ANEMIA

By Sherina Sundari Chen wei yu

contents
Definitions
Grading Classification/ Causes

Pathogenesis
Clinical Manifestations Labs/ Diagnosis Treatment

DEFINItion
According to WHO,
Anaemia is defined as a reduction of the haemoglobin (Hb) concentration, red-cell count or (Hematocrit)packed cell volume below normal levels.

Normal
Hemoglobin: Females- 12- 16g/dl

Males- 14-18g/dl
Hematocrit: Females- 37-47% Males- 42-52%
Source:Recommendation of Centers for Disease Control and Prevention

Erythrocytic indices
1. Mean Corpuscular volume(MCV): Mean voume of all the erthrocytes counted in the sample. N= 8094fL

MCV= Hct x 10/RBC count

Low MCV Microcytic

High MCV Macrocytic

Normal MCV- Normocytic

2. Mean Corpuscular Hemoglobin (MCH): Mean mass of hemoglobin in the RBC.

N= 27-31pg

MCH= Hgb x 10/RBC count

Microcytic- Low MCH Macrocytic- High MCH

3. Mean Corpuscular Hemoglobin Concentration (MCHC): Mean concentration of Hemoglobin in the red cell.
N= 32-36g/dl

MCHC= Hgb x 10/ Hct

Normochromic- Normal MCHC

Hypochromic- Low MCHC Hyperchromic- High MCHC

4. Reticulocyte count: A measure of new red

blood cells produced by the bone marrow

Normal range= 0.5-1.5%

Grading

GRADING
According to WHO,

Mild

: Hb of </=11.9 g/dl and >/=10 g/dl

Moderate : Hb of </=9.9 and >/=8.0 g/dl

Severe : Hb of <8.0 g/dl

Classification

Anemia

On the basis of Cause

On the basis of morphology (Cytometric)

BLOOD LOSS

INADEQUATE PRODUCTION OF NORMAL BLOOD CELLS

EXCESSIVE DISTRUCTION OF BLOOD CELLS

NORMOCYTI C

MACROCYTIC

MICROCYTIC

On the basis of cause

1. BLOOD LOSS

Heavy menstrual bleeding Trauma Gastrointestinal ulcers Cancers such as cancer of the colon

2. DECREASED RBC PRODUCTION

Iron Deficiency
Chronic kidney disease

Poor nutrition (Vit B12 and Folate deficiency):

Poor absorption of Vit B12 Leukemias/ Lymphoma/ Aplastic Anemia

3. INCREASED DESTRUCTION OF

RBC(HEMOLYSIS)
- Hgb defects (sickle cell, thalassemia)

- Membrane defects(Hereditary spherocytosis) - Enzyme defects(G6PD deficiency) - Immune mediated(Rh disease, ABO incompatibility, Autoimmune diseases - Microangiopathic (HUS, TTP)

Cytometric classification
MACROCYTIC
MICROCYTIC

NORMOCYTIC

MCV increased

MCV decreased

Normal MCV

Normocytic, normochromic anemia

NORMAL MCV/ NORMAL MCHC
Anemias of Chronic Diseases Hemolytic Anemias

Acute Hemorrhage
Aplastic Anemias

Hypochromic microcytic anemia

LOW MCHC/ LOW MCV
Iron Deficiency Anemia Thalassemias

Normochromic macrocytic
NORMAL MCHC/ HIGH MCV
Vitamin B12 deficiency Folate deficiency

PATHOGENESIS

GENESIS OF RBC
EPO IRON

Proerythroblast

Basophil erythroblast

Polychromatophil erythroblast

Orthochromatic erythroblast

Reticulocytes

Erythrocytes

ROLE OF ERYTHROPOETIN

Clinical manifestations

In Sickle cell anemia:

Laboratories
CBC
Stool Hgb test Peripheral blood smear

Level of Iron, transferrin, ferritin

Folate, Vit B12 Bilirubin

Laboratories
Reticulocyte count
Liver function tests kidney function tests

Bone marrow biopsy

Hgb electrophoresis

Diagnosis

Management
Iron supplements Oral iron: Fe sulfate, Fe gluconate, Fe fumerate, Fe succinate, Fe ammonium citrate, etc. Parenteral iron: Iron dextran

Transfusion of red blood cells

Vitamin supplements Cyanocobalamin, Hydroxycobalamin, Methylcobalamin.

management
Folic acid deficiency: oral therapy of folic acid Therapeutic dose: 2-5 mg/day Prophylactic dose: 0.5 mg/day Erythropoietin deficiency/low levels (chronic renal failure): Epoetin , (recombinant human erythropoietin)
I.V. or S.C. inj. 25-100 U/kg s.c. or i.v. 3 times a week (max. 600 U/kg/week

references
Gyton and Hall- Textbook of Medical Physiology
Harrisons Principles of Internal Medicine Red cell and Anemia by Edward O. Uthman

THANK YOU