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45-year-old Singaporean man at GP, lethargy for the last few months. Full…
45-year-old Singaporean man at GP, lethargy for the last few months. Full blood count shows anaemia
Microcytic
Anemia of chronic disease (can be normocytic too)
active pulmonary tuberculosis), inflammatory (eg, rheumatoid arthritis), or malignant (eg, Hodgkin lymphoma)
Thal
Fe deficiency
Pica and ice craving, Beeturia, Restless leg syndrome, Dry or rough skin, Blue sclerae, Koilonychia, Cheilosis, Atrophic glossitis with loss of tongue papillae
low serum ferritin concentration, an increased total iron binding capacity (transferrin), and low serum iron concentration
Causes
: Blood loss
Reduced iron absorption
Celiac disease/atrophic gastritis/H. pylori
Bariatric surgery
Sideroblastic anemia
congenital, lead exposure, medications
Normocytic
secondary to systemic cause e.g. liver, renal disease
fever, weight loss, anorexia, and malaise
BM failure
Blood loss
gastrointestinal (GI) hemorrhage
Hematemesis (either red blood or coffee-ground emesis) suggests bleeding proximal to the ligament of Treitz. Blood originating from the left colon tends to be bright red in color, whereas bleeding from the right side of the colon usually appears dark or maroon colored
●Vascular: Hemorrhoids, Ischemic, Inflammatory:Infectious, Inflammatory bowel disease, Ulcer
Neoplastic: Polyp, Carcinoma
●Varices or portal hypertensive gastropathy in a patient with a history of liver disease or alcohol abuse
●Aorto-enteric fistula in a patient with a history of an abdominal aortic aneurysm or an aortic graft
●Angiodysplasia in a patient with renal disease, aortic stenosis, or hereditary hemorrhagic telangiectasia
●Peptic ulcer disease in a patient with a history of Helicobacter pylori, nonsteroidal anti-inflammatory drug (NSAIDs) use, or smoking
●Malignancy in a patient with a history of smoking, alcohol abuse, or H. pylori infection
DIC
Hemolytic anemia
Physical trauma: prosthetic valve
prominent schistocytes, including helmet cells and triangular cells, on the peripheral blood smear, elevation of the serum indirect bilirubin concentration, and reduction in the serum haptoglobin concentration.
Autoimmune
Drugs: quinine, dapsone, sulphonamides
Malaria
tachycardia, tachypnea, chills, malaise, fatigue, diaphoresis (sweating), headache, cough, anorexia, nausea, vomiting, abdominal pain, diarrhea, arthralgias, and myalgias
Mechanical
a. Macroangiopathic (marching, prosthetic valves)
b. Microangiopathic: disseminated intravascular coagulation (DIC), thrombotic
thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS) 4.
Infections, such as malaria
Toxins, such as snake venom
Macrocytic
Megaloblastic
Folate
Substance abuse
Alcoholism
Poor dietary intake
Celiac disease (sprue)
Inflammatory bowel disease
Infiltrative bowel disease
Short bowel syndrome
Methotrexate
Trimethoprim
Ethanol
Pernicious, B12
Pernicious anemia
Gastrectomy/bariatric surgery
Gastritis
Malabsorption syndrome
Ileal resection or bypass
Crohn's disease
Strict vegans
Alcoholism
Regular ingestion of 80 grams of alcohol each day (eg, one bottle of wine) is sufficient to cause this effect
Liver disease
Cirrhosis, Thrombocytopenia is the most common hematologic abnormality, while leukopenia and anemia
BM infiltration
AML: pancytopenia, pallor secondary to anemia, petechiae or ecchymoses secondary to thrombocytopenia or disseminated intravascular coagulation, excess bleeding or bruising, and infection ,marked reduction in red cells, platelets, and mature neutrophils
Drugs: methotrexate, azithioprine
Hypothyroidism
fatigue, slow movement and slow speech, cold intolerance, constipation, weight gain, Hair may be coarse, hair loss is common, and the nails become brittle.
Aplastic anemia
Epstein-Barr virus
Seronegative (non-A through -G) hepatitis
Human immunodeficiency virus (HIV)
Anticonvulsants: carbamazepine, hydantoins, phenacemide
Antibiotics: sulfonamides, chloramphenicol
Non steroidal anti-inflammatory drugs (NSAIDs): phenylbutazone, indomethacin
Anti-thyroid medications: methimazole, propylthiouracil
recurrent infections due to profound neutropenia or mucosal hemorrhage due to thrombocytopenia. Infections are typically bacterial, including sepsis, pneumonia, and urinary tract infection.