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The Netherlands Journal of Medicine Apr 2020Anaemia is a common diagnosis for clinicians. This mini-review summarises criteria for diagnosing the cause of anaemia. Within the microcytic anaemias, iron-deficient... (Review)
Review
Anaemia is a common diagnosis for clinicians. This mini-review summarises criteria for diagnosing the cause of anaemia. Within the microcytic anaemias, iron-deficient anaemia is most common. In addition, we would like to raise awareness of thalassaemia as a differential diagnosis. A normocytic anaemia, such as anaemia of chronic disease, is a diagnosis of exclusion. A macrocytic anaemia scheme is provided and differentiates based on reticulocyte count. We aim to provide the readers a clear overview of anaemia and when to refer to haematologists.
Topics: Adolescent; Adult; Anemia; Child; Diagnosis, Differential; Female; Hemoglobins; Humans; Male; Pregnancy; Reference Values; Symptom Assessment; Young Adult
PubMed: 32332184
DOI: No ID Found -
American Family Physician Jun 2010Anemia is defined as a hemoglobin level of less than the 5th percentile for age. Causes vary by age. Most children with anemia are asymptomatic, and the condition is... (Review)
Review
Anemia is defined as a hemoglobin level of less than the 5th percentile for age. Causes vary by age. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. Screening is recommended only for high-risk children. Anemia is classified as microcytic, normocytic, or macrocytic, based on the mean corpuscular volume. Mild microcytic anemia may be treated presumptively with oral iron therapy in children six to 36 months of age who have risk factors for iron deficiency anemia. If the anemia is severe or is unresponsive to iron therapy, the patient should be evaluated for gastrointestinal blood loss. Other tests used in the evaluation of microcytic anemia include serum iron studies, lead levels, and hemoglobin electrophoresis. Normocytic anemia may be caused by chronic disease, hemolysis, or bone marrow disorders. Workup of normocytic anemia is based on bone marrow function as determined by the reticulocyte count. If the reticulocyte count is elevated, the patient should be evaluated for blood loss or hemolysis. A low reticulocyte count suggests aplasia or a bone marrow disorder. Common tests used in the evaluation of macrocytic anemias include vitamin B12 and folate levels, and thyroid function testing. A peripheral smear can provide additional information in patients with anemia of any morphology.
Topics: Adolescent; Age Factors; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Transfusion; Child; Child, Preschool; Erythrocyte Count; Erythrocyte Indices; Hemoglobins; Humans; Infant; Infant, Newborn; Iron; Reticulocyte Count; Risk Factors
PubMed: 20540485
DOI: No ID Found -
American Family Physician Feb 2009Macrocytosis, generally defined as a mean corpuscular volume greater than 100 fL, is frequently encountered when a complete blood count is performed. The most common... (Review)
Review
Macrocytosis, generally defined as a mean corpuscular volume greater than 100 fL, is frequently encountered when a complete blood count is performed. The most common etiologies are alcoholism, vitamin B12 and folate deficiencies, and medications. History and physical examination, vitamin B12 level, reticulocyte count, and a peripheral smear are helpful in delineating the underlying cause of macrocytosis. When the peripheral smear indicates megaloblastic anemia (demonstrated by macro-ovalocytes and hyper-segmented neutrophils), vitamin B12 or folate deficiency is the most likely cause. When the peripheral smear is non-megaloblastic, the reticulocyte count helps differentiate between drug or alcohol toxicity and hemolysis or hemorrhage. Of other possible etiologies, hypothyroidism, liver disease, and primary bone marrow dysplasias (including myelodysplasia and myeloproliferative disorders) are some of the more common causes.
Topics: Alcohol Drinking; Algorithms; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Cell Count; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Erythrocyte Count; Erythrocyte Indices; FIGLU Test; Folic Acid Deficiency; Humans; Hypothyroidism; Liver Diseases; Myeloproliferative Disorders; Neural Tube Defects; Predictive Value of Tests; Reticulocyte Count; Risk Factors; Sensitivity and Specificity; Vitamin B 12 Deficiency
PubMed: 19202968
DOI: No ID Found -
Journal of the American Veterinary... Aug 2019To characterize the clinical features of dogs with precursor-targeted immune-mediated anemia (PIMA).
OBJECTIVE
To characterize the clinical features of dogs with precursor-targeted immune-mediated anemia (PIMA).
ANIMALS
66 dogs with PIMA.
PROCEDURES
Electronic record databases of a teaching hospital were searched to identify dogs with a diagnosis of nonregenerative anemia between 2004 and 2013. Inclusion criteria included persistent nonregenerative anemia (Hct ≤ 30% and reticulocyte count < 76,000 reticulocytes/μL), cytologic findings supportive of ineffective bone marrow erythropoiesis, and absence of underlying disease. Information regarding clinical signs, clinicopathologic findings, treatment, and outcome was extracted from records of eligible dogs. A regenerative response was defined as a reticulocyte count > 76,000 reticulocytes/μL or sustained increase in Hct of > 5%. Remission was defined as a stable Hct ≥ 35%.
RESULTS
The median Hct was 13%, and reticulocyte count was 17,900 reticulocytes/μL. Rubriphagocytosis was identified in bone marrow aspirate samples from 61 of 66 dogs. Collagen myelofibrosis was detected in bone marrow biopsy specimens obtained from 31 of 63 dogs. Immune-mediated targeting of mature erythrocytes was uncommon. All dogs received immunosuppressive therapy. Fifty-five dogs developed a regenerative response at a median of 29 days, and 40 of those dogs went into remission at a median of 59 days after PIMA diagnosis. Thromboembolic events were confirmed for 9 dogs and were associated with a decreased survival time. Median survival time was 913 days for all dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that most dogs with PIMA responded to prolonged immunosuppressive therapy. Studies to determine optimal immunosuppressive and thromboprophylactic protocols for dogs with PIMA are warranted.
Topics: Anemia; Animals; Bone Marrow; Dog Diseases; Dogs; Immunosuppressive Agents; Reticulocytes
PubMed: 31298643
DOI: 10.2460/javma.255.3.366 -
Digestive Diseases (Basel, Switzerland) 2022Anemia is a presentation of an underlying disease or deficiency. As stated by the WHO, anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in... (Review)
Review
BACKGROUND
Anemia is a presentation of an underlying disease or deficiency. As stated by the WHO, anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. This review of clinical practice aimed to determine the diagnostic approach to anemia in primary care patients.
SUMMARY
Nutritional deficiencies, medications, chronic inflammatory conditions, malignancy, renal dysfunction, and bone marrow and inherent disorders contribute to anemia development. Anemia is classified and diagnosed by the values of hematological parameters, underlying pathological mechanism, and patient history. The diagnostic approach of anemia in primary care settings is focused on history, physical examination, laboratory findings including complete blood cell count, reticulocyte count, and peripheral smear examination, fecal occult blood test, and ultrasound findings.
KEY MESSAGES
Anemia is the most common hematological disorder that represents a major health burden worldwide. Hb levels alter with gender, ethnicity, and physiological status. Anemia is often multifactorial. The evaluation of a patient with anemia in primary care includes clinical history, physical examination, and laboratory findings with fecal occult blood test and abdominal ultrasound. The wide variations in general practice in European countries are based on different health care systems but also knowledge of GPs that reflect educational and research policy.
Topics: Anemia; Chronic Disease; Europe; Female; Hemoglobins; Humans; Male
PubMed: 34098557
DOI: 10.1159/000517579 -
American Family Physician Oct 2001Anemia in children is commonly encountered by the family physician. Multiple causes exist, but with a thorough history, a physical examination and limited laboratory... (Review)
Review
Anemia in children is commonly encountered by the family physician. Multiple causes exist, but with a thorough history, a physical examination and limited laboratory evaluation a specific diagnosis can usually be established. The use of the mean corpuscular volume to classify the anemia as microcytic, normocytic or macrocytic is a standard diagnostic approach. The most common form of microcytic anemia is iron deficiency caused by reduced dietary intake. It is easily treatable with supplemental iron and early intervention may prevent later loss of cognitive function. Less common causes of microcytosis are thalassemia and lead poisoning. Normocytic anemia has many causes, making the diagnosis more difficult. The reticulocyte count will help narrow the differential diagnosis; however, additional testing may be necessary to rule out hemolysis, hemoglobinopathies, membrane defects and enzymopathies. Macrocytic anemia may be caused by a deficiency of folic acid and/or vitamin B12, hypothyroidism and liver disease. This form of anemia is uncommon in children.
Topics: Adolescent; Adult; Aging; Anemia, Iron-Deficiency; Child; Child, Preschool; Erythrocyte Indices; Female; Hemoglobins; Humans; Infant; Infant, Newborn; Iron; Male; Severity of Illness Index
PubMed: 11681780
DOI: No ID Found -
Research Square May 2024Plasma free hemoglobin (PFH) is a direct biomarker for hemolysis that has been associated with clinical complications such as pulmonary hypertension and death in...
Plasma free hemoglobin (PFH) is a direct biomarker for hemolysis that has been associated with clinical complications such as pulmonary hypertension and death in patients with sickle cell disease (SCD). We sought to characterize the relationship between PFH and more clinically available hemolytic markers including lactate dehydrogenase (LDH), aspartate aminotransferase (AST), bilirubin, reticulocyte percentage and to derive a composite hemolysis score derived from principal component analysis (PCA) of these biomarkers. In 68 adult patients (median age 31 years old, IQR 25-39) with HbSS or HbSβ -thalassemia enrolled in the IMPROVE II study, median PFH was elevated at 21.9 mg/dL (IQR 9.9-44.9 mg/dL). Using Pearson correlation analysis, PFH had a stronger relationship to LDH (R=0.699), AST (R=0.587), and total bilirubin (R=0.475), compared to reticulocyte count (R=0.316). The hemolysis score was significantly associated with PFH (R=0.677). When compared with other laboratory measures, PFH correlated with hemoglobin (R= -0.275) and HbS (R=0.277),but did not correlate with white blood cell count (WBC) or HbF. The hemolysis score was significantly associated with WBC (R=0.307), hemoglobin (R = -0.393), HbF (R=- 0.424), and HbS (R=0.423). This study confirms that the conventional hemolytic biomarkers LDH, AST, bilirubin, and reticulocyte percentage correlate with PFH. Additionally, the hemolysis score is a valid tool to measure hemolysis and that it may be a marker of global hemolysis as opposed to PFH, which quantifies intravascular hemolysis. Further studies will be needed to elucidate the role of PFH and intravascular hemolysis in the development of clinical complications of sickle cell disease.
PubMed: 38746469
DOI: 10.21203/rs.3.rs-4252554/v1 -
Pediatrics and Neonatology Oct 2020There are few reports on reticulocyte count during the early postnatal period, and its clinical significance is not well understood. To examine the relationships between...
BACKGROUND
There are few reports on reticulocyte count during the early postnatal period, and its clinical significance is not well understood. To examine the relationships between neonatal reticulocyte count and other perinatal variables.
METHODS
We conducted a retrospective cohort study of neonatal infants who were admitted to the neonatal intensive care unit (NICU) of Ohta Nishinouchi Hospital, Japan, between April 1, 2016 and July 31, 2019. All blood samples were collected within 3 h after admission.
RESULTS
Four hundred and twenty-eight infants were included, of whom 317 (74.1%) were preterm and 111 (25.9%) were term. Two hundred and ninety-nine infants (69.9%) were born by cesarean section. The median reticulocyte counts (‰) for all gestational ages (GAs) were as follows: 24-25 wks (n = 11), 124.1 (range: 106.3 to 148.6); 26-27 wks (n = 25), 111.1 (range: 55.5 to 144.3); 28-30 wks (n = 52), 81.9 (range: 35.6 to 131.5); 31-33 wks (n = 86), 71.6 (range: 28.3 to 116.6); 34-36 wks (n = 143); 59.6 (range: 30.2 to 110.9); and 37-41 wks (n = 111), 43.2 (range: 21.9 to 69.2). There were significant relationships between the neonatal reticulocyte count and gender [p < 0.01, odds ratio (OR), 0.37; 95% confidence interval (CI), 0.21 to 0.64], GA (p < 0.01, OR, 0.92; 95% CI, 0.90 to 0.93), delivery type (p = 0.03, OR, 0.51; 95% CI, 0.28 to 0.95), maternal haemoglobin before delivery (p < 0.01, OR, 0.74; 95% CI, 0.60 to 0.91), tracheal intubation at resuscitation (p = 0.04, OR, 2.75; 95% CI, 1.04 to 7.32) and mean platelet volume (p < 0.01, OR, 0.51; 95% CI, 0.35 to 0.74).
CONCLUSION
A higher neonatal reticulocyte count in NICU infants may be one of the physiological responses to a more rapid environmental change during the early postnatal period.
Topics: Adolescent; Adult; Female; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Middle Aged; Pregnancy; Reticulocyte Count; Retrospective Studies; Young Adult
PubMed: 32381419
DOI: 10.1016/j.pedneo.2020.04.004