HEMATOLOGY BLOCK

ANEMIA
Each gram of hemoglobin can carry 1.34 ml of oxygen
Amount of blood intake of hookworm: 0.03 to 0.26 ml per day
Types of Anemia

Erythropoiesis

Iron Metabolism

DIAGNOSIS: IRON DEFICIENCY ANEMIA SECONDARY TO

HOOKWORM INFECTION
CLINICAL MANIFESTATION
1. Iron deficiency anemia
- Fatigue and diminished capability to perform hard labor
- Patients with severe iron-deficiency anemia may present with
lassitude, headache, palpitations, exertional dyspnea, syncope,
or edema.
- History of perverted taste and pica.

Rare cases, anemia may provoke ischemic symptoms such as

angina or claudication.

2. Hookworm infection
- pruritic maculopapular dermatitis (ground itch) at the site of
skin penetration as well as serpiginous tracks of subcutaneous
migration
- Pulmonary reaction (pneumonitis)
- Abdominal pain
- Nausea
- Vomiting
- Anorexia
- Iron deficiency anemia (pallor)
EXPECTED PE FINDINGS
- pallor, chlorosis (greenish-yellow skin discoloration)
- hypothermia
- spooning nails
- tachycardia
- Signs of high-output cardiac failure.
- >2 sec capillary refill
- Hypotension due to decrease blood volume(postural
hypotension)
- Peripheral edema(signs of CHF)
DIFFERENTIAL DIAGNOSIS
1. Hemolytic anemia- rule out: NO SIGNS OF JAUNDICE
2. Bleeding PUD- Rule out: NO NSAIDS MEDICATION, EPIGASTRIC
PAIN AND MELENA
DIAGNOSTIC TEST
1. CBC
- Check for rbc count, hemoglobin count and differential count esp.
Eosinophil
- Indication for blood transfusion
- Normal CBC:
Rbc count:
male:
4.3-5.6 x 1012/L
female:
4.0-5.2 x 1012/L
WBC count:
3.54-9.06 x 109/L
Diff. Count:
Segmenters - 50-70%
Lymphocyte- 15-45%
Monocytes- 20-80%
Eosinophil- 0-6%
Basophil- 0-1%

Hemoglobin count:
Male:
133-162 g/dL
Female:
120-158 g/dL
Hematocrit:
Male:
38.846.4
Female:
35.444.4
Platelet count:
165415 109/L
-

Expected findings:
Decreased rbc, hematocrit, hgb count
Increased eosinophil(parasitic infection
Thrombocytosis (increased platelet)
WBC count normal or increased

2.
-

Peripheral blood smear

Check for shape, size and color of blood smear
Normal finding: normocytic, normochromic rbc
Expected findings: microcytic, hypochromic rbc(iron deficiency
anemia)

3.
-

RPI(reticulocyte index)
Check if bone marrow response to blood loss
Normal:>2.5(think hemolytic anemia or blood loss)
<2.5(hypo proliferation or maturation disorder such as aplastic
anemia and megaloblastic anemia)

4.
5.
6.
7.

RBC indices decreased MCHC and MCV

Serum ferritin- check the iron storage
Normal
>15mg/dl- IDA
<30- 300mg/dl- inflammation
TIBC - Increased TIBC
Fecalysis- check if blood loss due to GIT bleeding, or parasitic
infection
a. Occult blood (+) if due to bleeding

8. Blood typing- preparation for blood transfusion

TREATMENT AND MANAGEMENT
Short term:
1. Oxygen therapy- if mat dyspnea
2. Whole blood transfusion
- If hgb <10g/dl in euvolemic patient--> packed rbc given
- If hgb <10g/dl in hypo olefin patient---> whole blood given
- In every 1bag of packed rbc will raise the hgb of 1g/dl
- Target liberal regimen of 10g/dl

Ex: patient hgb-7g/dl; need 3bags of packed rbc to raise 3g/dl

hgb
3. Anti- helminthic drugs
- albendazole (400 mg once a day
- mebendazole (500 mg once a day
4. Iron salt(oral)(ferrous sulfate)
- 250mg/cap once a day
RESPONSES TO IRON THERAPY OF IRON DEF ANEMIA
12-24 HRS Replacement of intracellular iron enzymes
36-48 hours initial bone marrow response; erythroid hyperplasia
48-72 hours reticulocytosis; peaking 5-7 days
4-30 days increase in Hemoglobin level
1-3 mos repletion of iron stores