DIAGNOSIS KLINIK ANEMIA

Definisi
Anemia (WHO)
– HGB <13 g/dL ( laki-laki dewasa)
– HGB < 12 g/dL(wanita tdk hamil)
– HGB <11% g/dL(wanita hamil)
 Evaluasi penderita
Anamnesis
– Ada perdarahan ?
– Ada tanda-tanda hemolisis?
– Bone marrow suppresi?
– Intake nutrisi kurang?
– Paparan toksin?
 Evaluasi penderita (2)
Evaluasi SYMPTOMS
Penurunan oxygen delivery
– Exertional dyspnea
– Fatigue
– Palpitasi
– Angina pektoris
 Evaluasi penderita (3)
PEMERIKSAAN FISIK:
• Pucat
• Ikterik
-hemolysis
•Limfadenopati
•Hepatosplenomegali
•Petechiae
•RT -? Occult blood
 Evaluasi Laboratorik
Initial Testing
– CBC/FBC
– Reticulocyte count
– Peripheral blood smear
 Evaluasi Laboratorik (2)
Bleeding
– Serial HCT or HGB
Iron Deficiency
– Iron Studies
Hemolysis
– Serum LDH, indirect bilirubin, haptoglobin, coombs,
coagulation studies
Bone Marrow Examination
Others-directed by clinical indication
– hemoglobin electrophoresis
– B12/folate levels
 Differential Diagnosis
Klasifikasi Etiopatogenesis

– Gangguan pembentukan eritrosit

– Blood Loss

– Hemolisis
 Differential Diagnosis
Klasifikasi morfologik

– Normositik normokromik

– Mikrositik dan atau hipokromik

– Makrositik
 Blood Loss
Akut
– Traumatik
– Variety of sources
Melena, hematemesis, menometrorrhagia
Kronik
– Occult bleeding
Colonic polyp/carcinonma
 Gangguan sintesis eritrosit
Anemia def.Folat
Anemia def.Vit.B-12
Anemia def.Fe
Anemia sideroblastik
Anemia aplastik
Anemia diseritropoietik
Anemia pada keganasan hematologik
NUTRITIONAL DEFICIENCY
Fe
B12
Folate
 Anemia Diagnosis

Classified by the size of

the RBC-MCV
– Microcytic (90%)
Under 80 fl
– Normocytic
80-100 fl
– Macrocytic
Over 100 fl
 Anemia Makrositik

MCV > 100

Megaloblastic:
– B12, Folate
Non-megaloblastic:
Abnormal RBC maturation
– Myelodysplasia
 Anemia Mikrositik

MCV <80
Reduced iron
availability
Reduced heme
synthesis
Reduced globin
production
 Anemia Mikrositik

Defisiensi Fe
– Deficient Diet/Absorption
– Increased Requirements
– Blood Loss

Anemia of Chronic Disease

– Low serum iron, normal serum ferritin
– MANY!!
Chronic infection, inflammation, cancer, liver disease
 Anemia Mikrositik
Lead poisoning
Acquired or
congenital
sideroblastic anemia
Characteristic smear
finding: Basophylic
stippling
 Anemia Mikrositik

Thalassemias
Smear Characteristics
– Hypochromia
– Microcytosis
– Target Cells
– Tear Drops
 HEMOLISIS
Immune Mediated
Non-immune Mediated
 HEMOLISIS
IMMUNE MEDIATED
Cold Agglutinin
– Paroxysmal nocturnal hemoglobinuria
– Post mycoplasmal hemolytic anemia
Warm Agglutinin
– Drug induced
– Autoimmune hemolytic anemia
– Transfusion reaction
 Increased Destruction
NON-IMMUNE MEDIATED
Extra-corpuscular
– Macro-circulatory
Hypersplenism
Extracorporeal circulation
– Micro-circulatory
DIC
TTP
HUS
Intra-corpuscular
– RBC Wall (membrane or enzyme defects)
– Heme or globin abnormalities (HbS, C)
 Algoritma Morfologik Anemia

MCV > 100 MCV 80- 100 MCV < 80

Normositik Mikrositik
Makrositik
 Algoritma Anemia Makrositik

Retikulosit N Retikulosit ↑

Non Megaloblastik Megaloblastik

Pasca perdarahan
Def.Folat Def.Vit.B-12 Non Def.
Hemolitik
Alkoholism

Peny Hepar

COPD

MDS
Algoritma Anemia Normositik

Retikulosit ↑ Retikulosit N

Pasca perdarahan Gagal Ginjal

Kronik Fe
↑ Fe N/↑

Hemolitik
Peny.Hepar Def.Fe Ggn BM
Kronik

Peny Endokrin
ACD
 Algoritma Anemia Mikrositik
Fe.serum

Fe ↑ Fe N Fe ↑

Anaemia of
chronic disease Ferritin normal Hb analysis Familial sidero-
blastic anaemia

Iron def anaemia Ferritin <20

BM examination
Ring sideroblasts?

HbA2 ↑ or HbF ↑ Normal pattern

Consider Hb analysis
Family studies,
chromosome 16
deletion search
β-thalassaemia
α-thalassaemia