The document discusses anemia classification and investigation tests. It provides definitions and classifications of anemia based on red blood cell count, hemoglobin, and hematocrit levels. The main types of anemia are outlined as blood loss, deficient red blood cell production, and excessive red blood cell destruction. A complete blood count, blood film, iron tests, and bone marrow examination are important tests to evaluate the cause of anemia. The reticulocyte count helps indicate whether the bone marrow is responding to the anemia.

1. Anemia classification
and
Investigation Tests
Developed By..Dr.Abdulrazaq Othman Alagbare- M.D-Lecturer of Hematology

2. Red Blood Cells
1.Function :transport oxygen from the lungs to the organs and
peripheral tissues, then return to the lungs carrying carbon
dioxide to be exhaled.
RBCs are pliable and designed to traverse the small capillary
beds.
1.Content: RBCs contain the oxygen carrying protein
Hemoglobin (HGB).
2.Enzymes G6PD and PK
3. Normal RBC life span = 120 days
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Introduction of anemia‘s

3. Normal adult red cell values:
Female
Male
11.5-15.5
13.5-17.5
Haemoglobin (g/dl)
36-48
%40-52
Haematocrite (PVC)
3.9-5.6
4.5-6.5
Red cell count (x10 12/l)
27-34
Mean cell haemoglobin (MCH pg)
80- 95
Mean cell volume (MCV fl)
32-36
Mean cell haemoglobin concentration
(MCHC g/dl)
%0.5-2
Reticulocyte count
Hb and PCV normal values - Normal values vary with age of children
Full term babies 13-19gm/dl
Children 1 year 11-13gm/dl
Children 10-12 years 12-15 gm./dl

4. Anemia's
Definition:
Anemia a decrease in
1. Red cell mass is
2. also defined as a decrease in the hemoglobin concentration
3. or decrease in the hematocrit (PCV)when compared with a normal
group.
Anemia is functionally defined as a decrease in the ability of blood to
carry oxygen to tissues thereby causing tissue hypoxia.
Red blood cells disorders
4
Introduction of anemia‘s
anemia is a decreasing of one or all of
RBC count
❖ Hb Level
❖ PCV value

5. Evaluation of Anemia
Anemia is a decrease in the oxygen delivery capacity (by the red blood
cells) to various tissue cells (medically referred to as "tissue hypoxia").
❑ Anemia is a complex of signs and symptoms
❑ Anemia is the most common disorder of the blood.
❑ Anemia is not disease
❑ Anemia is not a diagnosis
❑ It is the effect of another underlying disease
❑ The main test which indicate anemia is the Hb . PCV or RBCc estimation
Introduction of anemia‘s 5

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Values which anemia is considered to exist at sea level
Full term babies < 12gm/dl
Children 1 year <11gm/dl
Children 10-12 years < 11 gm/dl
Adult-men <12gm/dl
Adult-women <11gm/dl
Severity of Anemia :
Mild anemia Moderate anemia Severe anemia
Male 10-12g/dl 8-10 g/dl < 8 g/dl
Female 9-11 g/dl 7-9 g/dl < 7 g/dl

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Laboratory definition of
anemia:- it is a reduction of
1-RBC count
2-Hb
3-PCV or Hct
Also known as anemia
parameters
Patient History and symptoms
• Gives information about risk factors for particular anemia's,
• symptoms of anemia itself, and symptoms that reflect the underlying
disorder.
The diagnosis usually is based on
1. History,
2. clinical examination,
3. Blood analysis
4. And other blood tests
5. Occult blood in stool
6. Blood in the urine.

8. Symptoms and Signs:
1. Tiredness, weakness,
2. Headache,dizziness,
3. Dyspnea palpitation
4. Pallor,anorexia
Pallor of the conjunctive mucosa

10. Red blood cells disorders
Include the following
1-Anemias
2-Malignant RBC disorder (Polycythemia Rubera vera)
Anemia`s Mechanisms (Etiology of Anemia)
Anemia Classification
Anemia results from
1. Blood loss and divided into
1. Acute blood losing
2. Chronic blood losing
2. Deficient erythropoiesis (RBC production)
3. Excessive hemolysis (RBC destruction)
10
Introduction of anemia‘s

11. Acute blood losing anemia
Acute blood losing
Causes
1. GI bleeding
2. Injuries
3. Childbirth
4. Surgery…etc.
Characteristics of blood losing anemia
1- develop until several hours after
acute blood loss ( replacement of blood
volume)
Thus don’t occur changes in
1. the morphology
2. size (MCV)
3. content of RBC (Hb)
Change only in the RBC numbers
11
Introduction of anemia‘s

12. Chronic blood losing anemia
Chronic blood losing anemia
Causes
• Bladder tumors
• Cancer or polyps in GI tract
• Heavy menstrual bleeding
• Kidney tumors
• Ulcers in the stomach or
small intestine
Characteristics of Chronic blood
losing anemia
1- develop slowly needs long time
(week, months )
Thus occur changes in
1.the morphology
2.size (MCV)
3.content of RBC
4.and numbers of RBC
12
Introduction of anemia‘s

13. This may be
1-partial deficient (marrow
described as hypoblastic)
2-complete deficient ( marrow
described as aplastic)
The deficient of erythropoiesis may
combined with
Partial or complete WBC and
platelets production
The RBC changes in
1-Count
2-Morphology
3-content
4-size
Deficient erythropoiesis (RBC production)
13
Introduction of anemia‘s

14. Deficient erythropoiesis
1. Each anemia depended on the Iron defect ( uses. Transport,
utilization, reutilization etc)
2. Each anemia depended on the defect of Vitamin B12 C, folic
acid or Copper deficiency
3. Each anemia caused by Bone disease or diseases of other
organs
( Chronic diseases, aplastic anemia, metastic cancers etc)
Deficient erythropoiesis (RBC production)
14
Introduction of anemia‘s

15. Excessive hemolysis (RBC destruction)
caused by
1. abnormalities of RBCs (Intrinsic factors )or
2. by extrinsic factors,
intrinsic abnormalities of RBCs
All the causes are genetic defect on
1-Hb structure
o Hb chains numbers (thalassemias)
o Hb chains amino acids sequence
(sickle cells anemia's)
2-Membrane defects structure
3-Enzymatic deficiency
by extrinsic factors,
All they are acquired
1. Toxins
2. Parasites
3. Antibodies
4. Chemicals
5. others
15
Introduction of anemia‘s

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Morphological Classification of anemia`s
Based on size (MCV) value Hb content.
(1) Microcytic
hypochromic anemia :-
characterized with
Low
1. MCV
2. Hb
3. MCH
(2) Macrocytic normochromic
anemia : characterized with
1. High MCV,
2. slight low Hb
3. Normal MCH.
(3)Normocytic normochronic
anemia : characterized with
1. Low Hb
2. Normal MCV,
3. Normal MCH

17. Type of anemia MCV (fl) MCH (pg) Hb(g/dl)
▪ Normal 82-92 27-31 N
▪ Normocytic anemia 82-92 25-30 Low
▪ Macrocytic anemia 95-150 30-50 Slight low
▪ Microcytic anemia 50-80 12-25 Low
Terms described anemia
RBC content description of anemia
2-Hypochromia = Low Hb and MCH
3-Anoisochromia = RDW and the Hb vary in each cell
4-Polychromasia = Presence of reticulocytes in p. blood

18. Anemia investigation
8/13/2023 Anemia approach- Alagbare 18
Complete blood count (CBC)
1. RBC parameters (Hb-PCV- RBCc) and indices (MCV-MCH-MCHC-RDW)
2. WBC study
3. PLTs Study
4.peripheral blood smear study
Addiional tests
1. Reticulocyte count
2. Iron tests panel
3. Chemistry tests (LFT and RFT )
4. Bacteriological tests (T,B)
5. Serological tests (RF, ASO)
6. Bone marrow aspiration or biopsy
7. Stool occlut blood
8. Urine blood

19. A. Any abnormality in the CBC result needs Blood film study
B. It is essential to examine the blood film in all cases of anaemia
======================================
1-Blood film staining and evaluation
Each morphological change or content (inclusion) indicate and point to some
disease
2-the peripheral blood film is more accurate than automated
technologies for recognition of
1. altered RBC structure,
2. thrombocytopenia,
3. nucleated RBCs,
4. immature granulocytes
5. malaria and other parasites,
6. Intracellular RBC or granulocyte inclusions
RBC morphology-Blood film study - 1

20. 3-During the blood film examination MUST BE observed also:
➢ White cell number and differential count ,
➢ Platelet number and morphology are assessed
➢ The presence or absence of abnormal cells (e.g. normoblasts,
granulocyte precursors or blast cells) is noted.
RBC morphology-Blood film
RBC morphology-Blood film study -2

21. Normal RBC Reticulocyte Basophilic stipling Burr cells
Howell Jolly bodies Hypochromia Microcytic stomatocytes
Terms used on blood film report.

22. Spherocytes Target cell Tear drops NRBC
Sickle cell Schistocyte Elliptocytes Malaria
Terms used on blood film report.

23. Sederoblastic ring Polychromasia Rouleux formation Cabbot ring
Terms used on blood film report.

24. 1. Dimorphic Blood Film: two populations of red cells –
2. Hypersegmented neutrophils: a neutrophil with six or more lobes.
3. Hypochrom(as)ia: pale red cells.
4. Macrocytosis: large red cells
5. Microcytosis: small red cells
6. Pancytopenia: a reduction in all the formed elements of the peripheral
7. Poikilocytosis: unequal shape
8. Polychromasia: grey colored red cells on film, indicating presence of increased reticulocytes
9. Reticulocyte: an erythrocyte newly released from the bone marrow
10. Anisocytosis: red cells of unequal size.
11. Sideroblast- RBC with stainable iron
12. Tear drop cell- Cell pinched at one end
RBC morphological changes in Non hemolytic anemia

25. Reticulocytes
• Reticulocytes: immature RBCs
• Uses : Their Numbers uses as indicator of B.marrow
state production
• Normal retic count is 1.0-2.0%
• the absolute count 25-125 x 109/L.
• Low retic <1%= decreased marrow production of
RBCs causing anemia
• Elevated Retic > 2% = indicates anemia caused by
hemolysis or sever blood losing
• Low reticulocytes count in chronic nutrient anemia
25
Introduction of anemia‘s

26. Reticulocytes count test or Retics test:
Methods
1-manual: using new methylene blue stain which is a vital stain to
form a reticular network in the cell
2-automatoied: it is more accurate and done by
❑ blood cells analyzers
❑ and flowcytometry
Automated method
• Reticulocytes can be counted using flow cytometry
• The data are recorded as the number of reticulocytes per mill (‰)
of the total number of erythrocytes.
• It is accurate and exact rather than manual method because
measure the reticulocytes among millions of RBC
Introduction of anemia‘s 26

27. Reticulocytes Normal count:
❖ Normal 0.5-1.5 %
❖ As an absolute number (normal 21,000-100.000).
1-High reticulocyte counts There is an increase of
reticulocytes production e.g hemolytic anemia
2-low reticulocyte count: There is an decrease of
reticulocytes production e.g aplastic anemia
Introduction of anemia‘s 27

28. Normal reference OF RETICULOCYTES
Constitutes 1%–2% of the total RBC count
❖ Adult females 0.5%–2.5%
❖ Adult males 0.5%–1.5%
❖ Cord blood 3.0%–7.0%
❖ Newborn 1.1%–4.5%
❖ Neonates 0.1%–1.5%
❖ Infants 0.5%–3.1%
❖ Children >6 months 0.5%–4.0%
Introduction of anemia‘s
Normal increase of Reticulocytes
1. Women
2. Infants
28

29. Bone marrow examination for blood disorders
Methods: This may be performed by
1.Bone marrow aspiration → a liquid
sample of marrow for cells study
(morphology, developing state of
each cells type, iron staining study
cellularity etc.
or trephine biopsy → histological
bone marrow tissue examination for
structure study (architecture,
cellularity and presence of fibrosis
or abnormal infiltrates can be
reliably determined)

30. Measurement units of RBC tests
1-Hb- g/dl
2-PCV: %
3-MCV: fl
4-MCH:pg
5-MCHC:gr/dl or %
6-RDW: %

31. END OF THE LESSON