Differential Diagnosis Flashcards
Iron Deficiency Anaemia
Normal
Thalassaemia/ other hemoglobinopathies
Anaemia of chronic disease
Combination of IDA with other disease
Iron Deficiency Anaemia Further Tests
Serum iron - low Total Iron Binding Capacity (%) - high % saturation - <10% Ferritin - low Soluble transferrin receptor - high Bone marrow iron - absent/deficient
HPLS/ Hb Electrophoresis
Hb A - 98%
Hb F - less than 1%
HB A2 - within normal range
Alpha Thalassaemia Minor
Beta Thalassaemia minor
Iron deficiency anaemia
Other haemoglobinopathy
Alpha Thalassaemia Minor Further Tests
Hb electrophoresis and HPLC - normal
Family history - positive
Molecular tests - deletion of two alpha-globin genes
iron profile - normal
Beta Thalassaemia Minor
Other kinds of thalassaemia
Other haemoglobinopathies
Anaemia of chronic disease
Iron deficiency anaemia
Beta Thalassaemia Minor Further Tests
Hb A - decreased
Hb F - normal/slightly increased
Hb A2 - increased
Iron studies - normal
Beta Thalassaemia Major
Other Thalassaemias
Other Haemoglobinopathies
Anaemia of chronic disease
Some RBC membrane disorders
Beta Thalassaemia Major Further Tests
Hb A - decreased/ absent Hb F - marked increase Hb A2 - variable Iron studies - normal/increased Molecular tests - defect in beta-globin gene
Haemoglobin H disease
Beta thalassaemia
Iron deficiency anaemia
Autoimmune haemolytic anaemia
Nonimmune haemolytic anaemia
Haemoglobin H disease Further Tests
Demonstration of HbH inclusion bodies
Hb-electrophoresis - presence of Haemoglobin H
Molecular tests - deletion of three alpha-globin genes
Iron studies - normal
DAT - negative
Sickle Cell Anaemia
Other haemoglobinopathies Liver and kidney disease Appendicitis Neurological disorders Other haemolytic anaemia
Sickle Cell Anaemia Further Tests
Sickle cell solubility test - positive
Hb electrophoresis - 80% Hb S
Molecular test - defect in beta-globin chain
Anaemia of Chronic Disease
Iron deficiency anaemia
Thalassaemia
Anaemia due to drugs
Primary haematological disorder
Anaemia of Chronic Disease Further Tests
Serum iron - decreased
Ferritin - increased
C-reactive protein - increased
Serum albumin - reduced
Post Splenectomy
Severe haemolytic anaemia
Megaloblastic anaemia
Hereditary spherocytosis
Post Splenectomy Further Tests
Blood smear - increased number of howell-jolly bodies
Vitamin B12 and folate - normal
AGLT - negative (exclude hereditary spherocytosis)
Megaloblastic Anaemia
Liver disease
Drug-induced haemolytic anaemia
Megaloblastic Anaemia Further Tests
Serum B12 and Folate - decreased
Liver function test - normal
Drug history - no use
Liver Disease
Megaloblastic anaemia
Drug-induced haemolytic anaemia
Liver cancer
Liver Disease FUrther Tests
Liver function tests - abnormal
Glucose-6-Phosphate Deficiency
Sickle cell anaemia
Hereditary spherocytosis
Drug-induced haemolytic anaemia
Glucose-6-Phosphate Deficiency Further Tests
Glucose fluorescence spot test - no fluorescence
G6PD dye reduction test - no colour change
molecular tests - mutation in G6PD gene
G6PD enzyme - decreased
Direct Coombe’s test - negative
Pyruvate Kinase Deficiency
Autoimmune haemolytic anaemia
Thalassaemia
Haemoglobin E disease
Pyruvate Kinase Deficiency Further Tests
Hb electrophoresis - normal
Enzyme deficiency - deficient
Molecular tests - mutation in PK disease
DAT - negative
Hereditary Spherocytosis
Autoimmune haemolytic anaemia (AIHA) Drug induced haemolytic anaemia Sever burns Septicemia Biliary Disease
Hereditary Spherocytosis Further Tests
Biochemistry - increased unconjugated bilirubin
DAT - negative
Molecular test - defect in alpha and beta spectrin
