Anemia
Inability of the blood to supply the
tissue with adequate oxygen for
proper metabolic function.
Determining specific cause of
anemia is important appropriate
management.
Anemia :
Hemoglobin (g/dL)
Infants :
Newborns (<1 wk)
6 mo
Children (1-15 yo)
14.0 22
11.0 - 14
11.0 - 15
Adults :
Men
Women
14.0 18
12.0 - 16
Pallor
Weakness
Fatigue
Lethargy or malaise
Exercise dyspnea
Palpitation
Pica (consumption of
substance such as ice,
starch, or clay,
frequently found in
IDA)
Syncope (particularly
following exercise)
Dizziness
Headache
Tinnitus or vertigo
Irritability
Difficulty sleeping or
concentrating
Gastrointestinal
symptoms
Causes of anemia
Classification of anemia
Hemoglobin and Hematocrit
Red Blood Cell Indices
Red Blood Cell Indices and other
tests
Classification of anemia by
RBC Indices
Size (MCV)
(fL)
Hgb content
(MCHC) (%)
Possible causes
Normocytic
(80-100)
Normochromic
(32-36)
Macrocytic
(>100)
Normochromic
(32-36)
Microcytic
(<80)
Hypochromic
(<32)
Hemoglobin
Hematocrit
Red Blood Cell Indices
Peripheral Blood Smear (PBS)
Reticulocyte Count
Bone Marrow Smear & Biopsy
1. Hemoglobin
Cyanmethemoglobin (*)
Oxyhemoglobin
Measured Iron content
Cyanmethemoglobin method :
Cyanmethemoglobin
method
Blood
K3Fe(CN)6
methemoglobin
KCN
methemoglobin
cyanmethemoglobin
Read the solutions
absorbance with
spectrophotometer at 540 nm
Advantages of
Cyanmethemoglobin method
1.
2.
3.
4.
Errors :
1.
2.
3.
4.
2. Hematocrit
Problems in measurement :
Incorrect centrifuge calibration
Choice of sample site
Incorrect ratio of anticoagulant to
blood owing to improper amount of
blood drawn
Reading error
50-80 fL
Macrocytic 100-120
anemia
fL
MCH
15-25 pg
MCHC
22-30%
Increased if
N or
decreased spherocytosis
(+)
5. Reticulocyte Count
Leukemia
Definition
Classification of Leukemia
Acute Myeloid
Acute Lymphoblastic
Chronic Myeloid
Chronic Lymphoid
Classification of Acute
Myeloid Leukemia
Type of Leukemia
Abbrevation
FAB*
Alternate Names
AML
APL
M3
Hypergranular
promyelocytic
AMML
M4
Naegeli-type
leukemia
AMoL
M5
Schilling-type
leukemia
Erythroleukemia
AEL
M6
Di Guglielmos
syndrome.
Eryhtremic myelosis
AMegL
M7
M0
M1
M2
Classification of Acute
Lymphoblastic Leukemia
Type of Leukemia
Abbrevation
FAB
Alternate Name
L1,L2
L1,L2
Common ALL
Common ALL
B-cell ALL
L3
Burkitts leukemia
T-cell ALL
L1,L2
Classification of Chronic
Myeloid Leukemia
Type of Leukemia
Abbrevation
CML
CEL
CBL
FAB
Alternate Names
Chronic Granulocytic Leukemia
Classification of Chronic
Lymphocytic Leukemia
Type of leukemia
Abbrevation
CLL
Prolymphocytic Leukemia
PLL
HCL
Sezary syndrome
FAB
Alternate Names
Leukemic reticuloendotheliosis
Mycosis fungoides,
leukemic phase
Host Factors :
Heredity
Congenital Chromosomal Abnormalities
Immunodeficiency
Chronic Marrow Dysfunction
Environmental Factors :
Ionizing Radiation
Chemicals and Drugs
Viruses
Incidence
In USA : 8-10 new cases/100.000
individuals/year.
Increases exponentially with age
Ratio adult : children = 10 : 1
Ratio males : females = 1-2 : 1
ALL more common in children, AML
more common in adults
CHRONIC
Age
All ages
Adults
Clinical onset
Sudden
Insidious
Course (untreated)
< 6 mo
2-6 yr
Leukemic cells
Immature
Mature
Anemia
Mild to severe
Mild
Thrombocytopenia
Mild to severe
Mild
Variable
Increased
Organomegaly
Mild
Prominent
Clinical Manifestation
Thrombocytopenia
Bruising, bleeding
Granulocytopenia
Fever, infections
Organ Infiltration
Marrow expansion
Spleen
Splenomegaly
Liver
Hepatomegaly
Lymph nodes
Lymphadenopathy
Neurologic symptoms
Gums,mouth
Laboratory Evaluation of
Acute Leukemia
1.
2.
3.
4.
5.
1. CBC/Peripheral Blood
Smear
Anemia :
Platelet : decrease
WBC count :
Mild to severe
Normochrom normocytic
PBS :
2. Cytochemistry
Myeloperoxidase
Sudan Black B
Specific Esterase
Nonspecific Esterase
Periodeic Acid Schiff (PAS)
3. Immunologic Marker
Studies
1.
2.
3.
Reference Book:
Denise M.Harmening
Clinical Hematology and Fundamentals
of Hemostasis, 4th edition, 2001
Anemia
Leukemia
: pp 74-83
: pp 272-300
Thank You