Definition of anemia
Anemia is functionally defined as an
insufficient RBC mass to adequately
deliver oxygen to peripheral tissues.
Women
12.015.0
3343
3.55.0
Classification
Etiological
Blood loss
Increased red cell destruction
Decreased red cell production (Hypo-proliferative
or maturation disorder)
Morphological
Clinical features
Symptoms depend on duration of the disease
Weakness
Fatigue
Palpitation
Shortness of breath
Tachycardia
Headache,vertigo,tinitus,parasthesias
Patient History
Dietary habits
Bowel habits
Medications
Exposure to chemicals and toxins
History of fever
Menstrual bleeding
Bruises,ecchymoses
Family history
Physical examination
Angular Stomatitis
Glossitis
Koilonychia
Laboratory Examination
First Line Studies
- CBC:Hb, Hcrit, Rbc indices, Cell count,
Reti count
- PB morphology examination
- Chemistry
-Urine examination
Reticulocyte count
Corrected Reti(%)
(Reticulocyte Index, RI)
Normal
Anemia
Hcrit
PB
reticulocytes(days)
45
3.5
1.0
35
3.0
1.5
25
2.5
1.5
2.0
15
2.5
Production index
45
3:1
35
2-3
2:1-1:1
25
3-5
1:1-1:2
15
3-5
1:1-1:2
Ineffective erythropoeisis
Normocytic
Anemia of renal failure, MDS, Leukemia, Aplastic
anemia, ACD, Others
R.INDEX<2.5
RBC MORPHOLOGY
N/N
MICRO OR MACRO
HYPOPROLIFERATIVE
MATURATION DISORDER
MARROW DAMAGE
CYOPLASMIC DEFECTS
INFILTRATION/FIBROSIS
IRON DEFICIENCY
APLASIA
THALESSEMIA
STIMULATION
RENAL DISEASE
METABOLIC DEFECTS
INFLAMMATION
MILD IRON DEFICIENCY
SIDEROBLASTIC ANEMIA
NUCLEAR DEFECTS
VIT B12/FOLATE DEFICIENCY
DRUG TOXICITY
REFRACTORY ANEMIA
R INDEX>2.5
HEMOLYSIS/HAEMORRHAGE
BLOOD LOSS
INTRAVASCULAR HEMOLYSIS
MEMBRANE ABNORMALITY
HEMOGLOBINOPATHY
AUTOIMMUNE DEFECT
FRAGMENTATION HEMOLYSIS
METABOLIC DEFECT
Size
Central pallour
Shape
Distribution
Inclusions
Abnormal cells
Teardrop
myelofibrosis
Macrocytic picture
Megaloblasts in bone-marrow
Leuco-erythroblastic reaction
Spherocyte
http://www.wadsworth.org/chemheme/heme/microscope/spherocyte.htm
Sickle Cell
http://www.wadsworth.org/chemheme/heme/microscope/sicklecell.htm
Schistocyte
http://www.wadsworth.org/chemheme/heme/microscope/schistocyte.htm
Target Cell
http://www.wadsworth.org/chemheme/heme/microscope/targetcells.htm
Burr cell
http://www.wadsworth.org/chemheme/heme/microscope/echinocytes.htm
Rouleaux formation
http://www.wadsworth.org/chemheme/heme/microscope/rouleaux.htm
PBS - Inclusions
Nucleated RBC immature RBCs
Extramedullary hematopoiesis, hypoxia, hemolysis
http://www.wadsworth.org/chemheme/heme/microscope/howelljolly.htm
Basophilic stippling
http://www.wadsworth.org/chemheme/heme/microscope/basostip.htm
LD bodies in bone-marrow
Bone-marrow granuloma
Thank You..