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Strategi Diagnosis Anemia

Anemia is a decrease in red blood cells or hemoglobin. The causes of anemia must be diagnosed by evaluating underlying diseases or disorders. A complete blood count, peripheral smear, reticulocyte count, and other tests can help determine the type and cause of anemia. The red blood cell indices from the complete blood count can indicate if an anemia is microcytic, macrocytic, or normocytic. Further testing may include a bone marrow biopsy to examine red blood cell precursors if the cause of anemia is unclear or there are other abnormal blood cell counts. The overall goal is to diagnose the primary problem causing anemia so that it can be properly treated.

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Tri Ratnaningsih
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54 views14 pages

Strategi Diagnosis Anemia

Anemia is a decrease in red blood cells or hemoglobin. The causes of anemia must be diagnosed by evaluating underlying diseases or disorders. A complete blood count, peripheral smear, reticulocyte count, and other tests can help determine the type and cause of anemia. The red blood cell indices from the complete blood count can indicate if an anemia is microcytic, macrocytic, or normocytic. Further testing may include a bone marrow biopsy to examine red blood cell precursors if the cause of anemia is unclear or there are other abnormal blood cell counts. The overall goal is to diagnose the primary problem causing anemia so that it can be properly treated.

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Tri Ratnaningsih
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Anemia:

underlying
disease?
Tri Ratnaningsih
Clinical Pathology Departement, Faculty of Medicine, Public Health and
Nursing UGM
Hematology Division, Clinical laboratory Installation, DR. Sardjito Hospital
Content

• Definition
• Diagnosis Strategy of Anemia
• Summary
Anemia is a decrease in the number of
red blood cells (RBCs—as measured by
the hematocrit or red cell hemoglobin
content):
• Men
• hemoglobin < 14 g/dL (140 g/L),
Definition hematocrit < 42% (< 0.42) , or RBC <
4.5 million/mcL (< 4.5 × 1012/L)
• Women
• hemoglobin < 12 g/dL (120 g/L),
hematocrit< 37% (< 0.37), or RBC < 4
million/mcL (< 4 × 10 12/L)
The history should address: Common symptoms and
signs of anemia:
• Risk factors for particular
anemias • General fatigue
History and • Symptoms of anemia itself • Weakness
physical • Symptoms that reflect the • Dyspnea on exertion
underlying disorder
examination • Pallor
Signs of underlying disorders
are more diagnostically
accurate than are signs of
anemia

followed by laboratory testing with a complete blood


count and peripheral smear ➔ The differential diagnosis
(and cause of anemia) can then be further refined
CBC with WBC and platelets

RBC indices and morphology

Testing Reticulocyte count

Peripheral smear

Sometimes bone marrow aspiration and biopsy


Complete blood count and RBC
indices
• Hemoglobin, RBC count, WBC count, number of platelets,
Hematocrit
• RBC indices: MCV, MCH, MCHC
• Determine RDW

The RBC indices can help indicate the mechanism of


anemia and narrow the number of possible causes
Microcytic
Macrocytic
Normocytic
Reticulocyte count
• percentage of reticulocytes (normal
range, 0.5 to 1.5%)
• absolute reticulocyte count (normal
range, 50,000 to 150,000/mcL, or 50 to
150 × 10 9/L)
• The Maturation term represents the
maturation time of RBC's (in days) at
various levels of anemia.
• Maturation = 1.0 for Hct ≥40%.
• Maturation = 1.5 for Hct 30-39.9%.
• Maturation = 2.0 for Hct 20-29.9%.
RPI = (Hct / 45) *
• Maturation = 2.5 for Hct <20%.
Retic / Maturation
• An RPI >3 shows a normal marrow
response to anemia. An RPI <2 is an
inadequate response to anemia.
• With a normal H&H, an RPI of 1 is
normal.
Peripheral smear

• Highly sensitive
• More accurate than automated technologies
• The peripheral smear can also reveal
variation in RBC shape (poikilocytosis) and
size (anisocytosis)
Bone marrow aspiration and
biopsy
• direct observation and assessment of RBC precursors.
• The presence of abnormal maturation (dyspoiesis) of blood cells
and the amount, distribution, and cellular pattern of iron content
can be assessed.
• usually not indicated in the evaluation of anemia and are only
done when one of the following conditions is present:
• Unexplained anemia
• More than one cell lineage abnormality (ie, concurrent
anemia and thrombocytopenia or leukopenia)
• Suspected primary bone marrow disorder (eg, leukemia,
multiple myeloma, aplastic anemia, myelodysplastic
syndrome, metastatic carcinoma, myelofibrosis)
Other tests for
evaluation of anemia
• Serum bilirubin and lactate dehydrogenase
(LDH)
• vitamin B12 and folate levels
• iron and iron binding capacity
• Hemoglobin Electrophoresis
• Antiglobulin Testing
• Osmotic Fragility
• RBC Enzymes
Anemia is not a diagnosis; it is a
manifestation of an underlying
disorder

Anemia should be investigated


Summary so that the primary problem can
be diagnosed and treated

Anemia is usually suspected


based on the history and
physical examination
References
• Evan M. Braunstein, 2017. MSD MANUAL Professional Version.
https://www.msdmanuals.com/professional/hematology-and-
oncology/approach-to-the-patient-with-anemia/
• Palmer L, Briggs C, Mcfadden S, Zini G, Burthem J, Rozenberg G, Proytcheva M,
Machi SJ, 2015. ICSH recommendations for the standardization of nomenclature
and grading of peripheral blood cell morphological features. Int. Jnl. Lab. Hem.
37: 287–303
• Ramadas Nayak, 2017. Essentials in Hematology and Clinical Pathology, Second
Edition, The Health Sciences Publisher. pp 354-365
Thankyou
Yogyakarta, 30 Maret 2019

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