内科学 贫血总论-谢彦晖【荐】.ppt

ANEMIA Hematology Department,Huashan Hospital,Fudan University,Shanghai XieYan-Hui DIAGNOSIS AND CLASSIFICATION Anemia is an absolute decrease in hematocrit , hemoglobin concentration, or the RBC count.  Anemia is not a diagnosis, but a sign of underlying disease.. Hemoglobin(Hb): male(adult)120g/L female(adult)110g/L female(gestation)100g/L Red cell count male4.5x1012 /L female4.0x1012 /L Hemocrit(HCT) male0.42 female0.37 female(gestation)0.30 Determination of the cause:A. History1. Drug administration.2. Exposure to toxic chemicals 3. Family occurrence.4. Recent transfusions 5.menstruation(woman)6.ingestion(child)7.chronic disease8. Age at onset. B. Physical findings and complaintsa. Pale mucous membranes and skinsb. Weakness, loss of stamina, and exercise intolerance,Hypersensitivity to cold ,fever. c. Tachycardia and polypnea,Heart murmur. anemia associated cardiac disease: Hb30g/L more than 2 months heart enlargement ST depression d. headache,dizzinesse.anorexia,nauxea,abdominal fullness diarria or constipation, Icterus.f.menstruation disorder or amenorrea hemoglobinuria g. Shock if 1/ 2blood volume lost in short period.  C. Laboratory findings1. The Hct is the easiest, most accurate method for detecting anemia. Its result should be interpreted with knowledge of the hydration status and any alteration caused by splenic contraction. 2. Hb and RBC may be used to further classify the anemia. II. ClassificationA. Size (MCV) and Hb Concentration (MCHC)1. Normocytic, macrocytic, microcytic.2. Normochromic, hypochromic. (Hyperchromia does not occur) Type MCV(fl) MCHC(%) MCH(pg) disorder Macro 100 32 32-35 megaloblastic anemia MDS Normo