تعمريات-نموذج للنصح الطبي بخصوص حالة تعاني من أنيميا

 هذا رد بخصوص إستفسار عن حالة severe normocytic anemia with lukopenia in a 60 y old male 

From geriatrics point of view:

Make sure it's a chronic anemia, i.e. no acute bleeding e.g. bleeding piles, per rectum, in urine, hemoptysis nor hematemisis.

Need to see old CBC(s) to know baseline WBCs RBCs & Hb. Trend is very important.

Need to know his past history of any similar anemias/transfusion, gastritis, chronic constipation/piles/diverticulosis, prostate BPH, ur. Stones, chronic malnutrition, chronic, kidney disease, chronic malabsorption/diarrhea/inflam bowel diseases.

Any history of regular anticoagulation, antiplatelets or recent new medication introduction?

It's advised to do CBC with diffrential, reticulocytic count, iron profile, B12 level, 3 samples of occult blood in stool (proper diet precautions before sampling), renal & liver functions if not done. 

If not symptomatic due to the anemia, and no HF, coronary artery disease nor respiratory failure = mostly not urgent.

advice to see lab results & past history and mange any issue.

Advise not start iron & hematenics before sending labs.

If bone marrow depression is highly suspected, reticulocytes conut will improve after hematenics.

If symptomatic or active bleeding, even if mild, or heart failure/resp failure/coronary art disease, might need blood transfusion.

For the mild leukopenia, usually it's viral or new medication induced (even an NSAID can cause it). It resolves spontaneously.

IF CBC with diffrential is normal, B12 level normal, Would advise to repeat CBC to monitor it after 1 month.

The mild thrombocytosis, may be a good sign that bone marrow is reactive and trying to be hyperactive, however it can be also due to any viral infection or bleeding or any thing else.

Conclusion:

Good accurate history.

Labs, can be minimized if history reveals significant issue to manage.

Exclude need for urgant transfusion.

عافاه الله