LABORATORY DIAGNOSIS OF MACROCYTIC ANAEMIA

LABORATORY TEST
Peripheral smear

INTERPRETATION
Macrocytic anaemia

Bone marrow examination

Megaloblastic changes

No megaloblastic changes

Reticulocyte count Therapeutic response Responds to vit B12

Low

High

Low

Responds to folic acid Folic acid deficiency

Diagnosis

Vit B12 deficiency (determine if dietary or abnormal absorption

Probable haemolytic anaemia (continue workup)

Possible liver disease (evaluate liver function tests)

DIAGNOSIS
1. BLOOD SMEAR
A. RBC : Megaloblastic
Great variation in size & shape Howell Jolly bodies Circulating megaloblast cells

Liver diseases Haemolytic Less macrocytic Polychromatophilia uniform in size RBC & shape

B.

WBC
Hypersegmented PMN ( 6 lobes) or > 5% PMN have 5 lobes

C.

Platelet
Thrombocytopenia

Macrocytic

Microcytic hypochromic

Normocytic normochromic

Hypersegmentation

Macro ovalocyte with cabot ring inclusion

LABORATORY DIAGNOSIS OF HYPOCHROMIC MICROCYTIC ANAEMIA

LABORATORY TEST Peripheral smear Iron (Bone marrow) INTERPRETATION Hypochromic & microcytic anaemia

Absent

Increased

Ringed sideroblasts
Normal Abnormal Normal

Haemoglobin electrophoresis Diagnosis

Iron deficiency anaemia

Thalassaemia haemoglobino -pathies

Sideroblastic anaemia

LABORATORY DIAGNOSIS OF NORMOCYTIC ANAEMIA

LABORATORY TEST
PERIPHERAL SMEAR RETICULOCYTE COUNT BLOOD IN STOOL OR OTHER SOURCE OF BLEEDING IDENTIFIED ANTIHUMAN GLOBULIN (COOMBSTEST) BONE MARROW AND BONE MARROW BIOPSY INCREASED

INTERPRETATION
NORMOCYTIC ANAEMIA REDUCED

POSITIVE

NEGATIVE

POSITIVE

NEGATIVE

NEGATIVE

HYPERCELLULAR ERYTHROID HYPERPLASIA

HYPERCELLULAR ERYTHROID HYPERPLASIA

DECREASED CELLULARITY

REPLACEMENT OF NORMAL MARROW ELEMENTS

DIAGNOSIS

BLOOD LOSS ANAEMIA

AUTO IMMUNO HAEMOLYTIC ANAEMIA Erythroblastosis foetalis Transfusion reaction

OTHER HAEMOLYTIC ANAEMIAS Parasites Hypersplenism Microangiopathic haemolysis Hereditary spherocytosis Paroxysmal noctural haemoglobinuria Enzyme deficiencies Drug or toxin Haemoglobinopathies

OTHER Renal disease

MYELOPHTHISIC Tumor Myelofibrosis Infection Leukaemia

Infection
Malnutrition Aplastic anaemia Radiation

Collagen
vascular disease

NORMOCYTIC NORMOCHROMIC ANAEMIA & RETICULOCYTOSIS

1. Acute blood loss

Bleeding Phase I (day 1-3) Hypovolumic stage Post hemorrhagic anaemia (normocytic anaemia) Plasma volume RBC mass Haemodilution after 24 hour Erythropoiesis activity Phase II (day 3-5) Regeneration stage BM hiperplasia Reticulocytosis polychromatophilia RBC macrocytosis Thrombocytopenia

Thrombocytosis Leukocytosis Neutrophilia