ANEMIA
EVALUATION
- Age of onset
- Sex
- Family H/O
hemolytic anemia, neonatal jaundice, exchange transfusion, cholelithiasis,
cholecystectomy
- Nutritional History: Pica, Vegan diet, intake of goat’s milk,
- H/O Drug intake:
Antimalarials, phenytoin, penicillins, cytotoxic drugs
- H/O Chronic Diarrhea (Celiac, intestinal resection, IBD, CMP allergy)
- H/O worm infestation
- Pallor, listlessness, effort intolerance
- Behavioral problems, irritability
- WT, Ht, OFC, MUAC
- Dysmorphism
- Pallor in palms,
nails, conjunctiva, mucous membranes
- Jaundice, LN, Liver, Spleen
- Tachycardia, gallop, systolic murmur
- Signs of systemic disease (edema, joint
pains)
LAB
WORK
- Hb, TLC,
DLC, platelet count, reticulocyte count, RBC morphology
- PCV, MCV,
MCH, MCHC
- S/ iron,
TIBC, Ferritin
- Hb F, Hb
electrophoresis
- S.
creatinin, bilirubin, ANA, folate & B12 levels
- Stool C/E
& occult blood
- Coomb’s
test, osmotic fragility test
- Bone
marrow aspiration / trephine biopsy
MANAGEMENT
- Admit the Patient.
- Maintain I/V line
- Send investigations.
- Hb, TLC, DLC, Platelet & Reticulocyte Counts.
- RBC and WBC morphology by the hematologist in the morning hours
- (make slide if transfused in emergency)
- If urgent investigations are not possible, save 2ml EDTA vial
sample(for peripheral smear) and 5ml non-heparinized blood in
refrigerator. In addition to this , save 5 cc of EDTA vial blood sample
for Hb electrophoresis.
- Get Hb done on urgent basis. If
·
Hb level < 4g% ® transfuse the patient in emergency even if without sings and symptoms of CCF.
·
If Hb level 4-6g% ® transfuse only if CCF present.
·
If Hb level > 6g% ® wait for investigations (usually do not require transfusion on
urgent basis)
·
If Transfusion is Required:-
- Send blood for grouping & cross matching & screening,
- Sign grouping, cross matching the screening card from the blood
bank
- Transfuse 10ml /kg of packed cell transfusion over 2-3 hours
- Inj. Lasix 1 mg/kg- IV before transfusion in severely anemic
patients & mid transfusion in others
- Complete transfusion in 4 hour. (keep adrenaline,
hydrocortisone, avil and paracetamol at hand.)
- Stop transfusion if fever with shivering occurs. Give IV Inj.
avil ½ -1ml & Hydrocortisone 20 mg/kg stat. Get the blood re-cross-matched.
Restart Blood after lowering the
temperature. Discard the blood if fever occurs again. Discard if the bag
remains open for more than 4 hours.
No comments:
Post a Comment