationChapter 3 Diseases of the Blood and Bloodforming Organs and Certain Disorders Involving the Immune Mechanism D50-D89
Chapter 3 Diseases of the Blood and Bloodforming Organs and Certain Disorders Involving the Immune Mechanism D50-D89 Presented by Jennifer Kurkulonis 1 FOUR MAJOR TYPES OF BLOOD CELLS White blood cells
More informationRBCs Disorders 2. Dr. Nabila Hamdi MD, PhD
RBCs Disorders 2 Dr. Nabila Hamdi MD, PhD ILOs Discuss the classification of anemia into hypochromic-microcytic, normochromicnormocytic and macrocytic. Categorize laboratory test procedures used in the
More informationThe Complete Blood Count
The Complete Blood Count (Cartesian Thinking at Its Best) A SEM Image of Normal Human Blood Laurie Larsson February 22, 2010 Anatomy and Philology II Dr. Danil Hammoudi Introduction A complete blood count
More informationAssessing Iron Deficiency in Adults. Chris Theberge. Iron (Fe) deficiency remains as one of the major global public health problems for
Assessing Iron Deficiency in Adults Chris Theberge Iron (Fe) deficiency remains as one of the major global public health problems for two reasons. It affects about one fourth of the world s population
More informationBLOOD. Dr. Vedat Evren
BLOOD Dr. Vedat Evren Blood Liquid suspension of formed elements Blood = Blood cells + plasma Plasma = Coagulation factors + serum Cells = Erythrocytes + Leukocytes + Thrombocytes 8 % of the total body
More informationApproach to the abnormal CBC
Approach to the abnormal CBC Robert T. Means, Jr., M.D. Hematology and Blood & Marrow Transplant Division University of Kentucky and VA Medical Center Lexington KY General Considerations Always repeat
More informationDr.Abdolreza Afrasiabi
Dr.Abdolreza Afrasiabi Thalassemia & Heamophilia Genetic Reaserch Center Shiraz Medical University Hemoglobin tetramer Hemoglobin Structure % A 1 α 2 β 2 94-97% A 2 α 2 δ 2 2.5% A 1C α 2 (β-n-glucose)
More informationHAEMOGLOBINOPATHIES. Editing file. References: 436 girls & boys slides 435 teamwork slides. Color code: Important. Extra.
HAEMOGLOBINOPATHIES Objectives: normal structure and function of haemoglobin. how the globin components of haemoglobin change during development, and postnatally. the mechanisms by which the thalassaemias
More informationNormal Development. Normal Development 10/16/2012. Hematopoietic and Lymph Node Pathology. Red Blood Cell Maturation & Anemias
Hematopoietic and Lymph Node Pathology Normal Development Red Blood Cell Maturation & Anemias Normal Development Differentiation of Hematopoietic Cells 1 Bone Marrow Bone Marrow Bone Marrow, RBC Precursors
More informationANEMIAS OBJECTIVES. What is Anemia. A Narrow Exploration Mainly Involving Anemia Studies
A Narrow Exploration Mainly Involving Anemia Studies ANEMIAS OBJECTIVES Definition of Anemia What Causes Anemia Signs and Symptoms Types of Anemia Case Studies What is Anemia Derived from the ancient Greek
More informationHematology 101. Blanche P Alter, MD, MPH, FAAP Clinical Genetics Branch Division of Cancer Epidemiology and Genetics Bethesda, MD
Hematology 101 Blanche P Alter, MD, MPH, FAAP Clinical Genetics Branch Division of Cancer Epidemiology and Genetics Bethesda, MD Hematocrits Plasma White cells Red cells Normal, Hemorrhage, IDA, Leukemia,
More informationTECHNICAL UNIVERSITY OF MOMBASA
TECHNICAL UNIVERSITY OF MOMBASA Faculty of Applied and Health Sciences DEPARTMENT OF MEDICAL SCIENCES DIPLOMA IN MEDICAL LABORATORY SCIENCES (DMLS ) AML 2301 : HAEMATOLOGY II SPECIAL/SUPPLEMENTARY : EXAMINATIONS
More informationSession 11 Disorders of Red cells. B.M.C.Randika Wimalasiri Lecturer(Probationary) Department of Medical Laboratory Sciences
Session 11 Disorders of Red cells B.M.C.Randika Wimalasiri Lecturer(Probationary) Department of Medical Laboratory Sciences Red cells Biconcave cells carry oxygen to the peripheral tissues red colour-
More informationEDUCATIONAL COMMENTARY BLOOD CELL IDENTIFICATION
EDUCATIONAL COMMENTARY BLOOD CELL IDENTIFICATION Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click
More informationMid term Hematology-2011 Lejan 2009\2010
The correct statment: Maximal Activation of cytotoxic T-Cells involves both interactions through MHC-I & MHC-II 1) about the thalassemia major which of this is not true : a) HbA2 increases in B thalassemia
More informationCOEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE?
COEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE? M. DE SLOOVERE (1), L. HARLET (2), S. VAN STEENWEGHEN (3), E. MOREAU (1), D. DE SMET (1) (1) DEPARTMENT OF LABORATORY MEDICINE,
More informationCongenital Haemoglobinopathies
Congenital Haemoglobinopathies L. DEDEKEN, MD H O P I T A L U N I V E R S I T A I R E D E S E N F A N T S R E I N E F A B I O L A U N I V E R S I T E L I B R E DE B R U X E L L E S Red Blood Cell Disorders
More informationFBC CASES Vernon Louw Clinical Haematology 2010
FBC CASES Vernon Louw Clinical Haematology 2010 FOR EACH OF THE FOLLOWING PATIENTS, SELECT THE MOST LIKELY FINDING FROM THE ANALYSIS OF THE PERIPHERAL BLOOD. A patient with infectious mononucleosis. A
More informationTHE PHYSIOLOGY OF BLOOD
2 THE PHYSIOLOGY OF BLOOD Objectives 1. ERYTHROCYTES 2. ERYTHROCYTE AGGLUTINOGENES, 3. PLASMA AGGLUTININS 4. TRANSFUSION 5. Practical tasks ERYTHROCYTE COUNT BLOOD GROUPING RH FACTOR CROSSMATCHING TEST
More informationAnemia in the elderly. Nattiya Teawtrakul MD., PhD
Anemia in the elderly Nattiya Teawtrakul MD., PhD Contents Definition of anemia in the elderly The impact of anemia in the elderly Etiology of anemia in the elderly Management of anemia in the elderly
More informationDOWNLOAD PDF MACROCYTOSIS AND MACROCYTIC ANAEMIA
Chapter 1 : Macrocytic Anemia- Causes, Symptoms Treatment Macrocytosis is a term used to describe red blood cells that are larger than normal. Anemia is when you have low numbers of properly functioning
More informationEDUCATIONAL COMMENTARY MORPHOLOGIC CHANGES IN PERIPHERAL BLOOD CELLS
EDUCATIONAL COMMENTARY MORPHOLOGIC CHANGES IN PERIPHERAL BLOOD CELLS Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationScreening for haemoglobinopathies in pregnancy
Policy Statement All Southern Health patients will receive clinical care that reflects best practice and is based on the best available evidence. Index of chapters within background 1. Prevalence of haemoglobinopathies
More informationAn overview of Thalassaemias and Complications
An overview of Thalassaemias and Complications Haemoglobin Haemoglobin is the most abundant protein in blood, and exists as three main types in normal adults: HbA ( ) - 97% HbA 2 ( ) - 2.5% HbF ( ) - 0.5%
More informationThe Thalassemias in Clinical Practice. Ashutosh Lal, MD Director Comprehensive Thalassemia Program UCSF Benioff Children s Hospital Oakland
The Thalassemias in Clinical Practice Ashutosh Lal, MD Director Comprehensive Thalassemia Program UCSF Benioff Children s Hospital Oakland Outline Thalassemia: definitions and pathophysiology Epidemiology
More informationNUTRITIONAL CARE IN ANEMIA
االله الرحمن الرحيم بسم NUTRITIONAL CARE IN ANEMIA Nutrition Departement Faculty of Medicine University of North Sumatera Definition Deficit of circulating RBC associated with diminished oxygen-carrying
More informationTHE CLASSIFICATION OF ANEMIA*
THE CLASSIFICATION OF ANEMIA* RUSSELL L. HADEN, M.D. SUMMARY A laboratory and clinical classification of anemia has been outlined. The results of the blood study have been correlated with the clinical
More information1) Anemias Dr. Anwar Sheikha
1) Anemias Dr. Anwar Sheikha DEFINITION: Anemia can be defined as a reduction in the concentration of hemoglobin below what is normal for age and sex of the patient. This reduction of hemoglobin is usually
More informationCHERYL KOVALSKI, DO FACOI NO DISCLOSURES ACOI BOARD REVIEW 2018
CHERYL KOVALSKI, DO FACOI NO DISCLOSURES ACOI BOARD REVIEW 2018 ANEMIA Hemoglobin
More informationBeyond the CBC Report: Extended Laboratory Testing in the Evaluation for Hematologic Neoplasia Disclosure
Beyond the CBC Report: Extended Laboratory Testing in the Evaluation for Hematologic Neoplasia Disclosure I am receiving an honorarium from Sysmex for today s presentation. 1 Determining the Etiology for
More informationMDS: Who gets it and how is it diagnosed?
MDS: Who gets it and how is it diagnosed? October 16, 2010 Gail J. Roboz, M.D. Director, Leukemia Program Associate Professor of Medicine Weill Medical College of Cornell University The New York Presbyterian
More informationSymptoms and Signs in Hematology (2)/ 2013
Symptoms and Signs in Hematology (2)/ 2013 Abdallah Abbadi.MD.FRCP Professor of Medicine,Hematology & Oncology University of Jordan & JUH Email: abdalla.awidi@gmail.com Case one: A 24 yr old female complains
More informationTHALASSEMIA AND COMPREHENSIVE CARE
1 THALASSEMIA AND COMPREHENSIVE CARE Melanie Kirby MBBS, FRCP (C), Hospital for Sick Children, Toronto Associate Professor of Paediatrics, University of Toronto. Objectives 2 By the end of this presentation,
More informationAnemia (3).ms4.25.Oct.15 Hemolytic Anemia. Abdallah Abbadi
Anemia (3).ms4.25.Oct.15 Hemolytic Anemia Abdallah Abbadi Case 3 24 yr old female presented with anemia syndrome and jaundice. She was found to have splenomegaly. Hb 8, wbc 12k, Plt 212k, retics 12%, LDH
More informationDrop of Blood Unravels Mysteries. Prof. Salma Afrose Department of Hematology Dhaka Medical College
Drop of Blood Unravels Mysteries Prof. Salma Afrose Department of Hematology Dhaka Medical College Peripheral Blood Film (PBF) PBF is a laboratory workup that involves cytology of Peripheral blood cell
More informationTopics of this lecture : RBC. Structural characteristics Hemoglobin Erythropoiesis Erythrocytes destruction
Topics of this lecture : RBC Structural characteristics Hemoglobin Erythropoiesis Erythrocytes destruction Structural characteristics Its small size and biconcave shape provides more surface area than
More information