hematology immune/id

ER REFERRAL :

NEW ONSET CONFUSION

CHEST PAIN

DYSPNEA

ABDOMINAL PAIN

PERSISTENT VOMITING

SUSPICION OF EPIGLOTTITIS-DROOLING

WORSENING SYMPTOMS

COMPLICATION BACTERIAL PNA-ADVENTITIOUS LUNG SOUNDS

TYPE A OR B

USU SELF LIMITED VIRUS

HIGHLY CONTAGIOUS

ALL AGE GROUPS AFFECTED

RAPID OUTBREAKS 10-40% OF POPULATION

2009 NOVEL H1N1 SWINE FLU-NOW REGULAR FLU STRAIN

DROPLET SPREAD- TALK COUGH SNEEZE

VIRUS ENTERS EPITHELIAL CELLS OF RESP TRACT

PENETRATES CELLS

REPLICATES

CAUSES CELL DEATH AND DESQUAMATION-SYMPTOMS OCCUR

VIRUS EVOLVES 2/2 MUTATIONS OR RECOMBINATION EVENTS DURING REPLICATION-CALLED ANTIGENIC DRIFT

WHY YOU NEED ANNUAL SHOTS

INCUBATION 1-2 DAYS

FEVER-100 TO 104 UP TO 8 DAYS

CHILLS

HEADACHE

MALAISE

MYALGIA

ANOREXIA

DRY COUGH

NASAL CONGESTION-CLEAR

SORE THROAT

CONVALESCE 1-2 WEEKS

FEVER,

RED WATERY EYES

CERVICAL LYMPH ENLARGED AND TENDER

VIRAL SWABS

everse transcriptase polymerase chain reaction (RT-PCR) assays GOLD STANDARD-2-7 DAYS

RAPID TESTS NOT AS RELIABLE

A& B NASAL SWAB

FLU ANTIGEN

SERUM ANTIBODY TITRE( SPECIAL CIRCUMSTANCE)

COMMON COLD

( VIRAL RHINITIS)

RSV

PNA

SEVERE STREP PHARYNGITIS

REST

FLUID INTAKE

ISOLATE

ANTIPYRETICS

ANALGESICS

ANTIVIRAL MEDICATION (avm): FOR A & B

NEURAMIDASE INHIBITORS:

OSETALMIVIR TAMIFLU

ZANAMIVIR RELENZA

PERAMIVIR RAPIVAB

ANTIVIRALS FOR A ONLY

AMANTADINE

REMANTIDINE

RESISTANCE TO AV DEVELOP FAST- CHECK CDC GUIDLEINES FOR LATEST AVM

GIVE AVM WITHIN 48 HOURS- PRE EMPTIVE

65 AND OVER( MORTALITY FROM FLU -90 % ARE >65)

PULMONARY OR CARDIAC DX

DM

IMMUNOSUPPRESSION

PREGNANCY

<2 YEARS OLD

PRIMARY FLU PNA

BACTERIAL PNA

GUILLAN BARRE

ENCEPHALITIS

MYOSITIS

TSS

GET FLU VACCINE

STAY HOME WHEN ILL

AVOID CROWDS IN OUTBREAK TIMES

HYGIENE-WASH HANDS COVER MOUTH AND NOSE

ANNUAL VACCINATION 6 MONTHS OR OLDER IN FALL

FLU YEAR ROUND RISK IN TROPICS/SUBTROPICS

TRIVALENT IIV3-

2 A’S (ONE A IS H1N1), 1 B

QUADRIVALENT IIV4

2 A’S 2 B’S

IIV3 FOR 6 MONTHS UP NO EGG ALLERGY

IIV4 3 YEARS AND UP

NOW EGG FREE RECOMBINANT VACCINE FOR AGE 18-49 W EGG ALLERGY

KIDS 6MONTHS TO 8 YEARS-FIRST VACCINE SHOULD GET 2 VACCINES AT LEAST 4 WEEKS APART, THEN ANNUAL

2010 HIGH DOSE INACTIVATED FOR 65 UP -BETTER RESPONSE

LAIV -LIVE ATTENUATED INFLUENZA VACCINE NASAL SPRAY VACCINE- HEALTHY AGE 2-49 NON PREGNANT-DOES NOT CAUSE FLU

IXODES SCAPULARIS ( DEER TICK)

LYME’AB=NAPLASMOSIS

BABESIOSIS

POWASSAN

VIRAL

PROTOZOAL AND BACTERIAL PATHOGENS CARRIED BY BLT

INVENTED 1976

LYME CONTECTICUT

PREVALENT NE AND NORTHERM STATES

HIGHEST AGE 5-9 AND 50-55

SPRING EARLY -TICK OUT LOOOKING FOR BLOOD MEAL ,DIAGNOSIS PEAKS IN SUMMER

MOST COMMON VECTOR BORNE DISEASE US

6TH NATIONALLY NOTIFIABLE DISEASE IN US

BORRELIA BURGDORFERRI

TICK-ANIMAL RESERVOIR-HUMAN

LARVA NYMPH AND ADULT-BLOOD FEAST AT EACH STAGE

LARVA AND NYMPH USE RODENTS MICE CHIPMUNKS

DEER ARE ESSENTIAL FOR ADULT

TICK TAKES A MEAL B BURGDORFERRI MIGRATES FROM TICK MIDGUT TO HOST

THIS TAKES > 36 HOURS ATTACHMENT

INTO BLOOD AND LYMPHATIC SYSTEM

EARLY

ERYTHEMA MIGRANS 3-30 DAYS -WAIST AXILLAE GROINS IN 70-80% POP

> 5 CM -CAN TREAT EMPIRICALLY

FLU LIKE SYMPTOMS:

MALAISE

FATIGUE

LETHARGY

FEVERS

HEADACHE

ARTHRALGIA

MYALGIA

REGIONAL LYMPHADENOPATHY

MULTIPLE EM

NEUROLOGIC SYMPTOMS:

HEADACHE & NECK STIFFNESS ( LYMPHOCYTIC MENINGITIS)

CRANIAL NERVE PALSIES ESP BELLS OR FACIAL NERVE PALSY

MOTOR OR SENSORY NEURITIS

RARE CEREBELLAR ATAXIA OR ENCEPHALOMYELITIS

CARDIAC SYMPTOMS:

MYOPERICARDITIS-HEART BLOCK AND BRADYCARDIA

RARE LYME CARDITIS

INTERMITTENT ARTHRITIS LARGE JOINTS

RARER :

ENCEPHALOPATHY (SUBTLE MEMORY AND COGNITIVE CHANGES)

POLYNEUROPATHY

CLINICAL LOOK FOR ANTIBODIES TO B BURGDORFERI-,MAY NOT APPEAR FOR TWO WEEKS

IDSA AND CDC RECOMMEND: 2 STEP ALGORITHM

ELISA ( ENZYME LINKED IMMUNSORBENT ASSAY)

IF + OR EQUIVOCAL

IGM AND IGG WESTERN BLOT (WB ) ASSAYS TO CONFIRM

+= IGM WB 2 0F 3 BANDS PRESENT

+= IGGWB 5 OF 10 SPECIFIC BANDS PRESENT

70-80% PEOPLE DEVELOP AB 2-3 WEEKS AFTER INFECTION IGM

ALMOST 100% IGG AFTER 4-8 WEEKS AFTER INFECTION IF NOT TREATED.

PRESENTS ONE MONTH POST SYMPTOM ONSET W NEG ELISA - CONSIDER F/U CONVALESCENT SERUM TESING TO DIAGNOSE LYME

> ONE MONTH + ELISA ONLY DO IGG ( IGM WILL BE FALSE +VE)

LATE STAGE WILL HAVE + IGG WB

NO LYME WB TEST W/O + OR EQUIV ELISA

CANNOT TEST FOR CURE SP ABX. MOST PTS HAVE + IGG + IGM 10-20 YEARS AFTER DIAGNOSIS , MD INCORRECTLY ATTRIBUTES SYMPTOMS TO LYME

NEW C6 PEPTIDE LESS SENSITIVE TO EARLY STAGE DISEASE SO NOT RECOMMENDED AS STAND ALONE.

CSF PCR HAS FALSE NEGATIVES

LYME ARTHRITIS: ARTHROCENTESIS AND SYNOVIAL FLUID SENT FOR B BURG PCR ( MUCH HIGHER SENSITIVITY THAN CSF PCR

EM CAN BE OTHER ETIOLOGIES SUCH AS TICK BITE HYPERSENSITIVITY, BACTERIAL CELLULITIS

MULTIPLE ERYTHEMA MIGRANS VS ERYTHEMA MULTIFORME

CRANIAL NERVE PALSIES - LYME VS VZV AND HSV TYPE 1

MENINGITIS TYPES

LYME ARTHRITIS VS SEPTIC ARTHRITIS OR GOUT ,PSEUDOGOUT

FATIGUE /INSOMNIA/MYALGIA : LYME LATE PERS VS CHORNIC FATIGUE SYNDROME , FIBROMYALGIA

ALL STAGES CURABLE WITH APPROPRIATE TREATMENT

1. DOXYCYCLINE ( TREATS ANAPLASMOSIS AND HME ALSO -FROM TICKS)

   100 MG BID X 14 DAYS

2. AMOXICILLIN 500 MG BID X 14 DAYS

3. CEFUROXIME 500 MG BID X 14 DAYS-2nd gen

   
   

   2 & 3 IF ALLERGY TO DOXY OR PT PREGNANT

   FIRST GEN CEPHALOSPORINS NOT EFFECTIVE AGAINST B BURGDORF

NEURO

CEFTRIAXONE 2 GRAMS IV DAILY X 14 DAYS ( NOW 10)

NEURO DONT NEED HOSPITALIZATION:

DOXYCYCLINE PO X 14 DAYS ( GOOD ABSORPTION)

CRANIAL NERVE PALSY, EG VII + NO MENINGITIS SYMPTOMS -TREAT AS EARLY LYME- DOXY,AMOXI,CEFUROXI

HOSPITAL USU AS SYMPTOMATIC W DYSPNEA , CHEST PAIN, SYNCOPE, HEART BLOCK

IV ABX EG CEFTRIAXONE + MONITORING

COMPLETE HEART BLOCK USU RESOLVES ONE WEEK,

LESSER DEGREES OF HEART BLOCK - UP TO 6 WEEKS

DOXY,AMOXI,CEFUROXI X 28 DAYS,THEN REPEAT IF SYMPTOMATIC -SYMTPOMS LAG BEHIND RX. EITHER WAIT OR IMMED : ANOTHER 28 DAYS PO OR 14-28 IV ( CEFTRIAXONE)

ABX SAME AS NEURO BUT DO NOT OVERTREAT, NOW CALLED POST LYME DISEASE SYNDROME PLDS

PDLS NEED CLINICAL EVAL OF OTHER CAUSES OF THEIR SYMPTOMS

REFER TO RHEUMATOLOGIST

REFER TO CARDIOLOGIST FOR HEART BLOCK PROLONGED ISSUES MAY NEED PPM

LONG PANTS AND SLEEVES

AVOID HIGH GRASSES

USE TICK REPELLANT 20% DEET , PERMETHRIN

SHOWER AFTER HIKES

DRY CLOTHES ON HIGH HEAT KILLS TICKS ON CLOTHING:

10 MINS IF DRY

60 MINS IF WET

3 FOOT GRAVEL BORDER IN YARD

PROPHYLACTIC DOXY 200 MG IN 72 HOURS IF TICK FOUND + 87% PREVENTION OF ERYTHEMA MIGRANS

CLASSIC OBSTRUCTION: CYSTIC DUCT OR JUNCTION:

> WBC

>LFT

AMYLASE /LIPASE/BILIRUBIN WNL

COMMON BILE DUCT

>WBC

>BIL

> AMYLASE LIPASE

LFT WNL

PANCREATIC DUCT

>WBC

>BILI

> AMYLASE/LIPASE

>LFT

DROOLING

AIRWAY COMPROMISE2/2 TONSILLAR ENLARGEMENT/ABSCESS

ABD PAIN IN PRESENCE OF FEVER

JAUNDICE

ANY HISTORY OF ABDOMINAL TRAUMA INCLUDING SPORTS. WHY? RISK OF SPLENIC RUPTURE

ACUTE

SELF LIMITED

USU BENIGN

90% EPSTEIN BARR- CALLED EBV-IM

10% NEPBV-IM -CMV,TOXOPLASMA GONDII, HEPATITIS, ADVENOVIRUS, HIV

HIGHEST INCIDENCE 15-19 YO

> RATE YOUNG ADULTS GROUP SETTING:

COLLEGE STUDENTS

MILITARY PERSONNEL ACTIVE DUTY

UNCOMMON <2% IN ADULTS

EBV IS A HERPES VIRUS

OTHER VIRUSES:

CMV

HERPES 6

HEP A

FLU A&B

RUBELLA

SOME CANCERS

HIV

FRAGILE DNA VIRUS

SPREAD OROPHARYNGEAL - INVADE ORAL EPITHELIAL- B LYMPHOCYTES-CAUSE SIGNIFICANT BUT TIME LIMITED RESULT

IIMMUNE RESPONSE CAUSES SYMPTOMS

INCUBATION LOOOONG 4-8 WEEKS ( SIMILAR TO HEP A-15-45 DAYS)

HEPATIC INVOLVEMENT 10% YOUNG ADULTS, 30% OLDER ADULTS

ACUTE EBV STIMULATES ANTIBODIES THAT LAST A LIFETIME

INFECTION W IM > CHANCES OF MS > FOR NEXT 30 YEARS

CLASSIC TRIAD :

FEVER UP TO 104

PHARYNGITIS

LYMPHADENOPATHY ANTERIOR AND POSTERIOR CERVICAL CHAINS

TEENAGER PHARYNGEAL INFLAMMATION AND PALATAL PETECHIAE,TONSILLAR ENLARGEMENT

OLDER ADULTS: HEPATOMEGALY AND JAUNDICE - NOT SORE THROAT

SYMPTOMS PEAK 7 DAYS AFTER ONSET , LESS PRONOUNCED NEXT 1-3 WEEKS.

FATIGUE SEVERAL MONTHS

SPLENIC ENLARGEMENT 40-100%

LESS COMMON:

JAUNDICE , ABD PAIN , RASH -CAN BE MACULAR, URITCARIAL , PETECHIAL ERYTHEMA MULTIFORME

LOOK FOR TRIAD

ABDOMINAL EXAM FOR SPLENOMEGALY

HEPATO MEGALY

NOTE FOR RASH JAUNDICE

LAB

CBC-LYMPHOCYTOSIS

HETEROPHIL ANTIBODY (IDENTIFIES 85% ,FALSE-VE EARLY )

THROAT CULTURE-FOR STREP ( 3-30% HAVE STREP)

ADDITIONAL IF NEEDED

VCA

IMMUNOGLOBULINS IGM AND IGG- BETTER R/O THAN HETEROPHIL

LFT-> ELEVATED IN 80-90%

CMV

HIV

EBV NUCLEAR ANTIGEN

USS SPLEEN

IF ENLARGED- SERIAL USS, ASSESS FOR RUPTURE

STREP PHARYNGITIS

HEPATITIS A

VIRAL URI

REST

HYDRATE

NO STRENUOUS EXERCISE OR CONTACT SPORTS 4 WEEKS

REASON -SPLENOMEGALY + RISK OF RUPTURE

NSAIDS

TYLENOL MAX 4000 MG/24 HOURS

THROAT LOZENGES

2% LIDOCAINE GARGLES VISOUS PRESCRIBED

• ANTIVIRALS + OCS DONT HELP EXCEPT OCS USED FOR RARE COMPS

MOST CASES UNEVENTFUL

COMPS IN OLDER ADULTS:

FULMINANT HEPATITIS

SEVERE CHOLESTASIS JAUNDICE

BIOCHEMICAL MARKERS OF LIVER INJURY:

ALT . AST. ALK PHOS. BILIRUBIN .ggt

HEPATOCELLULAR FUNCTION MARKERS:

ALBUMIN. PROTHROMBIN. BILIRUBIN

BILIRUBIN. MEASURES LIVER ABILITY TO DETOXIFY METABOLITES AND TRANSPORT ORGANIC ANIONS INTO BILE

CHOLESTASIS IS BACKFLOW OF BILE

OLDER ADULTS AT RISK FOR MISDIAGNOSIS - IM RARE , AND DIFFERENT SYMPTOMS FEVER, NO PHARYNGITIS OR LYMPHADENOPATHY IN 50%

ACUTE UPPER AIRWAY OBSTRUCTION

HEPATOMEGALY

SPLENOMEGALY

SPLENIC RUPTURE

JAUNDICE 5%

DDD

HEM:

THROMBOCYTOPENIA

NEUTROPENIA 50-80%

APLASTIC ANEMIA

RASH IF TREATED WITH AMOXI OR AMIPICILLIN

NOT A DISEASE, BUT A SYMPTOM OF AN UNDERLYING DISORDER

3 MAIN CATEGORIES:

RBC PRODUCTION DISORDERS

RBC DESTRUCTION DISORDERS

BLOOD LOSS-ACUTE OR CHRONIC

LOW HGB <12G/DL WOMEN, <14 G/DL MEN

INDUCES ERYTHROID EPO

A GLYCOPROTEIN HORMONE

PRODUCED BY

PERITUBULAR CELLS OF THE KIDNEY

STIMULATES RBC PRODUCTION

INDUCES ERYTHROID PRECURSOR CELLS TO DIFFERENTIATE

PRODUCTION OF ERYTHROCYTES ( RBCS)

IN AXIAL SKELETON

AND PROXIMAL LONG BONES

BONE MARROW FUNCTION

HAS MATRIX OF RETICULAR CELLS AND FIBERS- MARROW STROMA

IN STROMA STEM CELLS STIMULATED BY COLONY STIMULATING FACTORS

TO GROW AND DIFFERENTIATE INTO VARIOUS BLOOD CELLS

CIRCULATING BLOOD CELL LIFE 100-120 DAYS

TURNOVER 1% A DAY

HYPOXIA AND ANEMIA WILL CAUSE MARROW PRECURSORS

TOO LITTLE OXYGEN TO TISSUES

NEED:

FUNCTIONAL BONE MARROW

INTACT ERYTHROPOETIN SYSTEM - RENAL

ADEQUATE IRON, B12, FOLATE, PROTEIN

ABSENCE OF CHRONIC INFLAMMATION

IROON DEFICIENCY ANEMIA IDA

ANEMIA OF CKD- UNDER PRODUCTION OF ERYTHROPOETIN = NO SIGNAL TO TRIGGER RBC PRODUCTION

FOLATE

VITAMIN B12

ACD

APLASTIC ANEMIA -RESULT OF BONE MARROW STEM CELL FAILURE

SICKLE CELL

HEREDITARY SPHEROCYTOSIS , ELLIPTOCYTOSIS ( ?TO DO WITH RBC SHAPE? NOT BICONCAVE?)

RBC ENZYME DEFECT -G6PD

AUTOIMMUNE ANTIBODY PRODUCTION- AUTOIMMUNE HEMOLYTIC ANEMIA( RARE-MONO)

ACUTE OR CHRONIC

CHRONIC CAN BE OVER PERIOD OF TIME AND AS LITTLE AS FEW TEASPOONS BLOOD LOSS DAILY GI

MENORRHAGIA

HEMATURIA

S+S NOT VISIBLE UNTIL <7.5G/DL

FATIGUE MALAISE

EXERCISE INTOLERANCE

TACHYCARDIA AT REST

DYSPNEA

WIDE PULSE PRESSURE

MIDSYSTOLIC OR PANSYSTOLIC MURMUR

BRITTLE NAILS

ANGULAR CHEILITIS

CLUBBING

PALLOR OF CONJUNCTIVAE,NAIL BEDS, PALMAR CREASES

REQUIRES HEAD TO TOE PHYSICAL, MULTIPLE CAUSES

CONSTITUIONAL

CARDIAC

RESP RATE, DYSPNEA

SKIN NAILS

GI

CBC W

RBC INDICES AND MORPHOLOGY

RETICULOCYTE COUNT

PERIPHERAL BLOOD SMEAR DETECTS MICROCYTIC EARLY

WBC W DIFFERNETIAL ( ALL BLOOD CELL LINES)

ADDITIONAL:

OCCULT BLOOD

VIT B12

THYROID FUNCTION TESTS

LFT

FOLATE

RENAL FUNCTION -BUN CREATININE eGFR

ERYTHROPOETIN LEVEL

COOMBS TEST

SERUM HOMOCYSTEINE

ESR

CRP

LDH /HAPTOGLOBIN

IMAGING

BONE MARROW BX

MCV- IDENTIFIES RBC SIZE

MICROCYTIC-<80FL

NORMOCYTIC 80-99 FL

MACROCYTIC>100 FL

MCH -AMOUNT OF HGB IN RBC 27-34 PG

< HYPOCHROMIC

NORMOCHROMIC

> HYPERCHROMIC

THS GUIDES OTHER TESTS FOR TYPE OF ANEMIA

IMMATURE RBCS

CALCULATE A RETICULOCYTE INDEX RI

LOW RI = MARROW THAT CANNOT COMPENSATE FOR ANEMIA

HIGH RI = MARROW RECOVERING FROM ANEMIA OR HEMOLYSIS

IF HIGH RI - R/O HEMOLYTIC ANEMIA BY CHECK BILIRUBIN ,>HAPTOGLOBIN,SERUM LDH-LACTATE DEHYDROGENASE( CELLULAR INJURY)

>LDH

>BILIRUBIN =MARKER OF HGB CATABOLISM

<SERUM HAPTOGLOBIN -LOW VALUE =INTRAVASCULAR HEMOLYSIS

EXPL: HAPTOGLOBIN BINDS TO FREE HEMOGLOBIN FROM LYSED RBCS IN BLOOD. IMPORTANT TO REMOVE TOXIC EFFECTS . BECAUSE HAPTOGLOBIN LEVELS BECOME DEPLETED IN THE PRESENCE OF LARGE AMOUNTS OF FREE HGB DECREASED HAPTO IS A SIGN OF HEMOLYSIS

HEMOGLOBIN-HAPTOBLOBIN COMPLEXES REMOVED FROM CIRCULATION BY RETICULOENDOTHELIAL SYSTEM

REFER TO HEMATOLOGIST

PERIPHERAL BLOOD SMEAR

DETECTS MICROCYTIC CHANGES OF IDA LONG BEFORE HGB CHANGES-SHOWS FUNKY SIZE AND SHAPE OF RBC CELLS

RDW- MEASURES DEGREE OF HOMEGENEITY OR VARIABILITY IN RBC SIZE

IF IDA OR LOW MCA:

SERUM FERRITIN- REFLECTS BODY STORES <12 IS LOW. CAN BE ELEVATED IF CHRONIC INFLAMMATION OR ALCOHOLISM

SERUM IRON- MEASURES IRON BOUND TO TRANSFERRIN

TIBC-TOTAL IRON BINDING CAPACITY

TRANSFERRIN SATURATION %. MEASURED BY

SERUM IRON/TIBC X100

BLOOD LOSS

ACUTE HEMORRHAGE

GI/GYN CAUSES

HEMOLYSIS

BONE MARROW FAILURE OR DX

MALIGNANCY'

RENAL FAILURE

MEAN CORPUSCULAR HGB

27-34-

HYPOCHROMIC ANEMIA

HYPERCHROMIC ANEMIA

SIZE OF RBC

CATEGORIZNG ANEMIA

MICROCYTIC

NORMOCYTIC

MACROCYTIC

IRON DEFICIENCY

THALASSEMIA

ANEMIA OF CHRONIC DX ( SOMETIMES)

(SIDEROBLASTIC ANEMIA’’HEMOGLOBIN E DX)

ACUTE BLOOD LOSS

ACD INCLUDING RENAL FAILURE

SICKLE CELL

ANEMIA OF CHRONIC DISEASE INC RENALFAILURE

(HEMOLYTIC ANEMIA)

MEGALOBLASTIC ANEMIA-VIT B12 OR FOLATE DEFICIENCY

(ACUTE SIDEROBLASTIC ANEMIA)

RED CELL DISTRIBUTION WIDTH

MEASURES VARIABILITY OF RBC SIZE

NORMAL -HOMOGENOUS RBC SIZE-ETOH, LIVER DX, RENAL INSUFF, ACD

INCREASED-HETEROGENOUS RBC SIZE

IDA

SICKLE

SCC

TARGETS

THALASSEMIA

HGB C

HGB E

SPHERICAL

SPHEROCYTOSIS HERED

IMMUNE HEMOLYSIS

ELLIPTICAL

HERED ELLIPTOCYTOSIS

MOST COMMON CAUSE OF ANEMIA

NUTRITIONAL DEFICIENCY

CROHNS- BLOOD LOSS

GIB 2/2 NSAIDS OR ASA OR ? DOAC

WOMEN MENORRHAGIA

INADEQUATE DIET

MALABSORPTION-CELIAC, H PYLORI GASTRIC BYPASS

PREGNANCY

;EXTREME ATHLETES

MCV LOW

MCH LOW

RDW HETEROGENOUS

FATIGUE

DYSPNEA ETC AS EARLIER CARD

ELDERLY -EXCACERBATION OF COMORBIDITIES -CHEST PAIN, DEMENTIA, HF

WOMEN PICA FOR ICE

THALASSEMIA BETA/ALPHA

MENDELIAN AUTOSOMAL RECESSIVE

NORMAL RATIO OF ALPHA TO BETA GLOBINS DISRUPTED

AFRICA -BETA, ASIA AND MEDITERRANEAN

TYPES

GENOTYPE ALPHA OR BETA

PHENOTYPE, MINOR , INTERMEDIA, MAJOR

NON ANEMIA DIFF DX

LO THYROID

PREGNANCY

FIBROIDS -BLEED

FERRITIN

IRON STORES

MOST ACCURATE TO TEST IDA

WOMEN 12-150

MEN 15-300 NG

DECREASED IDA

INCREASED ACD, SIDEROBLASTIC ANEMIA

IN CHRONIC INFLAMMATION STATES <5O NG IS IDA

SERUM IRON-CIRCULATING < WITH IDA

TIBC- TOTAL IRON BINDING CAPACITY

SERUM TRANSFERRIN INCREASED

TSAT TRANSFERRIN SATURATION -SERUM IRON/TIBC X100- DECREASED

FIRST RDW ELEVATED

SERUM FERRITIN LOW

PERIPHERAL SMEAR HYPOCHROMIA MICROCYTOSIS MILD ANICYTOSIS + POIKILOCYTOSIS

SERUM IRON LOW

MCV LOW

MCH LOW MCHC LOW

TIBC HIGH

RA

MICROCYIC HYPOCHROMIC ANEMIA 2/2 INFLAMMATION

MCV MCH

FERRITIN LEVEL INCREASED

TIBC NORMAL OR DECREASED??

ORAL REPLACEMENTS

180 MG ELEMENTAL IRON(150-200)

FESO4 325MG TID ( 65 MG ELEMENTAL IRON)

FERROUS GLUCONATE 325 MG (36MG)

ORAL INTOLERANCE OR SEVERE-REFER

NAUSEA/VOMITING

CONSTIPATION/DIARRHEA

EAT 30 MINS BEFORE MEALS - ABSORPTION <50 % WITH FOOD

TAKE PILL AT NIGHT

INCREASE DOSAGE SLOWLY

BLACK STOOLS

ENHANCED BIOAVAILABILITY WITH OJ