Human diseases for quality treatment must be correctly diagnosed. Modern technologies allow you to do this quite quickly, and methods - to avoid unnecessary expenditure of time and resources. For example, diff. Diagnosis of anemia uses the exclusion method to find out the cause of the problem, to clarify it and specify it with the help of special analyzes and studies.
The most important "transport"
Everyone will learn about the connection “hemoglobin - iron" even during anatomy classes in the middle classes of the school. It is she, one of the foundations of red blood cells, which are a component of blood - the liquid connective tissue of the human body. Blood circulates through a closed system of blood vessels ranging from large aorta and veins to the smallest capillaries, penetrating almost all organs and tissues. The structure of the blood itself is not so complicated. The liquid plasma contains suspended components:
- white blood cells;
- platelets;
- red blood cells.
It is in the red blood cells that hemoglobin is located, which gives the blood a red color due to the content of an iron atom in its composition.
Therapeutic analysis - differential. Diagnosis of iron deficiency anemia - helps a specialist establish the reason why hemoglobin levels are reduced. The adequacy of the diagnosis and the direction of treatment depend on the correct analysis. One of the pathological conditions of the blood composition is anemia.
Condition - Anemia
Anemia has a popular name that accurately reflects the essence of this symptom of many diseases and conditions - anemia. And what is meant by it is not a quantitative indicator of the volume of the liquid itself, but the level of hemoglobin. Anemia is not an independent disease, since it is a symptom of a certain type of pathology. Moreover, the problem can be both in the system of education and blood transport itself, and in the work of, say, external organs. This raises one serious problem: classic nosology for anemia is an inappropriate way to determine. But for types of anemia, one important sign is characteristic - a decrease in the amount of hemoglobin, most often associated with a decrease in the number of red blood cells. The hemoglobin – iron dependence is clearly traced here, since in some cases anemia is detected precisely as iron deficiency. In other cases, hemoglobin drops not only due to a reduction in iron in the blood, we will talk more about this below.
So: the differential diagnosis of anemia in children and adults aims to identify the cause of such a health problem as anemia.
The House Method
Artworks introduce readers, spectators, and listeners to all aspects of human life, sometimes very distant and obscure. For example, one of the popular series “House Doctor” interestingly and vividly explains the work of a diagnostic doctor. Moreover, the method of differential diagnosis in the heroes of the film is the main principle of work.
A correct diagnosis is the key to the highest quality treatment in each specific situation. For this, specialists use many methods, methods and techniques. Pathological conditions, such as, for example, hemoglobin deficiency, also urgently need an adequate etiology setting. One of the quality methods in this case is differential. diagnosis of anemia. The hypothesis put forward by a specialist is evaluated for rationality, confirmed or rejected by observations and analyzes, which allows to qualitatively calculate the cause of the pathological condition of the patient.
The separation technique itself (differentiation) is effective for the diagnosis of many pathological conditions when a single symptom or symptom complex can witness a large number of problems with the patient’s health. For example, the differential diagnosis of iron deficiency anemia allows you to accurately exclude any other types of hemoglobin deficiency, which helps to prescribe the necessary examinations in the shortest possible time to concretize the disease and prescribe quality therapy.
Steps for diagnosing a problem
Dif diagnosis of anemia is not the only method for finding the cause of the pathology. Any disease in a study in a particular patient goes through several stages. For hemoglobin deficiency, the doctor must perform the following steps:
- diagnosis of the syndrome, which will determine the pathogenetic option;
- diagnosis of pathology nosology, necessary to identify the basis of the problem in the form of a disease or pathological process of any organ or system.
At this stage, a clinical blood test is used, which serves as a source of identifying the anemia problem itself and its level. At the same stage, a study is carried out of the composition of the blood by its components - iron, transferrin and ferritin. If necessary, using bone marrow biopsy or sternal puncture - modern methods of sampling the biomaterial under study - the bone marrow is taken for analysis. With the help of such studies conducted differential. diagnosis of iron deficiency anemia and B12 anemia, which allows to specify the problem for a high-quality search for its solution.
Anemia research
Specialists have developed certain modern methods for the qualitative diagnosis of health problems in each patient. The essence of the differential diagnosis of anemia is the sequential exclusion of inappropriate variants of the problem, thus leading to a concrete and correct solution, and, therefore, to the selection of an adequate case of therapy.
What laboratory tests help to establish a diagnosis? It should immediately be said that for the analysis, modern devices and methods are used, which allows you to get the most accurate result.
Hematological studies allow you to determine:
- hematocrit (H tc);
- hemoglobin (Hb);
- blood group and Rh factor;
- white blood cells (Le);
- red blood cell count (Er);
- mean red blood cell volume (MCV);
- erythrocyte mean hemoglobin (Hb) concentration (MCHC);
- mean hemoglobin (Hb) in one red blood cell (MCH);
- reticulocytes (Rtc);
- erythrocyte sedimentation rate (ESR);
- platelets (Tr);
- color indicator (CPU).
Blood smears examined under a microscope make it possible to determine whether there are abnormal blood cells in the test sample.
When examining blood components such as plasma and serum, the following are determined:
- bilirubin;
- blood proteins;
- iron concentration;
- creatinine;
- lactate dehydrogenase;
- urea;
- total iron binding capacity of serum (OZHSS);
- transaminases;
- ferritin;
- alkaline phosphatase.
Also, for the diagnosis, the patient is assigned:
- urine analysis that determines the color, pH level, transparency, specific gravity, the presence of protein, urobilin, red blood cells, sediment composition;
- analysis of feces for eggs, worms, color, texture, occult bleeding.
Bone marrow studies are carried out in two ways:
- sternal puncture is performed to determine cytosis, the ratio of erythroid and myeloid cells, morphological examination of cells;
- trepanobiopsy shows bone marrow cellularity, morphological structure of cells.
The differential diagnosis of hypochromic anemia, however, as well as the vast majority of other problems related to the composition of the blood, uses not only the above, but also other, more detailed and narrowly targeted examinations.
Discrimination algorithm
The differential diagnosis algorithm for anemia is designed for high-quality and quick diagnosis of the type of blood pathology that a patient has. At the first stage, the type of anemia is determined in accordance with the level of the average volume of red blood cells:
- microcytic (+ \ - hypochromic; MCV <80 fl);
- normocytic (MCV 80-100 fl);
- macrocytic (MCV> 100 fl).
The abbreviation fl denotes a femtoliter equal to μm 2 . This indicator is rather arbitrary for characterizing anemia and only tells the diagnostician which direction should be taken further in the search for the source of the disease.
The next step is to isolate the features of a particular type of anemia. They will be like that.
For microcytic anemia , iron deficiency is characteristic either due to a reduction in its reserves, or as an increase in the amount of element consumed. Here, the specialist will already look for indicators of such conditions as:
- chronic iron deficiency anemia ;
- anemia of chronic diseases;
- thalassemia is a hereditary disease characterized by a decrease in the production of one of the components of hemoglobin - polypeptide chains;
- other microcytic hypochromic anemia.
Normocytic anemia is further differentiated by the activity of erythropoiesis - it is increased or decreased. Depending on the result, the following are distinguished:
- with reduced erythropoiesis - hemolysis, which indicates a hemolytic form of anemia, and blood loss, requiring the search for a source of bleeding;
- elevated erythropoiesis serves as evidence of either a disease of the bone marrow itself or a disease of any organ involved in the circulatory system - the liver, kidneys, endocrine pathologies.
When macrocytic anemia is established, the next stage is the distinction between megaloblasts:
- the presence of these formations implies megaloblastic anemia, which can be activated by a lack of folic acid or vitamin B12, as well as the action of toxins, drugs that affect DNA synthesis;
- if megaloblasts are not found in the analysis, then we are talking about non-megaloblastic anemia, which can be caused by alcoholism, liver diseases, hypothyroidism, chronic obstructive pulmonary disease (COPD) or myelodysplastic syndrome.
Dif diagnosis of anemia in the table will look like this:
Lack of core element
Dif Diagnosis of anemia in children and adults begins with the determination of its presence as such. Indeed, hemoglobin deficiency is a symptom of many pathological conditions of the body and can be caused by a complex of problems. One of the most common forms of blood pathologies is iron deficiency. Dif Diagnosis of iron deficiency anemia makes it possible to find out the reason why the synthesis of heme, an iron-containing pigment, is disturbed in red blood cells. They can be:
- chronic blood loss - gastrointestinal, uterine bleeding, cancer of the gastrointestinal tract and urinary system, hemosiderosis of the lung, hemorrhagic diathesis of various etiologies, paroxysmal night hemoglobinuria;
- increased need for iron, observed during pregnancy, lactation, in infancy, as well as in juvenile chlorosis;
- a lack of iron supplied with food, which occurs with gastroduodenitis, gastrectomy, infectious lesions of the intestine, and can also be observed with certain food systems - vegetarianism, starvation;
- violation of iron transport, characterized by a small amount or low functional activity of transferrin.
To conduct a qualitative diagnosis, the differentiation method is one of the most effective and high-quality. When making a diagnosis regarding iron deficiency anemia, the specialist first of all takes into account that this type of anemia is hypochromic in any case, but at the same time, initially detected hypochromic anemia may not be iron deficiency. And therefore, for such a diagnosis as hyperchromic anemia, diagnosis requires careful distinction, that is, differentiation. For this purpose, a blood smear is used, examined under a microscope, and the determination of free erythrocyte protoporphyrin (norm 2.7-9.0 μmol / l). A blood smear on the glass allows you to observe basophilic puncture in red blood cells. In case of iron deficiency anemia, the granularity will look soft, but in case of lead poisoning, for example, it is larger and clearer.
Thalassemia, being hereditary, also refers to hypochromic hemolytic anemia, it manifests itself in a violation of hemoglobin synthesis. In this case, family history, determination of hemoglobin fractions and signs of hemolysis help differentiation. Separating thalassemia from iron deficiency anemia also helps to determine the index of RDW (indicator of anisocytosis of red blood cells). If the patient has thalassemia, then it will be normal, if a person suffers from an iron deficiency form of anemia, then this level will be elevated.
Differential diagnosis of some deficient anemia uses an analysis to determine the level of serum transferrin receptors and the level of ferritin. If it is normal against the background of a lack of heme, then we are talking about anemia of chronic diseases.
Cobalamin deficiency
Another type of anemia is the so-called B12 deficiency anemia. This type of problem is part of a group of megaloblastic anemia based on impaired DNA and RNA synthesis. The basis for the development of this anemia is a deficiency of cobalamin (vitamin B12). Its definition is involved in the differential diagnosis of anemia. The causes of this problem are as follows:
- atrophic gastritis in the absence of an internal factor and with impaired absorption of B12;
- insufficient B12 vegetarianism with food;
- gastrectomy or resection of the small intestine;
- helminthiases (wide tape);
- malignant tumor of the fundus of the stomach;
- multiple diverticulosis with excessive development of intestinal microflora;
- enteritis with malabsorption.
In this case, the differential diagnosis of anemia is the main goal of separation from diseases in which megaloblastic type of hematopoiesis is characteristic, as well as from anemia with pancytopenia and hemolysis syndromes. It is performed using the following clinically relevant tests:
- a general blood test to determine the number of red blood cells, their diameter and volume, color index, hemoglobin level, white blood cell count, reticulocyte count, platelet count, white blood cell count, and erythrocyte sedimentation rate;
- general urine analysis;
- biochemical blood test, which determines the content of total protein and protein fractions, aminotransferases and bilirubin;
- blood levels of vitamin B12 and folic acid;
- ultrasound diagnostics of internal organs - liver, kidneys, pancreas, spleen, gall bladder, kidneys;
- fibrogastroduodenoscopy;
- fibrocolonoscopy.
To clarify the diagnosis of B12-deficient anemia, the patient is prescribed sternal puncture.
Folic acid deficiency
Differential diagnosis of iron deficiency anemia allows a very detailed determination of the health status of the human body as a whole. Quite often, in addition to directly iron deficiency in human blood, other forms of anemia are detected. For example, folic acid deficiency anemia, a characteristic feature of which is folate deficiency. This disease belongs to the group of megaloblastic anemia, and mainly young and middle-aged people suffer from it. As the name of the problem is clear, the lack of folic acid in food, the insufficient production of this element in the human body itself, is the basis of such a serious problem. Specialists noted that the differential. Diagnosis of anemia caused by a deficiency of vitamin B12 and folic acid has the same algorithms. At present, the main methodology for determining the amount of folate in the blood, which allows to make the correct diagnosis, is not. But these two types of blood problems often go together. This is the so-called combined anemia, which has many common manifestations and treatment options.
Erythrocyte pathology
In a special group, doctors distinguish diseases associated with congenital or acquired blood pathology, expressed by increased decay of red blood cells, as well as their shorter life. Dif the diagnosis of anemia begins the analysis with the general condition of the patient, since his well-being directly depends on a decrease in the oxygen-binding ability of the blood, as well as the presence of red blood cell decay products in the body. Therefore, a person constantly feels weakness, dizziness, palpitations, chills, fever. Due to the fact that a rather large amount of free hemoglobin can be in the plasma, the urine can turn red - from light pink to almost black - as hemoglobinuria develops.
An absolute indicator of this type of anemia in the differential diagnosis is the shortened life span of red blood cells, determined as a result of a radioisotope study. , . :
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- increased level of erythrokaryocytes in the bone marrow (more than 20-24%) - erythroid hyperplasia of the bone marrow;
- reticles (immature red blood cells) detected more than 2%;
- clinically established decrease in hemoglobin level.
Anemia is a serious symptom of disturbances in the work of various organs or systems of the human body. And in order to correctly determine the cause of the development of anemia, a thorough examination is necessary. The differential diagnostic method allows you to quickly, but at the same time correctly establish the reason why this problem appeared. This allows you to get an adequate treatment for the situation.