Hematological diseases







ANEMIA

You are anemic: your doctor has just diagnosed it thanks to the hemogram he had prescribed for you. This shows a decrease in your hemoglobin level; above 12 g / dl if you are a man and 11 g / dl if you are a woman. This diagnostic criterion is more reliable than that of the reduction in the number of red blood cells and it is this that your doctor will remember.

He must now determine the mechanism and cause of your anemia: production failure or excessive destruction of red blood cells:

- he will ask you: remember to tell him about the existence of identical cases in your family, possible recent bleeding: give him a list of the drugs that you take, including those that your doctor did not prescribe for you ... in hazardous self-medication practices.

- He will examine you and collect the additional information provided by your hemogram and the examinations he has requested to confirm his first hypotheses.

The three most common causes of anemia are: iron deficiency, vitamin deficiencies and excessive destruction of red blood cells (so-called hemolytic anemias).

Iron deficiency

Your doctor will discuss an iron deficiency if the red blood cells have decreased in size (microcytosis), if they have a low hemoglobin content (hypochromia). It will confirm this by measuring blood iron or, at best, ferritin, a molecule that precisely reflects the level of iron reserves in the body. In order to correct anemia, he will prescribe iron for an extended period of time. At the same time, he will look for the cause of the deficiency, usually due to gynecological or digestive bleeding, often occult.

Vitamin deficiencies

For your doctor, the most suggestive sign of a vitamin deficiency is the increase in the volume of red blood cells (macrocytosis). He will look for a deficiency in folate, the most frequent, of food origin (favored by alcoholism), or a deficiency in vitamin B12, much rarer (subjects operated on the stomach or suffering from Biermer's disease). Treatment consists of the absorption of folate or the intramuscular injection of vitamin B12.

Hemolytic anemias

They often associate with jaundice or a large spleen. In children, it will most often be hereditary diseases, of which there will often already be cases in the family. They are very diverse: abnormalities of the hemoglobile or red blood cell; specialist advice will be required. These diseases are chronic and require frequent transfusions. In adults, chronic hemolytic anemias have various causes, including taking certain medications.

In some cases, your doctor will need to use specialized examinations (sternal puncture, bone marrow biopsy) to establish the cause of your anemia: refractory anemia in the elderly, anemias revealing leukemia. Anemia may still be only one of the signs of a general disease: renal failure, chronic inflammatory diseases for example.

Copyright photo : Par E. Uthman, MD — https://www.flickr.com/photos/euthman/2274260085/, CC BY-SA 2.0

Bibliography : Medical and Surgical Complications of Sickle Cell Anemia de Ahmed Al-Salem

MEDULAR APLASIES

It starts suddenly.

They cause pallor, tiredness, infections, hemorrhages reflecting the collapse of the level of red blood cells, white blood cells and platelets that the bone marrow has become unable to produce.

The hemogram urgently requested by your doctor will decide the level of severity. Immediate hospitalization in a hematology department is essential. In this department the diagnosis of aplasia will be confirmed. Sternal puncture and biopsy will prove the desert character of the bone marrow.

Emergency palliative treatment will be initiated. It is a long-term treatment, especially hormonal aimed at stimulating the recovery of spinal function. The cause of the aplasia will not always be found. Most aplasia is caused by taking toxic drugs.

Bibliography : Aplasies Médullaires Aigues Adiopathiques  by MARTY Alain 

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