(21sept) anemia-6.double - dr. salman

7/17/2019 (21Sept) Anemia-6.Double - Dr. Salman

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DAFTAR RIWAYAT HIDUPDAFTAR RIWAYAT HIDUP

NamaNama :: dr. Salman Paris Harahapdr. Salman Paris Harahap Alamat Rumah Alamat Rumah :: Jl. Siaga Raya, Pejaten BaratJl. Siaga Raya, Pejaten Barat..

PendidikanPendidikan ::

Tahun 2002 : FK UPNTahun 2002 : FK UPN ““eteraneteran!.!.

Tahun 20"2 : S#e$iali$ %P& FK U%Tahun 20"2 : S#e$iali$ %P& FK U%

Pengalaman KerjaPengalaman Kerja ::

Tahun 2000 ' 200( : )aya$an Peguyu*an %+hla$ Am*ulan -etr %+hla$/.Tahun 2000 ' 200( : )aya$an Peguyu*an %+hla$ Am*ulan -etr %+hla$/.

Tahun 2002 ' 200( : &+ter Jaga Pu$+e$ma$ i#ayung.Tahun 2002 ' 200( : &+ter Jaga Pu$+e$ma$ i#ayung.

Tahun 2002 'Tahun 2002 ' 20012001 : Be+erja i Klini+ Tiara -ei+a i#inang.: Be+erja i Klini+ Tiara -ei+a i#inang.

Tahun 200( ' 2001 : &+ter Kn$ultan -ei$ i 3a*ratrium Klini+Tahun 200( ' 2001 : &+ter Kn$ultan -ei$ i 3a*ratrium Klini+

Pramita.Pramita.Tahun 2004 ' Se+arang: &+ter Kn$ultan Ke$ehatan i A$uran$i ignaTahun 2004 ' Se+arang: &+ter Kn$ultan Ke$ehatan i A$uran$i igna

Tahun 20056 Se+arang : Klini+ Tiara -ei+a 2.Tahun 20056 Se+arang : Klini+ Tiara -ei+a 2.

Tahun 20""6 Se+arang : Penanggung Ja7a* %n 8u$e lini9 -N 3ieTahun 20""6 Se+arang : Penanggung Ja7a* %n 8u$e lini9 -N 3ie

Tahun 20";6$e+arang : RSU& Buhi A$ihTahun 20";6$e+arang : RSU& Buhi A$ih

Tahun 20"; '$e+arang : RS Tugu %*uTahun 20"; '$e+arang : RS Tugu %*u



&%A<N=S%S &AN&%A<N=S%S &AN

-ANAJ>->N AN>-%A-ANAJ>->N AN>-%A

Dr. Salman Paris Harahap. SpPDDr. Salman Paris Harahap. SpPD



AN>-%A AN>-%A

DefinisiDefinisi ::

-enurunnya ma$$a eritr$it yang *erear-enurunnya ma$$a eritr$it yang *erear

$ehingga tia+ mam#u menjalan+an$ehingga tia+ mam#u menjalan+antuga$nya $e*agai ?ygen 9arrying #7er.tuga$nya $e*agai ?ygen 9arrying #7er.

Diandai !leh men"r"nn#a kadar:Diandai !leh men"r"nn#a kadar:

8emgl*in8emgl*in

8emat+rit8emat+rit

8itung eritr$it8itung eritr$it



Krieria Anemia $WH%&Krieria Anemia $WH%&

3a+i6la+i e7a$a : @"; gl3a+i6la+i e7a$a : @"; gl

anita e7a$a t+ hamil : @"2 glanita e7a$a t+ hamil : @"2 gl

anita e7a$a hamil : @"" glanita e7a$a hamil : @"" gl

Kriteria Klini+ :Kriteria Klini+ :8* @ "0 gl89t @ ;0 C>ritr$it @ 2,58* @ "0 gl89t @ ;0 C>ritr$it @ 2,5

jutamm jutamm



'i!l!gi'i!l!gi

". <angguan #em*entu+an eritr$it leh $um$um". <angguan #em*entu+an eritr$it leh $um$um

tulangtulang

2. Kehilangan arah +eluar tu*uh #erarahan/2. Kehilangan arah +eluar tu*uh #erarahan/ ;. Pr$e$ #enghan9uran eritr$it alam tu*uh;. Pr$e$ #enghan9uran eritr$it alam tu*uh

$e*elum 7a+tunya hemli$i$/$e*elum 7a+tunya hemli$i$/



Pendekaan diagn!sis anemiaPendekaan diagn!sis anemia

".Pene+atan +lini$".Pene+atan +lini$ mengetahui $iatmengetahui $iat

gejala anemia, a7itannya an *eratnyagejala anemia, a7itannya an *eratnya

anemia.anemia.

2.Pene+atan *era$ar+an ha$il la*.2.Pene+atan *era$ar+an ha$il la*.

;.Pene+atan *era$ar+an #la etilgi;.Pene+atan *era$ar+an #la etilgi

anemia.anemia.



(. Pendekaan klinis(. Pendekaan klinis

Bera$ar+an anamne$i$ an PF men9ari:Bera$ar+an anamne$i$ an PF men9ari:

"".. <ejala anemia: Sinrm anemia<ejala anemia: Sinrm anemia

2. Tana +ha$ anemia2. Tana +ha$ anemia;. <ejala #enya+it a$ar ;. <ejala #enya+it a$ar

D. <ejala yang tim*ul a+i*at #enya+it a$ar yangD. <ejala yang tim*ul a+i*at #enya+it a$ar yang

menye*a*+an anemia:menye*a*+an anemia:

a9ing tam*ang: $a+it #erut, #em*eng+a+ana9ing tam*ang: $a+it #erut, #em*eng+a+an

#arti$, 7arna +uning #aa tela#a+ tangan#arti$, 7arna +uning #aa tela#a+ tangan

Anemia #enyt +rni+ : Artriti$ remati, TB Anemia #enyt +rni+ : Artriti$ remati, TB



). Pendekaan la*!ra!ri"m). Pendekaan la*!ra!ri"m

Anali$i$ ha$il la*ratrium: Anali$i$ ha$il la*ratrium:

Pemeri+$aan #enyaring :Pemeri+$aan #enyaring :

Taha# a7al 8*, ine+$ eritr$it, B, Plt,Taha# a7al 8*, ine+$ eritr$it, B, Plt, A#u$an arah te#i, S%, T%B, Reti+ul$it A#u$an arah te#i, S%, T%B, Reti+ul$itll.ll.



+.Pendekaan p!la ei!l!gi+.Pendekaan p!la ei!l!gi

Jeni$ anemia yang #aling $ering i unia aalah:Jeni$ anemia yang #aling $ering i unia aalah: Anemia ei$ien$i *e$i A&B/ Anemia ei$ien$i *e$i A&B/

Anemia a+i*at #enya+it +rni+ A&/ Anemia a+i*at #enya+it +rni+ A&/

Pla etilgi $uatu aerah i#erhati+an:Pla etilgi $uatu aerah i#erhati+an:

aerah tr#i$ : A&B, A&aerah tr#i$ : A&B, A&

Bali : anemia a#la$ti+ 9u+u# $eringBali : anemia a#la$ti+ 9u+u# $ering

Jeni$ +elaminJeni$ +elamin

anita hamil: ei$ien$i *e$i an latanita hamil: ei$ien$i *e$i an latU$ia:U$ia:

Ana+2 : thala$emia Ana+2 : thala$emia

&e7a$a : anemia #enya+it +rni+&e7a$a : anemia #enya+it +rni+



Tahapan diagn!sis anemiaTahapan diagn!sis anemia

-enentu+an aanya anemia-enentu+an aanya anemia

-enentu+an jeni$ anemia-enentu+an jeni$ anemia

-enentu+an *eratnya anemia atau aanya-enentu+an *eratnya anemia atau aanya+eaaan ga7at arurat.+eaaan ga7at arurat.

-enentu+an etilgi #enya+it a$ar -enentu+an etilgi #enya+it a$ar



,enen"kan jenis anemia,enen"kan jenis anemia

$Klasifikasi anemia&$Klasifikasi anemia&

".".Kla$ii+a$i -rlgia.Kla$ii+a$i -rlgia.

Anemia hi#+rmi+6mi+r$iter- @ 50 l, Anemia hi#+rmi+6mi+r$iter- @ 50 l,-8 @ 21 #g/-8 @ 21 #g/

Anemia nrm+rmi+6nrm$iter - 506 Anemia nrm+rmi+6nrm$iter - 506E(l, -8 216 ;D#g/E(l, -8 216 ;D#g/

Anemia ma+r$iter - E( l/ Anemia ma+r$iter - E( l/



Alur #ene+atan menurut mrlgi Alur #ene+atan menurut mrlgi



). Klasifikasi 'i!pa!genesis). Klasifikasi 'i!pa!genesis

A. <angguan Pru+$i >ritr$it A. <angguan Pru+$i >ritr$it".". Ke+urangan *ahan #em*entu+ arahKe+urangan *ahan #em*entu+ arah

a. Anemia ei$ien$i *e$ia. Anemia ei$ien$i *e$i

*. Anemia ei$ien$i B"2 G a$am lat*. Anemia ei$ien$i B"2 G a$am lat

2. <angguan Utili$a$i Be$i2. <angguan Utili$a$i Be$i

a. Anemia a+i*at #enya+it +rni+a. Anemia a+i*at #enya+it +rni+

*. Anemia $ier*la$ti+*. Anemia $ier*la$ti+

;. Keru$a+an $um$um tulang;. Keru$a+an $um$um tulang a. 8i##la$iaa. 8i##la$ia Anemia a#la$ti+ Anemia a#la$ti+

*. %niltra$i*. %niltra$i anemia miel#ti$i+anemia miel#ti$i+



D. <angguan eritr#etinD. <angguan eritr#etin

a. Anemia #aa <<Ka. Anemia #aa <<K

(. &i$ung$i $um$um tulang(. &i$ung$i $um$um tulang a. Anemia i$eritr#eti+a. Anemia i$eritr#eti+

*. Anemia #aa $inrmamieli$#la$ti+*. Anemia #aa $inrmamieli$#la$ti+

B. PerarahanB. Perarahan

a. Anemia #a$9a #erarahan a+uta. Anemia #a$9a #erarahan a+ut

*. Anemia #a$9a #erarahan +rni+*. Anemia #a$9a #erarahan +rni+



-. Anemia aki*a hem!lisis-. Anemia aki*a hem!lisis

". Fa+tr e+$tra+r#u$+uler ". Fa+tr e+$tra+r#u$+uler

a. A+i*at #r$e$ imuna. A+i*at #r$e$ imun

*. 8i#er$#leni$me*. 8i#er$#leni$me 9. A+i*at *ahan +imiai$i+9. A+i*at *ahan +imiai$i+

. A+i*at ine+$i *a+teri atau #ara$it. A+i*at ine+$i *a+teri atau #ara$it

e. A+i*at a+tr me+ani+e. A+i*at a+tr me+ani+



2. Fa+tr intra+r#u$+uler 2. Fa+tr intra+r#u$+uler

a. <angguan mem*ran eritr$it mem*ran#ati/a. <angguan mem*ran eritr$it mem*ran#ati/

8ereitary $#her9yt$i$8ereitary $#her9yt$i$ *. <angguan en$im eritr$it en$im#ati/*. <angguan en$im eritr$it en$im#ati/

&ei$ien$i <4P&&ei$ien$i <4P&

9. <angguan #em*entu+an hemgl*in9. <angguan #em*entu+an hemgl*inhemgl*in#ati/hemgl*in#ati/

8emgl*in#ati $tru+tural: 8*S, 8*>, ll8emgl*in#ati $tru+tural: 8*S, 8*>, ll

Thala$$emiaThala$$emia

D. en"k -amp"ranD. en"k -amp"ran



,enen"kan *eran#a anemia aa",enen"kan *eran#a anemia aa"adan#a keadaan ga/a dar"raadan#a keadaan ga/a dar"ra

Kla$ii+a$i erajat anemia yang umumKla$ii+a$i erajat anemia yang umumiguna+an aalah $**:iguna+an aalah $**:

Ringan $e+ali : 8* : "0 gl6 9ut #intRingan $e+ali : 8* : "0 gl6 9ut #intRingan : 8* : 56E,E glRingan : 8* : 56E,E gl

Seang : 8* : 461,E glSeang : 8* : 461,E gl

Berat : 8* : @4 glBerat : 8* : @4 gl



,enen"kan ei!l!gi0pen#aki dasar ,enen"kan ei!l!gi0pen#aki dasar

<ejala an tana #enya+it a$ar:<ejala an tana #enya+it a$ar:

Anemia yang i$e*a*+an leh ine$ta$i 9a9ing Anemia yang i$e*a*+an leh ine$ta$i 9a9ingitanai g: #em*e$aran #arti$, Tela#a+itanai g: #em*e$aran #arti$, Tela#a+

tangan *er7arna +uning $e#erti jerami.tangan *er7arna +uning $e#erti jerami.Kan+er +ln: #eru*ahan BAB,e9e$ 9am#urKan+er +ln: #eru*ahan BAB,e9e$ 9am#ur

arah an lenir.arah an lenir.

TB: +eringat malam, *atu+ arah, BBHTB: +eringat malam, *atu+ arah, BBH



Prinsip erapi anemiaPrinsip erapi anemia

Peng*atan hena+nya ila+u+an $etelahPeng*atan hena+nya ila+u+an $etelahiagn$i$ anemia itega++an, an ata$iagn$i$ anemia itega++an, an ata$ini+a$i yang jela$.ini+a$i yang jela$.

Jeni$6jeni$ tera#i anemia a#at *eru#a:Jeni$6jeni$ tera#i anemia a#at *eru#a: ".Tera#i untu+ +eaaan ga7at arurat".Tera#i untu+ +eaaan ga7at arurat

2.Tera#i $u#rti2.Tera#i $u#rti

;.Tera#i +ha$ untu+ anemia;.Tera#i +ha$ untu+ anemia D.Tera#i untu+ #enya+it a$ar D.Tera#i untu+ #enya+it a$ar

(.Tera#i e?juIantiIu$(.Tera#i e?juIantiIu$



Terapi "n"k keadaan ga/a dar"raTerapi "n"k keadaan ga/a dar"ra

Tran$u$i arah :Tran$u$i arah :

". Paa +a$u$ anemia g #ayah jantung". Paa +a$u$ anemia g #ayah jantung

atau an9aman #ayah jantung.atau an9aman #ayah jantung. 2. Paa anemia +arena #erarahan a+ut.2. Paa anemia +arena #erarahan a+ut.

;. S#e$imen #emeri+$aan iam*il terle*ih;. S#e$imen #emeri+$aan iam*il terle*ih

ahulu $e*elum tran$u$i.ahulu $e*elum tran$u$i.



Terapi s"p!rif Terapi s"p!rif

Tera#i untu+ mengurangi gejala anemiaTera#i untu+ mengurangi gejala anemiaan men$ta*il+an heminami+:an men$ta*il+an heminami+:

". Paa #erarahan a+ut i*eri+an tera#i". Paa #erarahan a+ut i*eri+an tera#i9airan.9airan.

2. Paa gagal jantung i*eri+an +$igen.2. Paa gagal jantung i*eri+an +$igen.

;. Paa anemia a#la$ti+ g e*ri$ i*eri+an;. Paa anemia a#la$ti+ g e*ri$ i*eri+ananti#ireti+ .anti#ireti+ .



Terapi khas "n"k anemiaTerapi khas "n"k anemia

Tera#i ini tergantung jeni$ anemiaTera#i ini tergantung jeni$ anemia

". Anemia ei$ien$i *e$i : #re#arat *e$i". Anemia ei$ien$i *e$i : #re#arat *e$i

2. Anemia ei$ien$i lat : a$am lat2. Anemia ei$ien$i lat : a$am lat

;. Anemia ei$ien$i B"2 : Iitamin B"2, ll;. Anemia ei$ien$i B"2 : Iitamin B"2, ll



Terapi "n"k pen#aki dasar Terapi "n"k pen#aki dasar

Penya+it a$ar #erlu i*ati, *ila tia+,Penya+it a$ar #erlu i*ati, *ila tia+,anemia a+an +am*uh +em*ali.anemia a+an +am*uh +em*ali.

".Ka$u$ TB #eng*atan TB".Ka$u$ TB #eng*atan TB

2.Ka$u$ menrrhagi tera#i menragi2.Ka$u$ menrrhagi tera#i menragi

;.%ne$ta$i 9a9ing : *at 9a9ing;.%ne$ta$i 9a9ing : *at 9a9ing



Terapi e1j"2ani2"sTerapi e1j"2ani2"s

Tera#i yang ter#a+$a i*eri+an $e*elumTera#i yang ter#a+$a i*eri+an $e*elum

iagn$i$ a#at itega++aniagn$i$ a#at itega++an". Bila tia+ ter$eia a$ilita$ iagn$i$ yang". Bila tia+ ter$eia a$ilita$ iagn$i$ yang

men9u+u#i.men9u+u#i.

2. Jauh ari $entra a$ilita$ iagn$i$2. Jauh ari $entra a$ilita$ iagn$i$

;. 8aru$ ia7a$i +etat : *ila re$#n *ai+ tera#i;. 8aru$ ia7a$i +etat : *ila re$#n *ai+ tera#iiteru$+an,*ila tia+ eIalua$i +em*aliiteru$+an,*ila tia+ eIalua$i +em*ali



Alur iagn$i$ Anemia -a+r$iti+ Alur iagn$i$ Anemia -a+r$iti+



Alur iagn$i$ Anemia Nrm$iti+ Alur iagn$i$ Anemia Nrm$iti+

nrm+rmnrm+rm



Alur iagn$i$ Anemia -i+r$iti+ hi#+rm Alur iagn$i$ Anemia -i+r$iti+ hi#+rm



Anemia e Fe Anemia e Fe



Alur iagn$i$ Anemia A#la$ti+ Alur iagn$i$ Anemia A#la$ti+



Anemia A& Anemia A&



Alur iagn$i$ Anemia -egal*la$ti+ Alur iagn$i$ Anemia -egal*la$ti+



Anemia hemliti+ %mun Anemia hemliti+ %mun



Ka$u$ ".Ka$u$ ".

Pa$ien 7anita (0 tahun atang menemui +ter an

mengeluh+an lelah, $e$a+ naa$, +a+i an #ergelangan+a+inya *eng+a+ an mem*ran mu+$anya #u9at. &ari

ha$il #emeri+$aan i$i+ terlihat *ah7a +u+u #a$ien

*er*entu+ $en+. Setelah ila+u+an #emeri+$aan

la*ratrium i#erleh ha$il $**:B D?"0E 3

RB ; ? "0E3

8* 1 g3

- 10 3



Bera$ar+an ha$il #emeri+$aan la*r ini, +ter

meniagn$a #a$ien ini mengalami anemia

ii$ien$i *e$i. Karena nilai - an 8* nyayang renah.

Pertanyaan:

". A#a+ah yang ima+$u engan anemia

ei$ien$i *e$i2. A#a+ah #enye*a* anemia ei$ien$i *e$i

;. A#a+ah gejala anemia ei$ien$i *e$i

D. Bagaimana #enata+$anaan #a$ien ini

(. A#a yang haru$ iinrma$i+an +e#aa #a$ienatau +eluarga #a$ien



Ka$u$ 2.Ka$u$ 2.

anita, ;2 thn, <"P0A0 ma$u+ RS engan hamilanita, ;2 thn, <"P0A0 ma$u+ RS engan hamilE *ulan, #arturien, +eluhan tam#a+ #u9at.E *ulan, #arturien, +eluhan tam#a+ #u9at.

Keluhan #u9at juga ira$a+an #a$ien $eja+ *elumKeluhan #u9at juga ira$a+an #a$ien $eja+ *elum

meni+ah. Statu$ umum: BB: D1,( +g,TB: "D0 9m.meni+ah. Statu$ umum: BB: D1,( +g,TB: "D0 9m.

3a*ratrium:3a*ratrium:

8*: (,2 "26"4 g3/, 3eu+$it: (.(00;.50068*: (,2 "26"4 g3/, 3eu+$it: (.(00;.5006

"0.400mm;/, Trm*$it: "24.000 "(0.0006"0.400mm;/, Trm*$it: "24.000 "(0.0006

DD0.000mm;/, 8t: 2"C D06D5C/, <&S: 14DD0.000mm;/, 8t: 2"C D06D5C/, <&S: 14@"D0 mg3/, Ureum: "5, R:, S<=T: "1 $ ;"@"D0 mg3/, Ureum: "5, R:, S<=T: "1 $ ;"

mg3/, S<PT: "0 ,mg3/, S<PT: "0 ,



-: (E,E 506"00 3/, -8: "4,1 246;D #g/,-: (E,E 506"00 3/, -8: "4,1 246;D #g/,

-8: 21,5 ;26;4 g3/, Reti+ul$it : 4,E "62C/,-8: 21,5 ;26;4 g3/, Reti+ul$it : 4,E "62C/,

8*S Ag: 6/.8*S Ag: 6/.

Pemeri+$aaan arah te#i: Ke$an anemiaPemeri+$aaan arah te#i: Ke$an anemia

hemliti+.hemliti+.

Penerita ila+u+an $e+$i $e$aria ata$ ini+a$iPenerita ila+u+an $e+$i $e$aria ata$ ini+a$i

#anggul $em#it a*$lut, $e*elumnya itan$u$i#anggul $em#it a*$lut, $e*elumnya itan$u$i7a$h re 9ell +arena ma$ih i#i+ir+an aanya7a$h re 9ell +arena ma$ih i#i+ir+an aanya

autimun hemliti+ i $am#ing thala$emia anautimun hemliti+ i $am#ing thala$emia an

#ar+$i$mal n+turnal hemgl*inuria.#ar+$i$mal n+turnal hemgl*inuria.



TerimakasihTerimakasih



RB6The im#rtant #layer$RB6The im#rtant #layer$

8emgl*in8emgl*in

' reIer$i*ly *in$ an tran$#rt$ 02 rm lung$reIer$i*ly *in$ an tran$#rt$ 02 rm lung$

t ti$$ue$t ti$$ue$

' D gl*in 9hain$ G irnD gl*in 9hain$ G irn



RB6The im#rtant #layer$ 2/RB6The im#rtant #layer$ 2/

%rn%rn

' +ey element in the #ru9tin hemgl*in+ey element in the #ru9tin hemgl*in

' a*$r#tin i$ #r a*$r#tin i$ #r

Tran$errinTran$errin

' irn tran$#rter irn tran$#rter

FerritinFerritin

' irn *iner, mea$ure irn $tre$, Lal$irn *iner, mea$ure irn $tre$, Lal$

a9ute #ha$e rea9tantLa9ute #ha$e rea9tantL



&einitin$&einitin$

Anemia6Ialue$ hemgl*in, hemat9rit Anemia6Ialue$ hemgl*in, hemat9rit

r RB 9unt$ 7hi9h are mre than 2r RB 9unt$ 7hi9h are mre than 2

$tanar eIiatin$ *el7 the mean$tanar eIiatin$ *el7 the mean

' 8<B@";.( g3 men/8<B@";.( g3 men/ @"2 7men/@"2 7men/

' 8T@D"C men/8T@D"C men/ @;4 7men/@;4 7men/



AS>AS>

-3 i$ a 4D6year l male 7h ha$ nt ha-3 i$ a 4D6year l male 7h ha$ nt ha

any #rimary 9are r $eIeral year$. henany #rimary 9are r $eIeral year$. hen

he trie t giIe *l la$t 7ee+, he 7a$he trie t giIe *l la$t 7ee+, he 7a$

tl that he 7a$ anemi9. 8e #re$ent$ ttl that he 7a$ anemi9. 8e #re$ent$ tyur 9lini9 r eIaluatin.yur 9lini9 r eIaluatin.

hat 7ul yu hat 7ul yu



>Ialuatin the Patient>Ialuatin the Patient

8%ST=R)8%ST=R)

' %$ the #atient *leeing%$ the #atient *leeing

A9tiIely %n #a$t A9tiIely %n #a$t

' %$ there eIien9e r in9rea$e RB%$ there eIien9e r in9rea$e RB

e$tru9tine$tru9tin

' %$ the *ne marr7 $u##re$$e%$ the *ne marr7 $u##re$$e

' %$ the #atient nutritinally ei9ient Pi9a%$ the #atient nutritinally ei9ient Pi9a ' P-8 in9luing mei9atin reIie7, t?inP-8 in9luing mei9atin reIie7, t?in

e?#$uree?#$ure



>Ialuatin the Patient 2/>Ialuatin the Patient 2/

R>% =F S)-PT=-SR>% =F S)-PT=-S

&e9rea$e ?ygen eliIery t ti$$ue$&e9rea$e ?ygen eliIery t ti$$ue$ ' >?ertinal y$#nea>?ertinal y$#nea

' &y$#nea at re$t&y$#nea at re$t

' FatigueFatigue

' Sign$ an $ym#tm$ hy#erynami9 $tateSign$ an $ym#tm$ hy#erynami9 $tate

Buning #ul$e$Buning #ul$e$

Pal#itatin$Pal#itatin$

' 3ie threatening: heart ailure, angina, my9arial inar9tin3ie threatening: heart ailure, angina, my9arial inar9tin8y#Ilemia8y#Ilemia ' Fatigua*litiy, #$tural iMMine$$, lethargy, hy#ten$in,Fatigua*litiy, #$tural iMMine$$, lethargy, hy#ten$in,

$h9+ an eath$h9+ an eath



>Ialuatin the Patient ;/>Ialuatin the Patient ;/

P8)S%A3 >A-P8)S%A3 >A-

OOSta*le r Un$ta*leSta*le r Un$ta*le

6AB$6AB$

6ital$6ital$

OOPallr Pallr OOJauni9eJauni9e

6hemly$i$6hemly$i$

OO3ym#haen#athy3ym#haen#athy

OO8e#at$#lenmegally8e#at$#lenmegallyOOBny PainBny Pain

OOPete9hiaePete9hiae

OORe9tal6 =99ult *lRe9tal6 =99ult *l



3a*ratry >Ialuatin3a*ratry >Ialuatin

%nitial Te$ting%nitial Te$ting

' B 7 ierential in9lue$ RB ini9e$/B 7 ierential in9lue$ RB ini9e$/

' Reti9ul9yte 9untReti9ul9yte 9unt

' Peri#heral *l $mear Peri#heral *l $mear



3a*ratry >Ialuatin 2/3a*ratry >Ialuatin 2/

BleeingBleeing

' Serial 8T r 8<BSerial 8T r 8<B

%rn &ei9ien9y%rn &ei9ien9y

' %rn Stuie$%rn Stuie$

8emly$i$8emly$i$

' Serum 3&8, inire9t *iliru*in, ha#tgl*in, 9m*$,Serum 3&8, inire9t *iliru*in, ha#tgl*in, 9m*$,

9agulatin $tuie$9agulatin $tuie$

Bne -arr7 >?aminatinBne -arr7 >?aminatin

=ther$6ire9te *y 9lini9al ini9atin=ther$6ire9te *y 9lini9al ini9atin

' hemgl*in ele9tr#hre$i$hemgl*in ele9tr#hre$i$

' B"2late leIel$B"2late leIel$



&ierential &iagn$i$&ierential &iagn$i$

la$$ii9atin *y Path#hy$ilgyla$$ii9atin *y Path#hy$ilgy

' Bl 3$$Bl 3$$

' &e9rea$e Pru9tin&e9rea$e Pru9tin

' %n9rea$e &e$tru9tin%n9rea$e &e$tru9tin

la$$ii9atin *y -r#hlgyla$$ii9atin *y -r#hlgy

' Nrm9yti9Nrm9yti9

' -i9r9yti9-i9r9yti9

' -a9r9yti9-a9r9yti9



Bl 3$$Bl 3$$

A9ute A9ute

' Traumati9Traumati9

' ariety $ur9e$ariety $ur9e$

-elena, hemateme$i$, menmetrrrhagia-elena, hemateme$i$, menmetrrrhagia

hrni9hrni9

' =99ult *leeing=99ult *leeing

lni9 #ly#9ar9innmalni9 #ly#9ar9innma



&e9rea$e Pru9tin&e9rea$e Pru9tin

%ne9tiu$%ne9tiu$

Ne#la$ti9Ne#la$ti9

>n9rine>n9rineNutritinal &ei9ien9yNutritinal &ei9ien9y

Anemia hrni9 &i$ea$e Anemia hrni9 &i$ea$e

& P ti& P ti




%NF>T%=US%NF>T%=US

Ba9terialBa9terial

' Tu*er9ul$i$Tu*er9ul$i$

' -A%-A%

iraliral

' 8%8%

' ParIIiru$ParIIiru$

& P ti& P ti




N>=P3AST%N>=P3AST%

3eu+emia3eu+emia

3ym#hma-yelma3ym#hma-yelma

-yel#rlieratiIe Synrme$-yel#rlieratiIe Synrme$-yely$#la$ia-yely$#la$ia

& P ti& P ti




>N&=R%N>>N&=R%N>

Thyri &y$un9tinThyri &y$un9tin

' 8y#thyrii$m8y#thyrii$m

>rythr#ietin &ei9ien9y>rythr#ietin &ei9ien9y

' Renal FailureRenal Failure

& P ti&e9rea$e Pr 9tin




NUTR%T%=NA3 &>F%%>N)NUTR%T%=NA3 &>F%%>N)

%rn%rn

B"2B"2

FlateFlate



-a9r9yti9 Anemia-a9r9yti9 Anemia

- "00- "00

-egal*la$ti9:A*nrmalitie-egal*la$ti9:A*nrmalitie

$ in nu9lei9 a9i$ in nu9lei9 a9i

meta*li$mmeta*li$m

' B"2, FlateB"2, Flate

Nn6Nn6

megal*la$ti9:A*nrmalmegal*la$ti9:A*nrmal

RB maturatinRB maturatin

'-yely$#la$ia-yely$#la$ia

>T=8, liIer M,>T=8, liIer M,

hy#thryrii$m,hy#thryrii$m,

9hemthera#yrug$9hemthera#yrug$



-i9r9yti9 Anemia-i9r9yti9 Anemia

- @50- @50

Reu9e irnReu9e irn

aIaila*ilityaIaila*ility

Reu9e hemeReu9e heme$ynthe$i$$ynthe$i$

Reu9e gl*inReu9e gl*in

#ru9tin#ru9tin

-i ti A i-i ti A i



-i9r9yti9 Anemia-i9r9yti9 AnemiaR>&U>& %R=N AA%3AB%3T)R>&U>& %R=N AA%3AB%3T)

%rn &ei9ien9y%rn &ei9ien9y ' &ei9ient &ietA*$r#tin&ei9ient &ietA*$r#tin

' %n9rea$e Reuirement$%n9rea$e Reuirement$

' Bl 3$$Bl 3$$

' %rn Seue$tratin%rn Seue$tratin

Anemia hrni9 &i$ea$e Anemia hrni9 &i$ea$e ' 37 $erum irn, l7 T%B, nrmal $erum erritin37 $erum irn, l7 T%B, nrmal $erum erritin

' -AN)QQ-AN)QQhrni9 ine9tin, inlammatin, 9an9er, liIer i$ea$ehrni9 ine9tin, inlammatin, 9an9er, liIer i$ea$e





R>&U>& 8>-> S)NT8>S%SR>&U>& 8>-> S)NT8>S%S3ea #i$ning3ea #i$ning

A9uire r A9uire r

9ngenital9ngenital

$ier*la$ti9 anemia$ier*la$ti9 anemiahara9teri$ti9 $mearhara9teri$ti9 $mear

ining: Ba$#hyli9ining: Ba$#hyli9

$ti##ling$ti##ling

-i ti A i-i ti A i



-i9r9yti9 Anemia-i9r9yti9 AnemiaR>&U>& <3=B%N PR=&UT%=NR>&U>& <3=B%N PR=&UT%=N

Thala$$emia$Thala$$emia$

Smear hara9teri$ti9$Smear hara9teri$ti9$

' 8y#9hrmia8y#9hrmia

' -i9r9yt$i$-i9r9yt$i$ ' Target ell$Target ell$

' Tear &r#$Tear &r#$

3a* te$t$ irn ei9ien9y 3a* te$t$ irn ei9ien9y



3a* te$t$ irn ei9ien9y 3a* te$t$ irn ei9ien9y

in9rea$e $eIerityin9rea$e $eIerityN=R-A3N=R-A3 Fe ei9ien9yFe ei9ien9y

ithut anemiaithut anemiaFe ei9ien9yFe ei9ien9yith mil anemiaith mil anemia

Fe ei9ien9yFe ei9ien9yith $eIereith $eIereanemiaanemia

Serum %rnSerum %rn 406"(0406"(0 406"(0406"(0 @40@40 @D0@D0

%rn Bining%rn Bining

a#a9itya#a9ity

;006;40;006;40 ;006;E0;006;E0 ;(06D00;(06D00 D"0D"0

SaturatinSaturatin 206(0206(0 ;0;0 @"(@"( @"0@"0

8emgl*in8emgl*in NrmalNrmal NrmalNrmal E6"2E6"2 461461

Serum FerritinSerum Ferritin D06200D06200 @20@20 @"0@"0 06"006"0



&ierential &iagn$i$6ReIi$ite&ierential &iagn$i$6ReIi$ite

la$$ii9atin *y Path#hy$ilgyla$$ii9atin *y Path#hy$ilgy

' Bl 3$$Bl 3$$

' &e9rea$e Pru9tin&e9rea$e Pru9tin

' In3reased Desr"3i!nIn3reased Desr"3i!n



%NR>AS>& &>STRUT%=N%NR>AS>& &>STRUT%=N

%mmune -eiate%mmune -eiate

Nn6immune -eiateNn6immune -eiate

%n9rea$e &e$tru9tin%n9rea$e &e$tru9tin




%--UN> ->&%AT>&%--UN> ->&%AT>&

l Agglutininl Agglutinin

' Par?y$mal n9turnal hemgl*inuriaPar?y$mal n9turnal hemgl*inuria

' P$t my9#la$mal hemlyti9 anemiaP$t my9#la$mal hemlyti9 anemia

arm Agglutininarm Agglutinin

' &rug inu9e&rug inu9e

' Autimmune hemlyti9 anemia Autimmune hemlyti9 anemia

' Tran$u$in rea9tinTran$u$in rea9tin





N=N6%--UN> ->&%AT>&N=N6%--UN> ->&%AT>&>?tra69r#u$9ular >?tra69r#u$9ular ' -a9r69ir9ulatry-a9r69ir9ulatry

8y#er$#leni$m8y#er$#leni$m

>?tra9r#real 9ir9ulatin>?tra9r#real 9ir9ulatin

' -i9r69ir9ulatry-i9r69ir9ulatry&%&%

TTPTTP

8US8US

%ntra69r#u$9ular %ntra69r#u$9ular ' RB all mem*rane r enMyme ee9t$/RB all mem*rane r enMyme ee9t$/

' 8eme r gl*in a*nrmalitie$ 8*S, /8eme r gl*in a*nrmalitie$ 8*S, /

Ba9+ t - 3Ba9+ t - 3 )u a##r#riately)u a##r#riately



Ba9+ t -.3.6Ba9+ t -.3.6)u a##r#riately)u a##r#riately

e9ie t *tain mre hi$tryQe9ie t *tain mre hi$tryQ8P%: “%Ie *een a little mre tire than u$ual, *ut %Ie8P%: “%Ie *een a little mre tire than u$ual, *ut %Ie

*een *u$y at 7r+. %m getting 9l$e t retirement.*een *u$y at 7r+. %m getting 9l$e t retirement.

Nthing el$e i$ unu$ual. % aIi 9tr$ i % 9an!Nthing el$e i$ unu$ual. % aIi 9tr$ i % 9an!

P-8: %nguinal hernia re#air 20 yr$ agP-8: %nguinal hernia re#air 20 yr$ ag

F8: F G -<F6heart atta9+age 50/, *rther6al9hli$mF8: F G -<F6heart atta9+age 50/, *rther6al9hli$m

S8: -arrie ?DDyr, $m+e$ "##, “a 9u#le *eer$night!S8: -arrie ?DDyr, $m+e$ "##, “a 9u#le *eer$night!

->&S: aily multiIitamin->&S: aily multiIitamin

A33>R<%>S: nne A33>R<%>S: nneR=S:atigue, urine $eem$ a little ar+er latelyR=S:atigue, urine $eem$ a little ar+er lately



-re n -.3.-re n -.3.

P.>. ining$P.>. ining$ ' T E5.D 8R E5 Re$# 20 BP ""210T E5.D 8R E5 Re$# 20 BP ""210

' <en: NA&, a##ear$ yunger than $tate age<en: NA&, a##ear$ yunger than $tate age

' 8>>NT: $+in an 9njun9tiIa $lightly #ale8>>NT: $+in an 9njun9tiIa $lightly #ale

' N>K: n aen#athy r thyrmegallyN>K: n aen#athy r thyrmegally

' he$t: TABhe$t: TAB

' : RRR, n murmur : RRR, n murmur

' AB&: n 8S-, $t, nrma9tiIe *7el $un$ AB&: n 8S-, $t, nrma9tiIe *7el $un$

' <U: nrmal male<U: nrmal male

' Re9tal: n ma$$e$, #r$tate $mthnt enlarge,Re9tal: n ma$$e$, #r$tate $mthnt enlarge,guaia9 negatiIe $tlguaia9 negatiIe $tl



-.3.$ %nitial 3a*$-.3.$ %nitial 3a*$

=nly a B 7 i 7a$ *taine:=nly a B 7 i 7a$ *taine:

' B: 5.2, 8T ;2.2, - 1E, Platelet$ 22",B: 5.2, 8T ;2.2, - 1E, Platelet$ 22",

ierential 6 nrmalierential 6 nrmal



%nitial Thught$%nitial Thught$

Bl l$$Bl l$$

' Age #la9e$ him at ri$+ r 9ln A Age #la9e$ him at ri$+ r 9ln A


' Al9hl u$e, %rn ei9ien9y Al9hl u$e, %rn ei9ien9y


' ““&ar+er urine! lately&ar+er urine! lately



Further r+6u#Further r+6u#

A<> ue$tin$A<> ue$tin$

Peri#heral Bl Smear Peri#heral Bl Smear

Reti9ul9yte 9untReti9ul9yte 9unt

%rn Stuie$%rn Stuie$ ' FerritinFerritin

' T%BT%B

' C SaturatinC Saturatin

Urinaly$i$Urinaly$i$F=BT r 9ln$9#y reeralF=BT r 9ln$9#y reeral



-re Re$ult$-re Re$ult$

A<> $9reen reIeal$ n #$itiIe re$#n$e$A<> $9reen reIeal$ n #$itiIe re$#n$e$

Smear reIeal$ mi9r9yti9, mi9r9hrmi9 RB$Smear reIeal$ mi9r9yti9, mi9r9hrmi9 RB$

Reti9 9unt i$ inter#rete a$ “l7!Reti9 9unt i$ inter#rete a$ “l7!

Urinaly$i$ negatiIe r hemgl*inUrinaly$i$ negatiIe r hemgl*inF=BT: nt 9m#lete *y #atientF=BT: nt 9m#lete *y #atient

%rn Stuie$%rn Stuie$ ' Ferritin: "0Ferritin: "0

' T%B: ;(0T%B: ;(0

' C Sat: "(C Sat: "(



hat$ ne?that$ ne?t

Rule ut Sur9e$ BleeingRule ut Sur9e$ Bleeing ' un$eling regaring 9ln A an reerral run$eling regaring 9ln A an reerral r

9ln$9#y9ln$9#y

n$ier ral irn thera#yn$ier ral irn thera#y

&ietary 9un$eling irn $ur9e$, limiting eth,&ietary 9un$eling irn $ur9e$, limiting eth,et9/et9/

>n9urage ll76u# r health 9are>n9urage ll76u# r health 9aremaintenan9emaintenan9e

' a99inatin$ Tetnu$#neumIa?/a99inatin$ Tetnu$#neumIa?/ ' =ther 9an9er $9reening=ther 9an9er $9reening ' hle$terl S9reenhle$terl S9reen



&iagn$i$&iagn$i$

ln$9#y reIealeln$9#y reIeale$mall $u$#i9iu$ le$in in$mall $u$#i9iu$ le$in in$igmi 9ln, #athlgy$igmi 9ln, #athlgyreIealingreIealing

aen9ar9inma. 'aen9ar9inma. '>?9i$e $urgi9ally, n>?9i$e $urgi9ally, nmet$.met$.

Rutine la*$, ne yearRutine la*$, ne yearlater, reIeal an 8T later, reIeal an 8T

D0C. 8e eel$ “*etterD0C. 8e eel$ “*etterthan eIer!Qthan eIer!Q



Reeren9e$Reeren9e$

S9hrier, Stanley.A##ra9h t the #atient 7ithS9hrier, Stanley.A##ra9h t the #atient 7ithanemia. U# t &ate. 200Danemia. U# t &ate. 200D

S9hrier, Stanley. Anemia hrni9 &i$ea$e. U#S9hrier, Stanley. Anemia hrni9 &i$ea$e. U#t &ate. 200Dt &ate. 200D

S9hrier, Stanley. Anemia$ ue t e9rea$e reS9hrier, Stanley. Anemia$ ue t e9rea$e reell Pru9tin. U# t &ate 200Dell Pru9tin. U# t &ate 200D

S9hrier, Stanley. au$e$ an iagn$i$ S9hrier, Stanley. au$e$ an iagn$i$

anemia ue t irn ei9ien9y. U# t &ate. 200Danemia ue t irn ei9ien9y. U# t &ate. 200DTierney, et al. Anemia$. urrent -ei9alTierney, et al. Anemia$. urrent -ei9al&iagn$i$ an treatment. 200;. P#D4E6D5E&iagn$i$ an treatment. 200;. P#D4E6D5E

(21sept) anemia-6.double - dr. salman

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