This document discusses the classification and evaluation of anemia. It covers: 1. Functional classification including hypoproliferative and destructive causes. 2. Clinical classification based on causes such as blood loss, iron deficiency, or hemolysis. 3. Quantitative classification using hematocrit, hemoglobin, and red blood cell indices like MCV, MCH, and MCHC. It then provides details on calculating and interpreting various red blood cell indices and describes common red blood cell morphologies seen in different types of anemia.

1. Classification of anemia
• Functional classification:
• Hypoproliferative destruction (infective
hematopoiesis).
• Clinical classification:
• Causes of anemia (blood loss, IDA, hemolysis).
• Quantitative classification:
• Hematocrit
• Hemoglobin
• Blood cell indices (MCV, MCH, MCHC).
• Reticulocytes count.
Dr. Mamdooh Gari

2. Red cell indices
MCV (mean corpuscular volume)

The average volume of RBC
Hct
= × 10 (fl)
RBC count (m/µL)
e.g. Hct= 40%
RBC=5.0 (m /µL)
MCV= 40/5.0 × 10 = 80 fl
NR= 80-96 fl
Dr. Mamdooh Gari

3. MCH (mean corpuscular hemoglobin)

The average content of Hb in average RBC.

It is directly proportional to the amount of Hb
and RBC size.
Hb
MCH = × 10 (pg)
RBC count (m/µL)
e.g. Hb = 14 g/dl
RBC = 12 (m/µL)
MCH= 14/12 × 10
= 35 pg
NR= Mamdooh Gari
Dr. 27-32 pg

4. MCHC (mean corpuscular hemoglobin
concentration)

Express the average concentration of
hemoglobin per unit volume of RBC.

It defined as the ratio of the weight of
hemoglobin to volume of RBC.
Hb (g/dl)
MCHC= × 100 (%)
Hct (%)
e.g. Hb = 14 g/dl
Hct = 45 %
MCHC 14/45 × 100 = 31%
NR= 32-36%
Dr. Mamdooh Gari

5. Symptoms of Anemia
Normal or High Hemoglobin/Hematocrit
Check other
Causes of symptoms
e.g. Cardiac Low
Pulmonary RBC indices
MCV < 80 MCV=80-96 MCV > 98
MCHC < 32
History of acute blood loss
B12 and folate
Serum iron and Total Auto immune Hemolytic anemia
Iron binding capacity Anemia of chronic Diseases levels
of Ferritin Anemia of infection
Low Iron Normal High Iron Low B12 Low folate High or Normal
IDA, chronic Hb BM exam PA, GI Folate MPD
diseases, Renal electrophoresis For problems malnutrition Liver Disease
diseases for Thala. Sideroblastic Severe GI problems
anemia malnutrition. Liver disease
Dr. Mamdooh Gari

6. Normal red cell morphology
Dr. Mamdooh Gari

7. Hypochromic Hyperchromic
Macrocytic Mamdooh Gari
Dr. Microcytic

8. IDA
Target cells Stomatocytes
Poikiolocytosis Sickle cells Acanthocytes
Spherocytes
Ovalocyte Dr. Mamdooh Gari Nucleated RBC