HAEMATOLOGY

HOW TO INTERPRET THE TESTS AND APPROACH A CASE OF ANEMIA?

MANAGEMENT OF ANAEMIAS IRON DEFICIENCY ANAEMIAS….

Remember, among premenopausal women, 60% of iron deficiency anemia is due to pregnancy and menstruation related reasons. Among men and post-menopausal women, 80% is due to GI blood loss. Out of which, 25% is a malignant cause, more in

>50 yrs. Age group.

When B12 deficiency co-exists with iron deficiency, the bone marrow might show adequate iron stores because in the presence of megalo-blasticanemia, the marrow fails to use the iron stored.

·       DIETARY

·       DEWORM-MEBENDAZOLE 100 MG MD X 3 DAYS repeat after 2 wks. (safe in pregnancy)OR ALBENDAZOLE 400 MG STAT + REPEAT AFTER 2 WKS.

·       ORAL IRON THERAPY:

Tab. Ferrous SO4 200mg (60 mg elemental Fe) tid x 6months/ till adequate level of Hb. Is reached.continue for about same duration to replenish stores increased absorption with.C; do not take it with antacids, tetracyclines. Best absosrbed in empty stomach, but causes gastritis; therefore take at any time of the day. Check compliance by asking stool colour (black)

B12/Folate deficiency……….

Emperic therapy of megaloblastic anaemia with folic acid only is not recommended!----

Neurological abnormalities might worsen

FOLIC ACID:- 5mg / OD X 4mo; Maintenance -5 mg/ week

VITAMIN B 12:- (Inj. Neurobion Forte 1 ampoule contains 1 mg of Vitamin B12) 1mg IM Dailyfor 1 week..followed by 1 mg IM/wk x 1-2 mo till normalization of Hb. Maintenance- 1 mg IM/ mo (Ref. Washington manual) to decrease the rate of relapse.

Dimorphic anemias…..mostly nutritional, MCV and bone-marrow iron stores might be normal.Combine both the therapies mentioned above.

FOLLOW UP OF ORAL REPLACEMENT THERAPY:- MONITOR RETICS

IRON……….7-10 DAYS LATER (Adequate response is a rise of Hb. by 0.2g% at the end

of 3 wks oftherapy).

B 12........... 4 DAYS, PEAKS AT 1 WEEK

FOLATE............ 4 DAYS LATER

INDICATION FOR BLOOD TRANSFUSIONS:

Symptomatic:          Heart failure

Elderly with angina Hypoxic encephalopathy Shock due to haemorrhage Pregnancy with the <5gm%