For Pathology students the first class of hematology

1. APPROACH TO ANEMIA

3. ANEMIA
 Defined as quantitative reduction in
hemoglobin or erythrocytes or both below the
level that is expected for healthy person of
same age and sex in the same environment.

4. LEVELS
 Adult male
 Adult female
 Adult female
(Pregnant)
 >6-12 yr
 6m- 6yr
 2- 6m
 Newborn
 <13
 <12
 <11
 <11.5
 <11
 <9.5
 <13.6

5. CLASSIFICATION OF ANEMIA

7. APPROACH TO DX
 Severity
 Cause

8. PRESENCE OF ANEMIA
HEMOGLOBIN ESTIMATION PCV ESTIMATION
 Colorimetric method
 Gasometric method
 Chemical method
 Specific gravity method
 Wintrobe method
 Microhematocrit method

9. HISTORY IN A CASE OF ANEMIA
 Clinical evaluation
 Symptoms
Fatigability
Effort dyspnoea
Palpitation
 Signs
Pallor
 Chronic blood loss
 Pregnancy
 Pica
 Chronic alcoholism
 History of
malabsorption
 Drugs
 Hypoplastic
 Megaloblastic
 IDA
 HA

10. CONT….
 Primary underlying
disease
 CVD
 Mlg
 Chronic infection
 AIDS
 ESLD
 ESRD
 Endocrine ds
 Geographic Area

11. LABORATORY EVALUATION
 Initial investigations
 Peripheral blood smear
 Reticulocyte count
 Red cell indices
 Specialized investigations
 BM exam
 Serum iron
 Hemoglobin electrophoresis

12. PERIPHERAL BLOOD SMEAR

13. PERIPHERAL BLOOD SMEAR
 Head
 Body
 Tail

14. HOW TO ASSESS THE SIZE OF RBC IN PBS
 By comparing the size with the small
lymphocyte

15. NORMOCYTIC NORMOCHROMIC

16. ANISOCYTOSIS

17. POIKILOCYTOSIS

18. MICROCYTIC HYPOCHROMIC

19. MACROCYTOSIS
 Oval  Round

20. SICKLE CELLS

21. SPHEROCYTES

22. TARGET CELLS/CODOCYTES

23. SCHISTOCYTES

24. BURR CELLS

25. TEAR DROP CELL

26. BASOPHILIC STIPPLING

27. HOWELL JOLLY BODY

28. POLYCHROMATIA

29. RETICULOCYTE COUNT

30. RETICULOCYTE COUNT
 Young red cell that contain RNA element
 Stains with supravital stain
 Brilliant cresyl blue
 New methylene blue
 Assess erythropoietic activity of the bone
marrow

31. RETICULOCYTE… SUPRAVITAL STAIN

32. RETICULOCYTE MEASURES
 Reticulocyte count ( % )
 0.5 to 2.5 in adult
 2 to 5 in newborn
 Corrected reticulocyte count
 RC x PCV pt / PCV normal
 Absolute reticulocyte count
 RC x RBC count
 Reticulocyte production index

33. RETICULOCYTOSIS RETICULOCYTOPENIA
 Acute blood loss
 Hemolytic anaemia
 Response to specific
therapy in nutritional
anemia
 Decreased red cell
production
 Aplastic anemia
 Myelopthisic anemia
 IDA
 ACD
 Ineffective
erythropoiesis
 Megaloblastic
 MDS

34. RED CELL INDICES

35. aka … ABSOLUTE VALUES
 MCV
 MCH
 MCHC

36. MEASURED IN …AUTOMATED HEMATOANALYSER

37. MCV
 in femtoliters (fl)
 Average volume of a single cell
 PCV x 10 / RBC count
 RDW
 Mentzer index

38. MCH
 Picogram (pg)
 Average amount of Hb per cell
 Hb x 10 / RBC count
 Low in microcytic
 High in macrocytic

39. MCHC
 Gm/dl
 Average amount of HB in a given amount of
RBC
 Hb x 100 /PCV
 Low in microcytic hypochromic
 High in HS

40. RDW
 Degree of variation of red cell size

41. RDW HELPS TO DIFFERENTIATE
IDA Β THALASSEMIA MINOR
 Low MCV
 Low MCH
 Low MCHC
High RDW
 Low MCV
 Low MCH
 Normal MCHC
Low RDW
 Target cell
 Basophilic stippling

42. 3 MAJOR TYPES OF ANEMIA…

43. CASE 1
 35 yr F
 Strict vegetarian
 Weakness, paresthesias, muscle weakness,
or difficulty in walking, glossitis
 She had a child with NTD

44. BLOOD PARAMETER
 Hb 8.7gm/dl
 TLC 3800/cmm
 PLT 98000/L


45. ABSOLUTE VALUES
 MCV 116 ___ (tell the units)
 MCH 33 ___
 MCHC 32 ___

46. RETICULOCYTE COUNT
 Low

47. ?

48. MACROCYTIC ANEMIA

49. CAUSES
Oval
 Megaloblastic anemia
 Drug therapy
 MDS
Round
 Alcoholism
 Liver disease
 Hypothyroidism

50. WHAT ELSE CAN BE IN PBS
 Hyper segmented neutrophil
 Howell- jolly body
 Cabot’s ring

51. BM EXAMINATION
 Ineffective erythropoiesis
 Megaloblastic change in all series
 Giant band forms
 Giant metamyelocytes

52. OTHER CAUSES OF MACROCYTOSIS…HOW TO
RULE THEM OUT
 Hemolytic anaemia
 Features of hemolysis in addition with
macrocytosis
 Liver disease
 Target cell will be in the smear
 Myelodysplastic syndrome
 Elderly patients
 Bi/ Pancytopenia
 BM exam- ALIP ( abnormal localization of
immature precursor)

53. …CONT..
 Pregnancy
 Newborn
 Cytotoxic chemotherapy
 Aplastic anaemia

54. MICROCYTIC HYPOCHROMIC
ANAEMIA

55. CAUSES
 Iron deficiency anaemia
 Thalassemia syndrome
 Anaemia of chronic diseases
 Sideroblastic anaemia

56. MICROCYTIC HYPOCHROMIC EVALUATION

57. NORMOCYTIC NORMOCHROMIC ANAEMIA

58. NORMOCYTIC NORMOCHROMIC EVALUATION

59. EVALUATION OF HEMOLYSIS
 Within circulation
 Blackwater fever,
mismatch blood
transfusion, PNH
 Spleen normal
 Plsama Hb% markedly
increased
 Hb in urine +
 Hemosiderin in urine+
 Within RES
 Hb-pathies, Hereditary
haemolytic anaemia,
AIHA
 Size increased
 Mild increased
 Absent
 Absent
 Negative

60. Thank you for your
maintained silence