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11 Hematology - Oncology
Approach to Anemia
Confirmation of anemia with CBC with stained blood smear and reticulocyte counts.
Detail history (especially family & drug history) & physical examination
Procedures for Making the Initial Classification
Classification of Anemia
|Macrocytic Anemia (MCV > 100)
|Microcytic Anemia (MCV < 80)
|Normocytic Anemia (MCV 80-100)
Classification and Diagnostic Approach
Blood iron, vit. B12, or folate levels to check for deficiency.
Hemoglobin electrophoresis to check for inherited hemoglobinopathy.
Direct Coombs' (antiglobulin) test - to check for autoimmune hemolytic anemia; when both direct & indirect Coombs' tests are positive, immune-mediated destruction of RBS is occurring. In the majority of cases with positive direct but negative indirect Coombs' test, the immune-mediated destruction of RBs is absent.
Osmotic fragility test is abnormal in spherocytosis.
Sugar water test is positive in paroxysmal nocturnal hemoglobinuria (PNH) or AIHA.
Bone marrow study.
If MCV is < 70: blood iron level, TIBC, % sat, or ferritin;
Hemoglobin electrophoresis to check for Beta Thalassemia.
Common Causes of Anemia
Diminished Production of Mature Erythrocytes (RBC)
Replacement of Bone Marrow with Other Cells
Humoral or Cellular Inhibition of normal Cells
Accelerated Loss of Mature Erythrocytes (RBC) from the Circulation
Lee: Wintrobe's Clinical Hematology, 10th ed., Copyright © 1999
Erythropoiesis-Stimulating Agents (ESA)
1. Procrit /Epogen (Epoetin alfa)
2. Aranesp (Darbepoetin alfa)