Human diseases for quality treatment must be correctly diagnosed. Modern technologies allow you to do this quite quickly, and techniques to avoid unnecessary waste of time and resources. For example, diff. anemia diagnosis uses the exclusion method to determine the cause of the problem in order to clarify it and concretize it with the help of special analyzes and studies.
The most important "transport"
Everyone learns about the “hemoglobin-iron” connection in anatomy lessons in middle school. It is she, one of the bases of erythrocytes, which are a component of blood - the liquid connective tissue of the human body. Blood circulates through a closed system of vessels, ranging from large aortas and veins to the smallest capillaries that penetrate almost all organs and tissues. The structure of the blood itself is not so complicated. Liquid plasma contains suspended components:
- leukocytes;
- platelets;
- erythrocytes.
It is in the erythrocytes that hemoglobin is located, which gives the blood a red color due to the content of the iron atom in its composition.
Therapeutic analysis - diff. diagnosis of iron deficiency anemia - helps the specialist to establish the reason why the level of hemoglobin decreases. 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. Moreover, it means not a quantitative indicator of the volume of the liquid itself, but the level of hemoglobin. Anemia is not an independent disease, as 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, let's say, third-party organs. One serious problem arises here: the classical nosology for anemia is an inappropriate way of defining it. But for the types of anemia, one important feature is characteristic - a decrease in the amount of hemoglobin, most often associated with a decrease in the number of red blood cells. Here, the dependence of hemoglobin-iron is clearly traced, since in some cases anemia is detected precisely as iron deficiency. In other cases, hemoglobin drops not only due to a decrease in iron in the blood, we will discuss this in more detail below.
So: the differential diagnosis of anemia in children and adults aims to identify the cause of such a he alth problem as anemia.
House method
Fiction works acquaint readers, viewers, listeners with all aspects of human life, sometimes very distant and obscure. For example, one of the popular series "Doctor House" interestingly and vividly explains the work of a diagnostician. Moreover, the method of differential diagnosis for the characters of the film is the main principle of operation.
Establishing the correct diagnosis is the key to the highest quality treatment in each specific situation. To do this, specialists use many methods, methods and techniques. Pathological conditions, such as, for example, hemoglobin deficiency, are also in dire need of an adequate etiology setting. One of the qualitative 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 makes it possible to qualitatively calculate the cause of the patient's pathological condition.
The separation technique itself (differentiation) is effective for diagnosing many pathological conditions, when one symptom or symptom complex can be a witness to a large number of patient he alth problems. For example, the differential diagnosis of iron deficiency anemia makes it possible to exclude as accurately as possible any other types of hemoglobin deficiency, which helps in the shortest possible time to prescribe the necessary examinations to specify the disease and prescribe high-quality therapy.
Steps in diagnosing a problem
Dif. diagnosing anemia is not the only way to find the cause of the pathology. Anythe disease in the study of a particular patient goes through several stages. For insufficiency of blood hemoglobin, the doctor must carry out the following steps:
- diagnosis of the syndrome, which will determine the pathogenetic variant;
- diagnostics of the nosology of pathology, 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 for identifying the anemia problem itself and its level. At the same stage, the composition of the blood is studied by its components - iron, transferrins and ferritin. If necessary, with the help of trepanobiopsy or sternal puncture - modern methods of sampling the studied biomaterial - the bone marrow is taken for analysis. With the help of such studies, a differential is carried out. diagnosis of iron deficiency anemia and B12 anemia, which allows specifying the problem for a qualitative search for its solution.
Anemia variant research
Specialists have developed certain modern methods for the qualitative diagnosis of he alth problems in each patient. The essence of the differential diagnosis of anemia is the consistent exclusion of inappropriate variants of the problem, thus leading to a specific and correct solution, and, therefore, to the selection of an adequate therapy for the case.
What kind of laboratory tests help to establish the diagnosis? It should be said right away that for the analysismodern devices and methods are used, which allows you to get the most accurate result.
Hematological examinations can determine:
- hematocrit (H tc);
- hemoglobin (Hb);
- blood type and Rh factor;
- leukocytes (Le);
- erythrocyte count (Er);
- mean red cell volume (MCV);
- mean concentration of hemoglobin (Hb) in erythrocytes (MCHC);
- average hemoglobin (Hb) per red blood cell (MCH);
- reticulocytes (Rtc);
- erythrocyte sedimentation rate (ESR);
- platelets (Tr);
- color index (CPU).
Blood smears, viewed under a microscope, make it possible to determine whether there are abnormally shaped 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 Serum Iron-Binding Capacity (TIBC);
- transaminases;
- ferritin;
- alkaline phosphatase.
Also, for making a diagnosis, the patient is assigned:
- urinalysis, which determines the color, acidity pH, transparency, specific gravity, the presence of protein, urobilin, erythrocytes, sediment composition;
- analysis of feces for worm eggs, color, consistency, occult bleeding.
Bone marrow examinations are carried out in two ways:
- sternal puncturecarried out to determine cytosis, the ratio of erythroid and myeloid cells, morphological study of cells;
- trepanobiopsy shows the cellularity of the bone marrow, the morphological structure of cells.
Differential diagnosis of hypochromic anemia, however, as well as the vast majority of other problems associated with blood composition, uses not only the above, but also other, more detailed and narrowly focused examinations.
Discrimination algorithm
The algorithm for the differential diagnosis of anemia is designed for high-quality and rapid 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 erythrocytes:
- microcytic (+\- hypochromic; MCV < 80 fl);
- normocytic (MCV 80-100 fl);
- macrocytic (MCV > 100 fl).
The abbreviation fl stands for femtoliter, equal to microns2. This indicator is rather arbitrary for characterizing anemia and only tells the diagnostician which direction to go next in search of the source of the disease.
The next step is to isolate the features of a particular type of anemia. They will be like this.
Microcytic anemia is characterized by iron deficiency, either due to a decrease in its reserves, or as an increase in the amount of the consumed element. Here, the specialist will already look for indicators of such conditions as:
- chronic iron deficiency anemia;
- anemia of chronic disease;
- thalassemia –a hereditary disease characterized by a decrease in the production of one of the components of hemoglobin - polypeptide chains;
- other microcytic hypochromic anemias.
Normocytic anemia is further differentiated by the activity of erythropoiesis - it is increased or decreased. Depending on the result obtained, they are distinguished:
- with reduced erythropoiesis - hemolysis, which indicates a hemolytic form of anemia, and blood loss, requiring the search for a source of bleeding;
- increased erythropoiesis is 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 establishing macrocytic anemia, the next step is to differentiate by 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 disease, hypothyroidism, chronic obstructive pulmonary disease (COPD) or myelodysplastic syndrome.
Dif. diagnosis of anemia in the table will look like this:
Deficiency of the main element
Dif. Diagnosis of anemia in children and adults begins with determining its presence as such. After all, insufficiencyhemoglobin 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 allows you to find out the reason why the synthesis of heme, an iron-containing pigment, is impaired in red blood cells. They may be:
- chronic blood loss - gastrointestinal, uterine bleeding, oncological tumors of the gastrointestinal tract and urinary system, hemosiderosis of the lung, hemorrhagic diathesis of various etiologies, paroxysmal nocturnal hemoglobinuria;
- increased iron requirements during pregnancy, lactation, infancy, and juvenile chlorosis;
- lack of dietary iron, which occurs with gastroduodenitis, gastrectomy, intestinal infections, and can also be observed with certain nutrition systems - vegetarianism, starvation;
- impaired iron transport, characterized by a small amount or low functional activity of transferrin.
For high-quality diagnostics, 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 it is this type of anemia that is hypochromic in any case, but at the same time, initially identified hypochromic anemia may not be iron deficiency. And therefore, for such a diagnosis as hyperchromic anemia,diagnosis requires careful discrimination, that is, differentiation. For these purposes, a blood smear is used, which is examined under a microscope, and the determination of free erythrocyte protoporphyrin (normal 2.7-9.0 µmol/l). A blood smear on glass allows you to observe basophilic puncture in erythrocytes. With iron deficiency anemia, the grain will look soft, but with lead poisoning, for example, it is larger and more distinct.
Thalassemia, being hereditary, also refers to hypochromic hemolytic anemia, it is manifested by a violation of hemoglobin synthesis. In this case, family history, determination of hemoglobin fractions, and signs of hemolysis help differentiate. To separate thalassemia from iron deficiency anemia, the determination of the RDW indicator (an indicator of erythrocyte anisocytosis) also helps. If a patient has thalassemia, then he 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 anemias uses an assay to determine serum transferrin receptor levels and ferritin levels. 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 included in the group of megaloblastic anemias based on impaired DNA and RNA synthesis. The basis for the development of this anemia is a deficiency of cobalamin (vitamin B12). Its definition isdifferential diagnosis of anemia. The reasons for this problem are as follows:
- atrophic gastritis without intrinsic factor and B12 malabsorption;
- vegetarianism with insufficient B12 intake from food;
- gastrectomy or resection of the small intestine;
- helminthiases (broad tapeworm);
- malignant tumor of the fundus of the stomach;
- multiple diverticulosis with overgrowth of intestinal microflora;
- malabsorption enteritis.
In this case, the differential diagnosis of anemia, the main goal is to separate from diseases in which the 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:
- general blood test to determine the number of erythrocytes, their diameter and volume, color index, hemoglobin level, the number of leukocytes, reticulocytes, platelets, leukocyte formula, and erythrocyte sedimentation rate;
- urinalysis general;
- a biochemical blood test that 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, gallbladder, kidneys;
- Fibrogastroduodenoscopy;
- Fibrocolonoscopy.
To clarify the diagnosis of B12 deficiency anemia, the patient is prescribed a sternal puncture.
Folic acid deficiency
Differential diagnosis of iron deficiency anemia allows for a very detailed determination of the state of he alth of the human body as a whole. Quite often, in addition to direct iron deficiency in human blood, other forms of anemia are also detected. For example, folate deficiency anemia, a characteristic feature of which is folate deficiency. This disease belongs to the group of megaloblastic anemias, and it affects mainly people of young and middle age. As is clear from the name of the problem, 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. Experts noted that diff. the diagnosis of anemia caused by vitamin B12 and folic acid deficiency has the same algorithms. There is currently no basic method for determining the amount of folate in the blood, which allows making a correct diagnosis. But these two kinds of blood problems often go together. This is the so-called combined anemia, which has many common manifestations and ways of treatment.
Pathologies of erythrocytes
In a special group, doctors distinguish diseases associated with congenital or acquired pathology of the blood, expressed by increased breakdown 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 the decrease in the oxygen-binding capacity of the blood, as well as the presence of decay products in the bodyerythrocytes. Therefore, a person constantly feels weakness, dizziness, palpitations, chills, fever. Due to the fact that plasma can contain a fairly large amount of free hemoglobin, urine can turn red - from light pink to almost black - as hemoglobinuria develops.
The absolute indicator of this type of anemia in differential diagnosis is the shortened life span of erythrocytes, determined as a result of a radioisotope study. Unfortunately, this technique is expensive and rarely used. Differential diagnosis uses a more accessible set of the following observations and studies:
- haptoglobin in blood serum is present in insufficient quantities due to binding to free hemoglobin;
- hemosiderinuria - as evidence of exceeding the threshold of filtration through the renal glomeruli of free plasma hemoglobin;
- hemoglobinuria;
- jaundice, as a manifestation of an increased amount of free or "indirect" bilirubin in the blood serum;
- presence of anti-erythrocyte antibodies as a result of serological diagnosis - as an important step in establishing a nosological diagnosis (this analysis is also the basis for the differential diagnosis of acquired autoimmune hemolytic anemias (AIHA);
- increased level of erythrokaryocytes in the bone marrow (more than 20-24%) – erythroid bone marrow hyperplasia;
- Reticulum (immature erythrocytes) is detected more than 2%;
- Clinically established low hemoglobin levels.
Anemia is a serious symptom of disorders in the work of certain organs or systems of the human body. And in order to correctly find out the cause of the development of anemia, it is necessary to conduct a thorough examination. The method of differential diagnosis allows you to quickly, but at the same time correctly establish the cause of this problem. This allows you to receive adequate treatment for the situation.
