Anemia: Lesson 1 - Diagnostic Frameworks

[@alexandremello6913]

I am a hematologist and it is great to see a series of talks on anemia on your excellent page. Thanks a lot for your effort in putting together all those lessons. I have two observations. First, in the table of causes of anemia separated by MCV, the anemias caused by marrow invasion by hematologic neoplasms are missing (leukemias, lymphomas, myeloma etc). Second, a suggestion: I teach my students that microcytic anemias all have the common pathophysiolgy of reduced hemoglobin production, while macrocytic anemias are generally the result of troubled DNA synthesis. This is something that they will surely use in their practice.

[@StrongMed]

Thanks for the comment sir! Yeah, the anemia by MCV table is missing the marrow diseases - an oversight on my part. Regarding the second suggestion, I've seen people teach this as well and it's a cool way to connect physiology to what's seen on the smear, but have wondered about the macrocytic side...do those etiologies all come from issues with DNA synthesis, or just the megaloblastic anemias? (Honestly don't know, and some references I just checked were a little "hand wavey" about it)

[@nikolaykondratyev3021]

What is your opinion of the ret index as discussed in this video? Just out of curiosity.

[@alexandremello6913]

@@nikolaykondratyev3021 I haven't re-watched the video but what I usually teach my students is to get out of the box when considering ordering a RC. Usually, students build the inflexible and wrong conception that a high RC *means* hemolysis. They have to understand that iron, folate or b12 replenishment will result in a high RC if there was a deficient state. They need to understand that correcting anemia with transfusions will normalize the RC as well as the MCV and can mask the right diagnosis. Another important issue is the correct understanding of the difference between an uncorrected versus corrected RC. So basically I see the RC as a very specific test that should only be ordered to discriminate between an intact or impaired ertythropoietic response to hypoxemia. It is not a screening test, and the classification of anemias into hypo or normo or hyperproliferative is not really a meaningful or practical way to do it. Only order it if you are SURE that it will answer your question.

[@nikolaykondratyev3021]

@@alexandremello6913 thank you! :)

[@Kalemalex]

@@alexandremello6913 thanks

[@sunving]

Thank you doctor Strong, good lecture. It is so good and ,not too long on each topic. I listen to this lecture , 4 year ago already . Time fly. I learn much more from you than my school, I don’t blame my teacher ,instructor then , besides modern internet allow you to listen again and again. You are the best , especially in clinical , and practical.

[@GiasAhmed-tq8cx]

You are undoubtedly THE BEST TEACHER! Thank you, Dr. Strong. And love the starting piano of your lessons. 🥰

[@howtomedicate]

Really great video! As a student I always struggled with the diagnostic framework of anemia, but here you explained it very clearly. Thanks 👍

[@mustafamerrick7975]

instaBlaster.

[@cornelbacauanu1544]

The best explanation so far of the MCV vs Retic index for clinical practice. Thank you for Anemia lectures.

[@jackgreen7273]

IiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiT's about Tiiiiiiiiiiiiiiiime!!!. I must have gone through 2 days worth of watching videos on all sorts of classification of anemias: normo macro micro cytic with each one putting diseases in different categories. Then they throw in Production vs Destruction, and reticulocyte counting. Oh yeah, and the megalo non-megalo thing. I wasted sooooo much time trying to figure it all out. Then I watched your video which simply dealt with the pros and cons of the methods, pointing out that using MCV puts certain anemias in more than one category. Hemolytic can be all three MCVs. Now things make sense. Thanks.

[@mathesondaniel]

Thought this said "Diagnostic Fireworks" to begin with, so initially disappointed but still very grateful for the great vid

[@ooocebutcebut1699]

Thank you!! Thank you!! Thank you!!! Thank you!! Thank you!! All of you videos help more than you know!!!!! Again, Gracias!! And by the way, I would sit through hours of your videos in order to grasp the concept. :) :) Cheers!!

[@nasreddinekhayati2121]

Hello Dr Strong ! I was going through this lecture and particularly the classification of Normocytic anemia. Got this idea to create a group of Anemias of chronic disorder (anemia of Chronic Kidney Disease, anemia of chronic inflammation, and anemia of chronic infection like HIV/AIDS, TB..) I think this could help students and practitioners to memorize this part of anemia's classification

[@wasm5007]

would you agree that elderly patients may have low Hb but normal MCV because their kidney function is generally low? Would you treat with iron?

[@sarahgamaleldean3775]

Thanks alot ...waiting for more...lwill always follow..go on u r the top

[@mariamdaod8184]

Well done Dr Eric

[@kevouyreid4518]

These anemia lectures provide a structured and systematic approach to diagnose and investigate patients.

[@abc-ei3ik]

Nothing’s frustrating, grateful for everything. Ty

[@menpagnaroat1269]

Thank you very much Dr. Eric for responding to my request.

[@suneelsharma1763]

great videos sir . i love your lectures. plss keep posting . love from India....

[@nikolaykondratyev3021]

You have a great teaching voice.

[@Natie_Deme]

Thank you for the explanation... I am anemic. And I am weighing things before having the covid vaccine.

[@chanellewilson7094]

This is great!! Can you a video on renal disease and interpreting lab work? I work with a huge elderly population and a lot of CKD. As a new NP, it would be a great help.

[@StrongMed]

I have a brief series on interpretting the UA which touches on various forms of renal disease: kzbin.info/www/bejne/roazYaeAhdJnjJY Also a series on AKI: kzbin.info/www/bejne/qHjRg4iHr7h2ras And there are a number of videos on the main channel about all of the major electrolyte disorders. I don't have any videos specifically on CKD yet, but it's on my list of topics to cover!

[@SFL3G]

Thank you sir for sharing always great content on your site.

[@haemy5495]

Thanks Dr. Eric 💕🙏🏻🙏🏻

[@IamSomaMohanty]

I am not sure if I will get a response to my query here but I am hopeful. My mother, 58 has declining Hb over time. She has recovered from covid about 5 months ago. During her hospitalization due to covid back in May her Hb was 7.7 and had to under go blood transfusion of 1 unit. The transfusion rose the Hb to 11.2 and after discharge, from followup CBC we found out that the Hb had improved to 12.2. But we would do her CBC every month and in September this month, her Hb has gone down to 10.6 and MCV 85, PCV 36.5. Last month, in October she had fever and we repeated the Hb and found out that it has come down to 9.8. Doctored ordered for B12, vit D3, Ferritin and Iron profile tests. The B12 and D3 are normal. Ferritin is 220 and the TIBC is low 263 and Iron 21.3. During this we also did her Kidney function test and liver function test and the albumin/globulin ratio was 1.23. The doctored suggested her to continue taking Iron supplements and eat protein rich food because she usually follows a vegetarian diet with very low consumption of milk products. Just looking for an answer for her condition. Is it chronic inflammation? Her crp was 4.7 mg/l(nephelometry). Could this be auto-immune disease? That said she is neither diabetic, not has abnormal Thyroid condition. She is not having thalassemia either. No medical surgery, no occult blood in stool.

[@StrongMed]

I'm very sorry, but I cannot offer specific, individualized medical advice on this channel.

[@IamSomaMohanty]

@@StrongMed it's alright. Can you do it personally? Can I reach out to you through email?

[@StrongMed]

No, I'm very sorry but I cannot. Providing medical advice as a physician requires establishing a doctor-patient relationship, obtaining a full history of the situation by speaking directly with the patient, performing a relevant physical exam (if possible), and reviewing the relevant medical records. This cannot be done safely via email.

[@sorrelknott3653]

High MCV but low MCHC - could this mean both Iron and B12 deficiencies? Could this equate to normo?

[@CeruleanDreamer]

2:30 what if its a Hemolytic Anemia?

[@StrongMed]

Lesson 3 in this series is all about hemolysis: kzbin.info/www/bejne/gIHMqKGvmK2gqZY

[@mamunrashid8972]

Love love love from Sweden 🇸🇪

[@winnieprune4900]

How does liver disease cause macrocytic anaemia? And hypothyroidism? And alcohol?

[@sunving]

Thank you Doctor Strong.

[@Drtehminah]

Thanks for. the video series.

[@nystagmus]

Just use both retic index and mcv

[@blacksea2001]

Hi I have thalassemia beta how to treatment

[@ahmedalaa-bv8xx]

A patient with long standing indigestion has noticed increasing lack of energy and tiredness when walking uphill.on questioning he has noticed that the bowl motons are unusually dark from time to time.Due to the indigestion the patient takes a bland diet without much meat or vegetables.(iron deficiency anemia_pernicious anemia)

[@mdsaimon4536]

Thank u Dr.eric

[@kurootsuki3326]

saving my grades

[@youssefkhial6791]

thank you

[@TriKienkienminhtri]

Thanks

[@arielol89]

Thanks 🙏🏻

[@DrTay-zn5re]

awesome

[@sonalibanerjee5196]

THANK YOU

[@venkybly]

Tq

[@XX-ru5wu]

*Great!* Greetings from Germany

[@HafizahHoshni]

thank you so much! 27/9/2022

[@mehrshxd]

MY G