Anemia may be defined as reduction of hemoglobin concentration per unit volume of blood below the lower limit of normal range for age & sex of the individual and clinically may be manifested by pale coloration in the skin & mucous membrane.
Hematocrits Normal, Hemorrhage, IDA, Leukemia, Hemolysis, B12, P Vera Plasma White cells Red cells
Second-line investigations of anaemia Direct antiglobulin test (DAT) - if DAT neg: G6PD screen, refer to haematologist Evidence of haemolysis Coeliac antibodies and/or duodenal biopsy - if small bowel malabsorption, refer to gastroenterologist Low red cell folate Gastric parietal cell antibodies (not specific), intrinsic factor antibody (specific for pernicious anaemia), Schilling test (B12 absorption test) Low serum B12 Oesophagogastroduodenoscopy (OGD), colonoscopy, gynaecological examination, coeliac antibodies (anti-tissue transglutaminase) Iron deficiency
Third-line investigations of anaemia Thyroid function tests, Liver function tests, Haemolysis screen (if not already performed) Macrocytic anaemias Renal function, Haemolysis screen (if not already performed), Immunoglobulins and paraprotein screen, Search for evidence of underlying infective, inflammatory or neoplastic disorder Normocytic anaemias Haemoglobin electrophoresis Search for evidence of underlying infective, inflammatory or neoplastic disorder (blood cultures, ESR, C-reactive protein, ANA, CXR etc.) Microcytic anaemias
N HB A 2 ,F increase N N HB electro Ring form present absent absent Blast iron present present Present Absent BM Iron I N N D Ferritin Normal Normal D I TIBC Inc Normal D D Serum Iron D D D decrease MCHC D D D “ MCH Decrease Decreas e Low/N decrease MCV Sidero Thal ACD Fe Def Investigation
This correction produces the corrected reticulocyte count In a person whose reticulocyte count is 9%, hemoglobin 7.5 g/dL, hematocrit 23%, the absolute reticulocyte count = 9 × (7.5/15) [or × (23/45)]= 4.5% Correction #2 for longer life of prematurely released reticulocytes in the blood: This correction produces the reticulocyte production index In a person whose reticulocyte count is 9%, hemoglobin 7.5 gm/dL, hematocrit 23%, the reticulocyte production index (7.5/15)(hemoglobin correction) 2 (maturation time correction) = 9 × = 2.25