This document discusses various types of anemia classified by their pathogenesis: decreased red blood cell production due to nutrient deficiencies, bone marrow disorders, or increased destruction/loss of red blood cells from bleeding, hemolytic conditions, or red blood cell membrane/hemoglobin defects. The top six anemias discussed are iron deficiency, megaloblastic, aplastic, immune hemolytic, and those caused by defective red blood cell membranes or hemoglobin. Clinical indicators for diagnosing different anemia types include mean corpuscular volume, reticulocyte count, iron/B12/folate levels, and symptoms.

2. ….. foundation of clinical medicine
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
Clinical Pathology:
RBC 15: Anemia Summary

3. Pathogenetic Classification of Anemia:
 Decreased Production:
 Nutrient Deficiency.
 Iron def (IDA) / Megaloblastic (MBA)
 Hemopoietic cell defect:
 Anemia of chronic disorders (ACD)
 Aplastic anemia (AA).
 Dysplastic anemia. Myelodysplastic Syndromes
 Increased loss / destruction:
 Blood loss anemia – Acute / Chronic - bleeding.
 Hemolytic anemia – Congenital / Acquired.
 Acquired / External injury.
 Immune AIHA (Warm/Cold) Mechanical, Drugs, Parasites
 Congenital / Internal RBC defect
 Defective Membrane (Spherocytic an)
 Defective Hemoglobin (Sickle & Thal.)
 Deficient Enzyme (G6PD)
2
•Cell Mem
•Hb.
•Enzymes
Top 6 Anemias:
1. IDA & Megaloblastic
2. ACD & Aplastic An.
3. IHA – Warm & Cold.
2
2

4. Anemia: Summary
4
MCV
90
MCV
110
DNA: B12, Folate
Hb: Iron
Megaloblastic anemia
Iron Deficiency anemia
Aplastic anemia
Dysplastic anemia
Hemolytic anemia
Immune
Mechanical
Infection
Drugs
Defective*

5. Haemolytic An. Introduction
 Anemia due to Increased RBC destruction
  life span (<120d) - Abnormal forms
 Bilirubin  Unconj. Jaundice (N. urine)
 Increased RBC production - ↑ Reticulocytes
 Acute: Pallor, Jaundice (normal urine)
 Chronic: Splenomegaly, pigment gall stones.
 Intravascular & Extravascular Hemolysis*.
Unconj. Jaundice
Immune
Mech.
Infection
Porphyrin  Bil. Unconj
Globins
Iron
Bil. Conj
Jaundice
Splenomegaly
Pigment Gall stones
Pallor

6. Iron Deficiency
Megaloblastic
Hemolytic
Normal

7. MCV
Microcytic Normocytic Macrocytic
Iron studies - Ferritin
Low Normal/high
IDA ACD / Thalassemia
Reticulocyte count
high low ACD /
Aplastic anemia
Hemolytic anemia or
blood loss
Measure B12 + folate
Megaloblastic
Normal Low
Anemia clinical DiagnosisHistory & Exam:
Cong / Acq.?
Acute / Chronic?
Hemolysis?
< 80 80-100 >100

9. Sideroblastic anemia:
 Group of disorders anemia with sideroblasts
 (+ve iron). Suggesting lack of Iron utilization.
 Microcytic Hypochromic anemia.(Macrocytic/dimorphic)
 Two major types:
 Congenital: X-Linked, mitochondial etc.
 Acquired : Myelodysplastic Syndrome (MDS)
Copper & Vit. B6 deficiency. Lead poisoning
Alcoholism, Drugs, Idiopathic.
 Porphyria:
 Excess porphyrin secretion.
 Acute abdominal pain
 Neuropathy etc.
Iron
Iron stain: blue

10. Polycythemia: (high Hb)
 Relative or spurious erythrocytosis
 Dehydration: Diarrhea, vomiting, diuretics,
excess alcohol. etc.
 Absolute erythrocytosis (True ):
 Secondary: Tissue Hypoxia: Smoking (CO),
High altitude, Lung disease. Cardiac shunts,
High O2 affinity Hb.
High Erythropoietin – Paraneoplastic
Syndromes, Androgen therapy.
 Primary - Polycythemia Rubra vera:
Myeloproliferative disorder: Neoplastic
proliferation of erythroid cells in bone
marrow – old age, hepatosplenomegaly.
10
 Hb, skin flushing &
Hepatosplenomegaly

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13. Thalassemia Minor
Sickle
Thalassemia Major
Normal