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Anemia no Idoso. Importância do diagnóstico laboratorial
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Resumo(s)
Resumo parte 1:
O estágio foi realizado entre julho de 2019 e dezembro de 2019, no âmbito do Mestrado em Análises Clínicas da Faculdade de Farmácia da Universidade de Lisboa, e decorreu no Laboratório de Análises Clínicas - Villalab - Análises Clínicas, Lda, um laboratório dirigido para a comunidade, em Cascais.
Este laboratório desenvolve todas as valências, e essas valências são as de Bioquímica Clínica, Microbiologia, Hematologia e Imunologia.
Este relatório de estágio vai subdividir-se nas valências de Bioquímica Clínica e de Microbiologia, por serem as áreas que foram desenvolvidas no estágio.
Na valência de Bioquímica Clínica iremos descrever a fase pré-analítica, fase analítica em que são mencionados os equipamentos e os parâmetros bioquímicos (perfis lipídico, hepático, pancreático, renal e cardíaco), e posteriormente a fase pós-analítica, que corresponde à validação dos resultados por um farmacêutico especialista, assim como a emissão do boletim dos resultados e a entrega desses resultados ao doente ou ao médico.
Na valência de Microbiologia, será descrita a fase pré-analítica, os equipamentos, os métodos de diagnóstico na fase analítica, os produtos biológicos e a fase pós-analítica. Será também descrito o controlo de qualidade interno e externo. No controlo interno da qualidade, amostras com valores conhecidos de matriz idêntica à biológica são analisadas como sendo amostras biológicas com a finalidade de monitorizar a precisão dos métodos analíticos.
Para o efeito de controlo de qualidade externo, amostras com valores desconhecidos de matriz idêntica à biológica, fornecidas pelo Instituto Nacional de Saúde Doutor Ricardo Jorge, são analisadas como sendo amostras biológicas. Na data prevista, com a finalidade de se aferir a exatidão dos métodos analíticos do laboratório Villalab, serão realizadas uma avaliação retrospetiva, validação de metodologias e de procedimentos, cálculo do erro total, qualificação dos colaboradores e avaliação das necessidades de formação, com o objetivo final de promover a confiança dos clientes no laboratório.
Resumo parte 2:
A Organização Mundial de Saúde define anemia como uma diminuição da concentração de Hemoglobina (Hb) no sangue (abaixo de 13,0 g/dL nos homens e abaixo de 12,0 g/dL nas mulheres não grávidas) ou da quantidade de glóbulos vermelhos (GV), abaixo dos valores de referência para a idade, género e altitude relativamente ao nível do mar, do local onde se vive.
As causas de anemia podem ser múltiplas, nomeadamente deficiências nutricionais (vitamina B12, ácido fólico, ferro), anomalias genéticas (talassemias) e diversas outras condições como doenças infeciosas/inflamatórias, neoplasias, doenças crónicas e/ou autoimunes.
Após os 65 anos a prevalência de anemia é maior nos homens e, nestes, ainda é maior nos que têm mais de 85 anos, uma vez que a Hb diminui com a idade. A anemia mais comum é por deficiência em ferro e segundo a Associação Portuguesa para o Estudo da Anemia (Anemia Working Group Portugal - AWGP), estima-se que afete entre 4 a 5 mil milhões de pessoas em todo o mundo, ou seja, 15% da população mundial.
Segundo a AWGP, a prevalência de anemia em Portugal é de cerca de 20% (20,6%), ou seja, 1 em cada 5 portugueses sofre de anemia, sendo que destes, a grande maioria (84%) desconhece ter esta condição, pelo que apenas 2% da população recebe tratamento de forma adequada, pelo que este é considerado um importante problema de saúde pública nacional, o índice de prevalência da anemia é superior à média dos países desenvolvidos, pois enquanto nestes países a taxa é de 9%, a taxa nacional é mais do dobro, atingindo os 20%.
No Norte do país a anemia é mais prevalente em adultos até aos 65 anos e no Centro do país mais prevalente nos adultos com mais de 65 anos, acompanhando a prevalência da deficiência em ferro nestas regiões.
Nos idosos a etiologia da anemia é classificada em três categorias principais: uma categoria é a deficiência nutricional em ferro, folato ou vitamina B12 que pode estar associada à desnutrição frequente nos idosos, outra categoria são as doenças crónicas como a inflamação e doença renal crónica e, por último, temos a anemia, para a qual não é conhecida uma causa evidente.
No Laboratório de Análises Clínicas – Villalab, foram estudados 26 casos de anemia com Hb entre o intervalo de 7,3-10,9 g/dL e os pacientes foram agrupados em 3 grupos
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(A, B e C), de acordo com os seus parâmetros analíticos. No grupo A foram incluídos 10 casos, os quais apresentavam os índices hematimétricos (VGM, HGM, CHGM e RDW) dentro dos valores normais, mas uma produção de GV reduzida.
No grupo B foram incluídos 11 casos, os quais apresentavam 3 dos quais apresentavam o VGM diminuído. Em 3 casos suspeitou-se de anemia ferropénica, num dos casos de beta-talassemia e nos restantes 7 casos suspeitou-se de uma anemia causada por doenças crónicas.
No grupo C foram incluídos 5 casos, os quais apresentavam GV, Hb e Ht baixos e VGM elevado. Em 4 casos, com VGM inferior a 110 fL, suspeitou-se de anemia causada por hipoplasia medular, ou decorrente de uma doença hepática, já que os doentes tinham mais de 90 anos. Num caso, com VGM superior a 110 fL, colocou-se a hipótese de ser uma anemia megaloblástica, mas seria necessário proceder ao doseamento do ácido fólico e da vitamina B12, análises que não foram requisitadas pelo médico.
Abstract parte 1: The internship took place between July 2019 and December 2019, within the scope of the Master's Degree in Clinical Analysis at the Faculty of Pharmacy, University of Lisbon, and took place at the Laboratory of Clinical Analysis - Villalab - Análise Clínicas, Lda, a laboratory directed to the community, in Cascais. This laboratory develops all valences, and these valences are those of Clinical Biochemistry, Microbiology, Hematology and Immunology. This internship report will be divided into Clinical Biochemistry and Microbiology, since these were the areas developed in the internship. In the Clinical Biochemistry valence we will describe the pre-analytical phase, the analytical phase in which the equipment and biochemical parameters are mentioned (lipid, liver, pancreatic, renal and cardiac profiles), and later the post-analytical phase, which corresponds to the validation of results by a pharmaceutical specialist, as well as issuing the results bulletin and delivering these results to the patient or doctor. In the valence of Microbiology, the pre-analytical phase, the equipment, the diagnostic methods in the analytical phase, the biological products, as well as the post-analytical phase, will be described. Internal and external quality control will also be described. In the internal quality control, samples with known matrix values, identical to biological matrix, are analyzed as being biological samples, in order to monitor the accuracy of the analytical methods. For the purpose of external quality control, samples with unknown matrix values, identical to biological matrix, supplied by the National Institute of Health Doutor Ricardo Jorge, are analyzed as being biological samples. On the scheduled date, with the purpose of assessing the accuracy of the analytical methods of the villalab laboratory, a retrospective assessment, validation of methodologies and procedures, calculation of the total error, qualification of employees and assessment of training needs will be carried out, with the objective of of promoting customer confidence in the laboratory. Abstract parte 2: The World Health Organization (WHO) defines anemia as a decrease in the concentration of hemoglobin (Hb) in the blood (below 13.0 g / dL in men and below 12.0 g / dL in non-pregnant women), or in the amount of RBC, below the reference values for age, gender and altitude of the patient’s place of residence. There are multiple causes of anemia, namely nutritional deficiencies (vitamin B12, folic acid, iron), genetic abnormalities (thalassemia) and several other conditions such as infectious / inflammatory diseases, neoplasms, chronic and/or autoimmune diseases. In men above 65 years of age, the prevalence of anemia is higher, and even higher in men over 85 years of age, since Hb decreases with age. The most common anemia is due to iron deficiency, and according to the Anemia Working Group Portugal (AWGP), a portuguese association for the study of anemia), it is estimated to affect between 4 and 5 thousand million people worldwide, that is, 15% of the world population. According to AWGP, the prevalence of anemia in Portugal is around 20% (20.6%), that is, 1 in 5 portuguese suffer from anemia. The vast majority (84%) is unaware of suffering from this condition, and only 2% receive adequate treatment, so this is considered an important national public health problem. The prevalence of anemia has an average rate of 9% in developed countries, while in Portugal it is more than double, reaching 20%. In the north of the country, anemia is more prevalent in adults up to 65 years of age and in the center of the country it is more prevalent in adults over 65 years of age, following the prevalence of iron deficiency in these regions. In the elderly, the etiology of anemia is classified into three main categories: one category being the nutritional deficiency in iron, folate or vitamin B12, which may be associated with frequent malnutrition in the elderly; another category is chronic disease such as inflammation and chronic kidney disease, and finally, anemia, to which there is no known evident cause. At the Laboratory of Clinical Analysis - Villalab, 26 cases of anemia with Hb between the range of 7.3-10.9 g / dL were studied and the patients were grouped into 3 groups (A, B and C), according to its analytical parameters. Group A included 10 cases, which had hematimetric indices (MCV, MCH, MCHC and RDW) within normal values, but reduced RBC production. In group B, 11 cases were included, 3 of which had decreased MCV. In 3 cases, ferropenic anemia was suspected, in one of the cases beta-thalassemia was suspected, and in the remaining 7 cases, anemia caused by chronic diseases was suspected. Group C included 5 cases which had low RBC, Hb and Hct, and high MCV. In 4 cases, with a MCV of less than 110 fL, anemia caused by spinal cord hypoplasia, or due to liver disease, was suspected, as the patients were over 90 years old. In one case, with a MCV greater than 110 fL, the hypothesis was that it was a megaloblastic anemia, but it would be necessary to proceed with the determination of folic acid and vitamin B12, analyzes that were not requested by the doctor.
Abstract parte 1: The internship took place between July 2019 and December 2019, within the scope of the Master's Degree in Clinical Analysis at the Faculty of Pharmacy, University of Lisbon, and took place at the Laboratory of Clinical Analysis - Villalab - Análise Clínicas, Lda, a laboratory directed to the community, in Cascais. This laboratory develops all valences, and these valences are those of Clinical Biochemistry, Microbiology, Hematology and Immunology. This internship report will be divided into Clinical Biochemistry and Microbiology, since these were the areas developed in the internship. In the Clinical Biochemistry valence we will describe the pre-analytical phase, the analytical phase in which the equipment and biochemical parameters are mentioned (lipid, liver, pancreatic, renal and cardiac profiles), and later the post-analytical phase, which corresponds to the validation of results by a pharmaceutical specialist, as well as issuing the results bulletin and delivering these results to the patient or doctor. In the valence of Microbiology, the pre-analytical phase, the equipment, the diagnostic methods in the analytical phase, the biological products, as well as the post-analytical phase, will be described. Internal and external quality control will also be described. In the internal quality control, samples with known matrix values, identical to biological matrix, are analyzed as being biological samples, in order to monitor the accuracy of the analytical methods. For the purpose of external quality control, samples with unknown matrix values, identical to biological matrix, supplied by the National Institute of Health Doutor Ricardo Jorge, are analyzed as being biological samples. On the scheduled date, with the purpose of assessing the accuracy of the analytical methods of the villalab laboratory, a retrospective assessment, validation of methodologies and procedures, calculation of the total error, qualification of employees and assessment of training needs will be carried out, with the objective of of promoting customer confidence in the laboratory. Abstract parte 2: The World Health Organization (WHO) defines anemia as a decrease in the concentration of hemoglobin (Hb) in the blood (below 13.0 g / dL in men and below 12.0 g / dL in non-pregnant women), or in the amount of RBC, below the reference values for age, gender and altitude of the patient’s place of residence. There are multiple causes of anemia, namely nutritional deficiencies (vitamin B12, folic acid, iron), genetic abnormalities (thalassemia) and several other conditions such as infectious / inflammatory diseases, neoplasms, chronic and/or autoimmune diseases. In men above 65 years of age, the prevalence of anemia is higher, and even higher in men over 85 years of age, since Hb decreases with age. The most common anemia is due to iron deficiency, and according to the Anemia Working Group Portugal (AWGP), a portuguese association for the study of anemia), it is estimated to affect between 4 and 5 thousand million people worldwide, that is, 15% of the world population. According to AWGP, the prevalence of anemia in Portugal is around 20% (20.6%), that is, 1 in 5 portuguese suffer from anemia. The vast majority (84%) is unaware of suffering from this condition, and only 2% receive adequate treatment, so this is considered an important national public health problem. The prevalence of anemia has an average rate of 9% in developed countries, while in Portugal it is more than double, reaching 20%. In the north of the country, anemia is more prevalent in adults up to 65 years of age and in the center of the country it is more prevalent in adults over 65 years of age, following the prevalence of iron deficiency in these regions. In the elderly, the etiology of anemia is classified into three main categories: one category being the nutritional deficiency in iron, folate or vitamin B12, which may be associated with frequent malnutrition in the elderly; another category is chronic disease such as inflammation and chronic kidney disease, and finally, anemia, to which there is no known evident cause. At the Laboratory of Clinical Analysis - Villalab, 26 cases of anemia with Hb between the range of 7.3-10.9 g / dL were studied and the patients were grouped into 3 groups (A, B and C), according to its analytical parameters. Group A included 10 cases, which had hematimetric indices (MCV, MCH, MCHC and RDW) within normal values, but reduced RBC production. In group B, 11 cases were included, 3 of which had decreased MCV. In 3 cases, ferropenic anemia was suspected, in one of the cases beta-thalassemia was suspected, and in the remaining 7 cases, anemia caused by chronic diseases was suspected. Group C included 5 cases which had low RBC, Hb and Hct, and high MCV. In 4 cases, with a MCV of less than 110 fL, anemia caused by spinal cord hypoplasia, or due to liver disease, was suspected, as the patients were over 90 years old. In one case, with a MCV greater than 110 fL, the hypothesis was that it was a megaloblastic anemia, but it would be necessary to proceed with the determination of folic acid and vitamin B12, analyzes that were not requested by the doctor.
Descrição
Relatório de estágio de mestrado, Análises Clínicas, Universidade de Lisboa, Faculdade de Farmácia, 2020
Palavras-chave
Anemia prevalence Clinical aspects of anemia Anemia in adults Elderly anemia Anemia WHO Teses de mestrado - 2020