(anemia) ก hemoglobin concentration, hematocrit deviation 1 1 ก hemoglobin, hematocrit mean corpuscular volume (MCV) 2

Transcription

1 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) ( ) : Female Male : Female Male : Female Male

2 ก ก ก 3 ก 1. ก 2. Hemolytic anemia 2.1 ก ก (corpuscular defect) - ก Hereditary spherocytosis, Hereditary ovalocytosis Hereditary stomatocytosis - ก Glucose-6-Phosphate-Dehydrogenase (G-6-PD) deficiency Pyruvate Kinase deficiency - ก ก Thalassemia disease 2.2 ก ก ก (extracorpuscular defect) - กก ก ก autoimmune hemolytic anemia (AIHA), bloodgroup incompatibility, collagen vascular disease malignancy - กก ก ก ก,, physical trauma 3. ก 3.1 ก ก ก, ก ก, B6, B12, C, ก 3.2 ก ก ก aplastic anemia pure red cell aplasia 3.3 ก ก ก (Myelopthisis) malignancy, myelofibrosis ก ก ก ก 3 neonatal period ก ก ก ก กก ก ก ก ก ก ก ก ก isoimmunization ABO incompatability ก congenital infection ก approach anemia 2 1. ก ก - : ก ก (term) ก nutritional iron deficiency ก 6 ก ก ก (preterm) ก nutritional iron deficiency ก ก 2 ก ก - : ก X-linked disorder ก

3 - : Thalassemia Hemoglobinopathy Hemoglobin E ก ก - ก ก ก ก ก (pica) ก iron deficiency anemia - ก : G-6-PD deficiency ก ก hemolytic crisis : dilantin metrotrexate ก megaloblastic anemia : chloramphenical ก aplastic anemia - ก hepatitis ก aplastic anemia, Parvovirus B19 ก red cell aplasia ก HIV ก ก ก ก - ก ก - - ก ก ก ก กก congenital hemolytic anemia G-6-PD deficiency - ก 2. ก ก ก - ก : ก malnutrition ก nutritional anemia - Vital signs: respiratory rate, heart rate, pulse pressure blood pressure - Skin: Clay skin thalassemia hemoglobinopathy : Petechiae, Purpuric spots vascular defect, thrombocytopenia bone marrowaplasia / infiltration : Ecchymosis coagulation defect platelet dysfunction : Jaundice hemolytic anemia : Carvernous hemangioma microangiopathic hemolytic anemia : Hyperpigmentation Fanconi aplastic anemia - Face : Frontal bossing, prominent of the malar and maxillary bone thalassemia severe iron deficiency anemia - Eyes : Cataracts galactosemia with hemolytic anemia, congenital rubella : Retinal hemorrhage chronic, severe anemia

4 : Puffy eyelids infectious mononucleosis with hemolytic anemia chronic renal failure - Mouth : Glossitis iron deficiency vitamin B 12 deficiency : Angular stomatitis iron deficiency - Hand : Hypoplasia of the thenar eminence Fanconi aplastic anemia : Spoon nails (koilonychia) iron deficiency - Abdomen : Splenomegaly congenital hemolytic anemia, leukemia, lymphoma, portal hypertension acute infection : Hepatomegaly thalassemia, leukemia lymphoma 3. ก ก (Investigation) 3.1 Initial investigation - Complete blood count (CBC): ก ก ก ก hematocrit hemoglobin ก ก ก ก ก ก ก Bone marrow failure pancytopenia - Peripheral blood smear: ก ก ก กก ก ก ก ก ก ก blood smear 1 Thalassemia disease anisocytosis poikilocytosis ก red cell (hypochromia) ก (microcytosis) target cell, tear drop, ovalocyte, schistocyte, stomatocyte

5 2 Iron deficiency anisocytosis poikilocytosis ก hypochromia microcytosis ก red cell ก 3 Megaloblastic anemia red cell (macrocytosis) (hypochromic) hypersegmented neutrophil 4 Hereditary spherocytosis microspherocyte กก 50 % 5 Hereditary ovalocytosis ovalocyte กก 50 %

6 6 G-6-PD deficiency red cell with contracted hemoglobin (basket cell ghost cell), red cell with hemoglobin leakage 7 Microangiopathic hemolytic anemia (MAHA) fragmented burred cell ก ก ก 8 AIHA rouleaux formation

7 - Red cell indices: Mean corpuscular volume (MCV) ก MCV ก ก microcytic Mean corpuscular hemoglobin (MCH) ก ก MCH ก ก hypochromia Mean corpuscular hemoglobin concentration (MCHC) ก ก MCHC ก ก hypochromia ก 2 ก MCH MCHC 1 MCH MCHC (Pg) (g/dl) ( ) newborn Female Male Red cell distribution width (RDW) ก ก ก ก anisocytosis anisocytosis ก ก %

8 - ก Reticulocyte ก 1% Brilliant cresyl blue methylene blue RNA ก ก 9 ก ก ก ก ก ก 1-2 % ก ก ก ก ก ก (hemolytic anemia) ก ก ก ก corrected reticulocyte count Corrected reticulocyte count (%) = reticulocyte x Hct Hct ก 9 Reticulocyte กก methylene blue 10 Inclusion body ก Alpha thalassemia 11 Heinz body G-6-PD deficiency with acute hemolysis

9 3.2 Confirmatory studies ก ก - Iron study ก iron deficiency anemia serum iron total iron binding capacity (TIBC) transferring saturation - ก G-6-PD - ก (osmotic fragility test) ก autohemolysis ก hereditary spherocytosis - ก hemoglobin typing ก DNA ก thalassemia disease - ก direct antiglobulin test ก AIHA - ก ก ก (bone marrow aspiration and biopsy) ก ก ก ก ก 1. Lanzkowsky P. Classification and diagnosis of anemia during childhood. In: Lanzkowsky P, ed. Manual of pediatric hematology and oncology. 4 th ed. Amsterdam: Elsevier, 2005: Oski FA, Brugnara C, Nathan DG. A diagnostic appoarch to the anemic patient. In: Nathan DG, Ginsburg D, Orkin SH, Look AT, eds. Nathan and Oski s Hematology of infancy and childhood. 6 th ed. Philadelphia: W.B. Saunders, 2003: ก. ก. :,, ก, ก. ก. 3. ก : ก - ; 2538.p

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