Sunday, May 29, 2016

Special and differentiating investigations in Anemia

Here, we would try to summarize all the investigations useful to differentiate various types of anemias--

1. Microcytic hypochromic anemias
-S. Ferritin, Total Iron Binding capacity, Transferrin saturation help in distinguishing IDA, AOCD, Beta thal trait.
HbA2 levels between 3.5-8% are diagnostic of beta thal trait.

2. Macrocytic anemias
S. VitB12 and S.Folic acid assays to differentiate megaloblastic from non megaloblastic macrocytic anemias.
PBS f/s/o megaloblastic anemia - macovalocytes, hypersegmented neutrophils, pancytopenia +/-

3. Warm Antibody against P antigen and cold antibodies (I antigen) to detect AIHA and also to differentiate AIHA from HS.

4. G6PD Assays- suspected G6PD deficiency anemias

5. Hemoglobin electrophoresis- Thalassemia

6. Hemoglobin electrophoresis with sickling test- Sickle cell anemia. Hb electrophoresis is alone not sufficient as HbD & HbQIndia have the same electrophoretic mobility as HbS.

7. Flow cytometry is diagnostic of PNH. Sucrose lysis and Ham's test are no longer used.

8. S. Erythropoeitin levels- reduced in Anemia due to chronic kidney diseases.

9. Bone marrow biopsy- In aplastic anemias, pure red cell aplasia, myelofibrosis and anemia due to marrow infiltration/storage diseases.

10. The most basic investigation in suspected hemolytic anemia is Reticulocyte count. Reticulocyte count more than 2.5% is highly s/o hemolytic anemia.

That's almost done!!

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