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Anemia編輯

長庚

  • MCV= Hct/RBC < 80fl 定義
  • Hct= MCV * RBC 現今

小血球性貧血 (microcytic anemia),而答案中A的缺鐵性貧血與B的輕度地中海型貧血 (thalassemia trait),都是可能的原因。

這兩種常見的小血球性貧血,可以藉由MCV與紅血球計數的比值得知比較可能的診斷。算法為:(MCV X 106)/紅血球計數 (/dL),此數值超過13者,比較可能是缺鐵性貧血;此比值低於12者,比較可能是輕度地中海型貧血。問題中病例的此數值為11,所以是輕度地中海型貧血的可能性最高。

Microcytic編輯

  • IDA, thalassemia, anemia of chronic disorder (ACD)
  • Anemia > WBC?PLT? > pure anemia > IDA, thalassmia, ACD

Thalassemia編輯

  • RBC count high, retico mild increase, RDW% elevate depend on the severity of thalassmia, Target cell not specific
  • HbA: >97%
  • HbA2: <3%
  • HbF: 0% in adult
  • HbH: minimal in electropheresis, use Hb H staining (只有北榮在做) to detect
  • Hb H disease- large amount of HbH when 3 gene deletion alpha-thalassmia. But HbH will be made in all alpha-thalassmia.
  • Fe Sat is only valuable when elevated TIBC

Iron deficiency anemia編輯

  • plt high, cause unknown, RDW-CV% high in early stage, 15-20% mild leukopenia cause unknown
  • Low ferritin without anemia: should treat
    1. Iron depletion: graudally ferritin level, others normal
    2. IDA: low ferritin, low Fe, high TIBC/UIBC, low iron sat (Fe/TIBC)
  • Combine Thalassmia and IDA
    • thalassemia easy iron overloading, only in moderate to severe case, we can still add Fe to thalassmia minor + IDA patient

anenmia of chronic disease 編輯

  • Feature: nil
  • Impaired utilizatiun of iron, low serum iron and low TIBC, normal or high ferritin
  • Malignancy, chronic inflam, chronic infection
  • Tx of underlying dz, avoid erroneous supplementation of iron

Macrocytic Anemia編輯

  • Reticulocytosis make MCV elevated
  • We should check reticulocyte count in high MCV patient

Reticulocytosis編輯

  • emergency indicator, check LDH + Bil (T/D)
  • Hemolysis makes inderect bil elevated, but the mount of T.bil will not over 5 mg/dl in pure hemolysis
  • Urine OB (+), Urine RBC (-), U hemosiderin (+), Direct Coombs' test positive -> AIHA
  • Comb' neg hemolysis: consider TTP

Megaloblastic 編輯

  • B12 (major), folic acid deficieny (rare), DNA metabolic impair > Pancytopenia, (leuko < 2000, rare in pure case), (plt < 20000, rare in pure case)
  • RBC raptured in bone marrow, d/d with hemolysis by reticulocyte count, LDH isoenzyme
  • Caustion when Young female with macrocystic anemia

Myelodysplastic編輯

  • Myeoloma- usually pure anemia
  • Pancytopenia > BM
  • BM: severe hypocellularity > AA
  • BM: severe hypercellularity blasts 15% > MDS
  • BM: severe hypercellularity blasts 80% > "Aleukemic leukemia"
  • BM: severe hypercellularity, good maturation? > Impossible

Auto-Immue Hemolytic Anemia (AIHA)編輯

  • is not a final diagnosis
  • SLE, CLL, lymphoma, MM

ICD9: 283.0 中文:自體免疫溶血性貧血

CBC-Anemia編輯

  • WBC
    • DC-man counting good but machine counting poor
    • DC in post C/T, Seg/Lym 1/19, Seg/Lym/Mono ?/10/10 indicate WBC generation → Seg predominat → WBC increase through 500,1000
  • Plt 150k-40k
  • Hb M14, F12 at least
  • MCV 80-100FL
    • 小球性貧血: IDA, thalathemia, ACD, 鉛中毒...
  • RBC number: M 4.7-6.1, F 4.2-5.4
    • RBC number much more Hb → thalasemia, espi in Hb > 8
  • MCV to d/d IDA(big), thala(micro)
  • RDW: thala in Normal range, IDA large
  • PLT: some IDA patient has mild thrombocytosis
  • WBC: some IDA pt has mild neutropenia
  • Hb electrophoresis
    • HbA2 > 3.5 → beta thala
    • if HbH → alpha thala
    • HbH stain → 1-4+ alpha thala, more sensitive than electrophroesis
  • Iron overload > 60%
    • Ferritin, iron, bone marrow iron stain
  • (reticulocyte is larger than RBC, Make MCV larger)
  • Macrocytic anemia
    • Case Pancytopenia, MCV 135(macro)
    • Reticulocytosis, AA, M dysplasia Syndrome, liver dz, endocrime dz
  • Reticulocytosis, check Reticulocyte count → acute bleeding, acute hemalysis, regeneration BM (treating IDA, B12 defi about 1 wk to peak, Hb increase in 2wk, treat B12 1 shot/Day in 1wk, 1 shot/wk...)
  • Megalo → CBC no use, SMAC good
  • 無效造血>髓內溶血, LDH ↑↑ , T.bil, D.bili ↑
  • D/D AIHA autoimmue hemalysis anemia: check LDH iso-enzyme (LDH 2) Megalo(LDH 1)
  • (LDH 1 has 2 dz: Megalo, AMI)
  • MDS 輕微骨內溶血, LDH ↑ , PLT--
  • Normocystic
  • ACD, renal anemia, AA, MDS, endocrime
  • Renal anemia, EPO related
  • Chronic disease anemia, no good diagnosis tool
  • SMAC: Alb low, Ca 10.8, corret: Ca-Alb +4
  • Multiple myeloma: anemia, poor renal function, hyper Ca++, check immunoglobin IGGAM

Hemolysis編輯

  • Acute anemia,
  • anemia+ jundice
  • lab: Ret, I.bil
  • comf
    • Ret 1,2,3 days
    • LDH (LDH2)
    • free Hb in plasm, urine if large intravescular hemolysis
    • I.Bil > 80% T.Bil
    • T.bil < 18 mg/dl
  • etiology
  1. Immue (coomb +) > Steroid
  2. Non immue (coomb-) > blood smear, HS?, HE?, target cell?, fragment RBC? (MAHA-TTP, DIC,), Normal RBC (G6PD....)

其他連結編輯

wikipedia:Anemia

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