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He Li Fang
Hematology
About me
Loudi Central Hospital, Department of Hematology, Attending Physician.
Proficient in diseases
Specializes in the diagnosis and treatment of common diseases in hematology.
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How is iron deficiency anemia diagnosed?
The diagnosis of iron deficiency anemia includes two aspects: one is to establish whether there is anemia caused by iron deficiency, and the other is to clarify the cause of the iron deficiency. First, we need to carefully inquire and analyze the medical history, combined with the patient's physical examination, which can provide a series of clues for diagnosing iron deficiency anemia. A definitive diagnosis also requires laboratory evidence. Clinically, we can divide iron deficiency and iron deficiency anemia into three stages: iron deficiency, iron-deficient erythropoiesis, and iron deficiency anemia. The following describes the diagnostic criteria for iron deficiency anemia specifically. Iron deficiency anemia is characterized by a significant reduction in hemoglobin in red blood cells, presenting as microcytic hypochromic anemia. Its diagnostic basis includes three aspects: first, conforming to the diagnosis of iron deficiency and iron-deficient erythropoiesis; second, having microcytic hypochromic anemia; and third, effective treatment with iron supplements. These three factors together can confirm the diagnosis of this disease.
What tests are for thalassemia?
Thalassemia firstly requires genetic diagnosis through a series of techniques such as DNA restriction endonuclease map PCR, which identify the genotype of thalassemia. Secondly, hemoglobin electrophoresis needs to be completed. Through complete hemoglobin electrophoresis, it can discriminate between silent gene carriers and those with thalassemia, hemoglobin H disease, and hemoglobin Bart's hydrops fetalis syndrome. Additionally, a significant increase in hemoglobin A2 in overt thalassemia also has certain specificity. Thirdly, a complete bone marrow picture is necessary, which will match the bone marrow picture of hemolytic anemia. There is pronounced erythroid hyperplasia, positive iron staining, and an increase in sideroblastic erythroblasts. Fourthly, a complete blood count is needed. Different types of blood counts show different levels of hemoglobin reduction. In mild thalassemia and thalassemia traits, hemoglobin is mostly normal or mildly decreased. In severe thalassemia, hemoglobin is generally below 50 grams per liter, indicating a severe anemic state. Blood smears might show anisocytosis, poikilocytosis, and target cells. It is common to see nucleated erythrocytes and reticulocytes significantly increased, which matches the signs of hemolytic anemia. Fifth, iron metabolism testing needs to be completed. By improving iron metabolism testing, it serves as a discriminant for silent gene carriers, as well as those with thalassemia traits and patients with mild thalassemia based on serum iron, iron saturation, and serum ferritin concentration. Sixth, X-ray examination needs to be completed. Severe thalassemia features typical hair-on-end changes, visible as vertical striations between the trabeculae of the cortical bone in the skull X-rays, resembling upright hair and rays of sunlight.
The key to curing iron deficiency anemia
Iron deficiency anemia, a common and frequently occurring disease in the department of hematology, is not difficult to diagnose and treat. The key to treatment lies in addressing the cause of the iron deficiency, and it is essential to eliminate the underlying causes as much as possible. Using iron supplements alone can only restore blood counts; neglecting the primary disease will not lead to a complete cure of the anemia and can easily lead to recurrence. Treatment consists of two phases: first, the supplementation with iron supplements. After taking iron supplements for three to four days, an increase in reticulocytes will occur, reaching a peak around seven days, and hemoglobin will significantly rise after two weeks of medication, returning to normal levels after one to two months. However, after hemoglobin levels normalize, some patients may stop taking the medication. It is important to note that continuing to take iron supplements for three months is necessary to replenish the body's iron stores completely.
Characteristics of iron deficiency anemia blood picture
The clinical manifestations of iron deficiency anemia are due to the specific characteristics of anemia caused by iron deficiency and the underlying disease causing the iron deficiency. Its hematological characteristics present as typical microcytic hypochromic anemia. What does this concept mean? It refers to the values in a complete blood count where MCV is less than 80 femtoliters, MCH is less than 27 picograms, and MCHC is less than 30%. MCV refers to the average red blood cell volume, MCH refers to the mean corpuscular hemoglobin concentration, and MCHC refers to the mean corpuscular hemoglobin concentration of red blood cells. The extent of changes in red blood cell indices correlates with the duration and severity of anemia. The blood smear typically shows pale-stained red blood cells with an enlarged central pallor and varying sizes. Platelet count often tends to be high when there is concurrent bleeding and generally tends to be low in infants and children. White blood cell count is usually normal or slightly reduced, with normal differential. These are the hematological characteristics of iron deficiency anemia.
Chronic Granulocytic Leukemia Classification
Chronic granulocytic leukemia is a myeloproliferative tumor originating from pluripotent stem cells, characterized by the presence of the Philadelphia chromosome or changes in the BCR/ABL fusion gene. Chronic granulocytic leukemia progresses through four stages: asymptomatic, chronic, accelerated, and blast crisis phases. Most patients are diagnosed after the onset of symptoms. Only a very few patients are diagnosed through routine physical examinations or other reasons when blood abnormalities are discovered. The earliest symptoms experienced during the chronic phase of the illness typically include fatigue, dizziness, and abdominal discomfort. The accelerated phase is a transitional stage before the blast crisis, marking a turning point where the disease worsens. It is often difficult to distinctly separate the accelerated phase from the blast crisis, and about 20%-25% of patients may enter the blast crisis phase directly without passing through the accelerated phase.
Mediterranean anemia's blood routine manifestations
The hematological manifestations of thalassemia, including those of silent gene carriers, generally show normal complete blood counts. In thalassemia and mild thalassemia, hemoglobin levels are normal or slightly decreased. Patients with Hemoglobin H disease have hemoglobin levels between 70-100 grams per liter. In cases of Hemoglobin Bart's hydrops fetalis syndrome and severe thalassemia, hemoglobin levels are typically below 50 grams per liter, falling into the category of severe anemia, requiring regular blood transfusions for survival. Their MCV, MCH, and MCHC are significantly decreased. Blood smears may reveal anisocytosis and poikilocytosis including target cells, and even nucleated red cells, with a marked increase in reticulocytes. Typically, the white blood cell count remains normal for such patients, although the platelet count may be slightly elevated. During periods of increased spleen activity, there may be a reduction in both white blood cells and platelets. These are the hematologic features observed in different thalassemia patients.
Iron deficiency anemia is what type of anemia?
Iron deficiency anemia refers to the anemia that occurs when the body's stored iron is depleted and cannot meet the needs for normal red blood cell production. Before the production of red blood cells is limited, the body's stored iron has already been exhausted. However, at this stage, the routine blood tests may not yet show obvious signs of anemia; this condition is then referred to as iron deficiency. The characteristics of iron deficiency anemia include a lack of stainable iron in the bone marrow and other tissues, as well as reduced serum ferritin and transferrin saturation, presenting as typical microcytic hypochromic anemia. Therefore, iron deficiency anemia is a type of microcytic hypochromic anemia and is classified according to the level of marrow proliferation as a hyperproliferative anemia.
Chronic granulocytic leukemia symptoms
The clinical symptoms of chronic myeloid leukemia can be divided into two phases: 1. During the chronic phase, the earliest subjective symptoms include fatigue, dizziness, and abdominal discomfort. Other symptoms may also appear such as general malaise, decreased endurance, and nausea. Some patients may exhibit signs of increased basal metabolism, such as sweating, weight loss, palpitations, and nervousness. As the disease progresses, patients may experience enlargement of the liver and spleen. An enlarged spleen can cause abdominal bloating, discomfort in the upper left abdomen, and a feeling of fullness after eating. In a few cases, bleeding may occur in the early stages. In female patients, excessive menstruation is common, and while bone pain and joint pain are less common at initial diagnosis, they can also occur. 2. During the accelerated phase, patients often exhibit unexplained low-grade fever, fatigue, lack of appetite, night sweats, and increased weight loss. These symptoms are accompanied by rapid enlargement of the spleen causing discomfort and fullness, sudden swelling of lymph nodes, clear sternal tenderness, and osteolytic changes in bones leading to bone pain. Anemia also progressively worsens. Once patients enter the blast crisis phase, they may show extramedullary infiltration symptoms such as skin nodules, testicular infiltration, abnormal penile erections, and the appearance of green tumors in the eye sockets, among other serious complications.
Causes of Iron Deficiency Anemia
There are many reasons for iron deficiency anemia, which we can categorize into several aspects. The first aspect is a decrease in iron intake, including diet, meaning insufficient dietary intake. The second aspect is decreased absorption, such as the absence of a target organ for absorption or the lack of stomach acid affecting its absorption efficacy. The second aspect refers to excessive loss, most commonly chronic gastrointestinal bleeding, such as in patients with tumors, duodenal ulcers, gastric ulcers, gastritis, ulcerative colitis, a parasitic infection with hookworms, as well as hemorrhoids, and arteriovenous malformations, all of which can cause gastrointestinal bleeding leading to increased iron loss. Excessive menstrual flow in female patients, multiple blood donations, and multiple pregnancies can all lead to iron deficiency. These are the various causes related to iron deficiency.
What are the symptoms of iron deficiency anemia?
Iron deficiency anemia is a type of anemia that exhibits common symptoms found in all anemia patients. It is characterized by a range of clinical symptoms caused by oxygen deficiency in tissue organs due to a lack of blood in the body. Common symptoms include dizziness, headaches, fatigue, shortness of breath and palpitations after activity, easy fatigability, difficulty concentrating, and decreased memory. Some patients may also experience blurred vision, ringing in the ears, and in severe cases, fainting, transient darkening of vision, and even arrhythmias. Because iron deficiency anemia is also accompanied by iron deficiency, it presents a range of clinical symptoms specific to iron deficiency, including pica, angular cheilitis, glossitis, unusual tongue conditions, decreased appetite, and even constipation among other symptoms.