1 ST 8
FROM 8 WEEK UP TO 6
FROM 6 MONTHS AND
IN BONE MARROW
In infants & young children red & white marrow are
involved in hematopoiesis.
In adults red marrow only.
Very important :--
Active bone marrow contain:Erythroid cells ………………...give RBCs
Myeloid cells ………................give WBCs
Megakaryocytic cells ……….. produce platlets
Normally : myeloid erythroid ratio is 21
In erythroid hyperplasia ( eg. Heamolytic anemia ) this ratio become
less than 2l1
Factors affecting erythropoiesis:
1- The factory
healthy bone marrow
2- primitive material
3- manager of factory
healthy organs such as liver
It represents about 1/3 of RBC mass.
It consists of a globin molecule attached to 4 heme groups.
In normal adults there are 3 types of Hb:
1. Hb A adult Hb. (97%).
2. Hb F Fetal Hb. (0.5%). Its production decreases after birth.
3. hb A2 (2- 2.5%).
4. at 3-6 th months ther is switching from gama to beta chain
hemoglobin so this is age of manifestation of thalassemia.
RBC life span 120 days.
RBC splits into: 1. Globin which enters the protein
2. Heme is converted into bilirubin which is excreted
by the liver
It means decrease of hemoglobin concentration below t he normal level for
age & sex.
1)presentation & duration
2)history of presenting illness
3)prenatal natal post natal history: Infant and mother's blood type
History of exchange or intrauterine
transfusion, and a history of anemia
in the early neonatal period
Gestational age at birth is important,
as premature infants may have iron
or vitamin E deficiencies resulting in
The presence of jaundice or need for
phototherapy may signify the
presence of an inherited hemolytic
4)past medical history
a-Hemorrhage (acute or chronic) e.g. Anklystoma, Accidents &
b-Jaundice & dark urine (Hemolytic anemia
5)past surgical history.
6)Drug history Drugs can cause anemia through:
B.M. depression (chloramphenicol & sufa).
Hemolysis through: G6PD deficiency & autoimmune hemolysis
7)nutritional history Nutritional anemia
8) family history Congenital anemia (e.g. thalassemia).
B- Clinical picture: (general C/P of all types of anemia).
Skin, mucosae – pallor, dryness, purpura
Hands – koilonychias, palmar crease pallor
Facies – skull bossing, maxillary hyperplasia
Eyes – jaundice, pallor
Mouth – glossitis, cheilosis, ulcers
Heart – tachycardia, functional murmurs, CCF
Lungs – breathlessness
Abdomen – hepatosplenomegaly
PR – bleeding, occult blood
Others – lymphadenopathy.
C- Investigations: (Steps)
(1) Is it a case of anemia or not? By
a- Hb (15gm%).
– In cases of anemia:
b- RBCs count (4-6 million/mm3). the 3 parameters.
c- Hematocrit value (45%).
(2) What is the type of anemia? 3types according to RBCs size & Hb
content (blood indices).
a. Microcytic hypochromic.
b. Normocytic normochromic.
(3) What is the cause of anemia?
Microcytic hypochromic anemia:
a) Iron deficiency anemia (IDA).
c) Sideroblastic anemia
d) Chronic infection
f) Lead poisoning.
Normocytic normochromic anemia:
(a) Hemolytic anemia (except Thalassemia). (c) Aplastic anemia
(b) Hemorrhagic anemia
A) Anemia of newborn (excluded by age).
B) Megaloblastic anemia.
(4) Classification of normocytic normochromic anemia:
(Normal: 1-2% of RBCs count)
(normal: 27- 32 picogram)
MCH Hypochromic (< 27 picogram).
3) Mean corpuscular hemoglobin concentration (MCHC):
(normal: 33- 37 gram%).
* Coombs' test:
> A test for detection of antibodies against RBCs.
> Either: 1. Direct detects Abs on the surface of RBCs.
2. Indirect detects Abs in plasma.
* Reticulocytic count:
> It is the single test to detect hemolytic anemia.