C27 p1 Anemia approach

Macrocytic anemia

Microcytic anemia

• DDx of IDA and thalassemia– IDA, PB: anisocytosis, (poikilocytosis), RBC poor

RBC number, – Thalassemia: PB: less anisocytosis, target cells,

poikilocytosis RBC number increase,

• Treatment of – B12: 1mg daily for one week, weekly for one month,

monthly for life(須先補 b12), if data ok 可用 3 年– Folate: 1-5 mg /day till– Iron(Fe+2) till ferritin to 100 and more 1/2

yr(foliromin 1# bid)

• Thalassemia– a-tha: hemoglobin H: (100X)

• trait: 1-5#( +),6#(+2)• major: 1000#(3+),all(++++)

– b-thal• A2>4%

• IDA:– In “male or post menopause female” : 排除腫瘤– Elder: R/O CAPEScoloscopy– YoungerR/O ulcer(PES)

IDA: 10% with mild leukopenia and reactive thrombocytosis

Normocytic anemia

3低3高

↑↓ 發炎

In MΦ

• When to did BM and R/O cancer studies– Clues:

• PB: leukoerythroblatosis,…..--> BM studies• LDH elevated, reticulocytopenia,

thrombocytopeniaBM studies• ALKR/O Ca