Anemia in the tropics

reference value/cut-off of Hb

• adjust according to altitude of living

diagnosis

• POC test kit: HemoCue
• ferritin increases in inflammation in order to deliver more iron stimulated by inflammation itself as well as to avoid pathogens try to consume iron
• serum transferrin (TIBC) increases in IDA, decreases in inflammation
• zinc protoporphyrin (Zpp)
• soluble transferrin receptor (sTfr)

cause

• malaria does not cause IDA directly; destruction of RBCs by Plasmodium does not cause iron loss
  • anemia by malaria is mainly by inflammation, which suppresses iron absorption

sickle cell anemia

• monogenetic recessive disorder
• hemoglobin mutation
• HbA mutated into HbS (sickle cell trait) or HbC (West Africa)
• sickle cell trait protect against death from severe malaria
  • not prevent infection itself

clinical picture of SCD

• affects all organ systems
• disease pattern and severity varies very much on patients

chronic management

• first to identify high risk groups

thalassemia

• decreased hemoglobin production
  • sickle cell trait is problem of hemoglobin destruction
• beta thalassemia affects beta chain of hemoglobin
• alpha thalassemia affects alpha chain of hemoglobin
• major, media, minor