This document provides information on approaches to diagnosing and classifying anemia. It discusses levels of hemoglobin and red blood cells used to define anemia for different age groups and sexes. Methods for measuring hemoglobin and hematocrit are described. A peripheral blood smear examination can identify abnormalities in red blood cell size, shape, and contents to classify anemia types. Red cell indices like MCV, MCH and MCHC further characterize anemia as microcytic, macrocytic, or normocytic. Causes and evaluations are discussed for the major anemia types: iron deficiency, megaloblastic, and normocytic anemia.

1. APPROACH TO ANEMIA

3. ANEMIA
 Defined as quantitative reduction in
hemoglobin or erythrocytes or both below the
level that is expected for healthy person of
same age and sex in the same environment.

4. LEVELS
 Adult male
 Adult female
 Adult female
(Pregnant)
 >6-12 yr
 6m- 6yr
 2- 6m
 Newborn
 <13
 <12
 <11
 <11.5
 <11
 <9.5
 <13.6

5. CLASSIFICATION OF ANEMIA

7. APPROACH TO DX
 Severity
 Cause

8. PRESENCE OF ANEMIA
HEMOGLOBIN ESTIMATION PCV ESTIMATION
 Colorimetric method
 Gasometric method
 Chemical method
 Specific gravity method
 Wintrobe method
 Microhematocrit method

9. HISTORY IN A CASE OF ANEMIA
 Clinical evaluation
 Symptoms
Fatigability
Effort dyspnoea
Palpitation
 Signs
Pallor
 Chronic blood loss
 Pregnancy
 Pica
 Chronic alcoholism
 History of
malabsorption
 Drugs
 Hypoplastic
 Megaloblastic
 IDA
 HA

10. CONT….
 Primary underlying
disease
 CVD
 Mlg
 Chronic infection
 AIDS
 ESLD
 ESRD
 Endocrine ds
 Geographic Area

11. LABORATORY EVALUATION
 Initial investigations
 Peripheral blood smear
 Reticulocyte count
 Red cell indices
 Specialized investigations
 BM exam
 Serum iron
 Hemoglobin electrophoresis

12. PERIPHERAL BLOOD SMEAR

13. PERIPHERAL BLOOD SMEAR
 Head
 Body
 Tail

14. HOW TO ASSESS THE SIZE OF RBC IN PBS
 By comparing the size with the small
lymphocyte

15. NORMOCYTIC NORMOCHROMIC

16. ANISOCYTOSIS

17. POIKILOCYTOSIS

18. MICROCYTIC HYPOCHROMIC

19. MACROCYTOSIS
 Oval  Round

20. SICKLE CELLS

21. SPHEROCYTES

22. TARGET CELLS/CODOCYTES

23. SCHISTOCYTES

24. BURR CELLS

25. TEAR DROP CELL

26. BASOPHILIC STIPPLING

27. HOWELL JOLLY BODY

28. POLYCHROMATIA

29. RETICULOCYTE COUNT

30. RETICULOCYTE COUNT
 Young red cell that contain RNA element
 Stains with supravital stain
 Brilliant cresyl blue
 New methylene blue
 Assess erythropoietic activity of the bone
marrow

31. RETICULOCYTE… SUPRAVITAL STAIN

32. RETICULOCYTE MEASURES
 Reticulocyte count ( % )
 0.5 to 2.5 in adult
 2 to 5 in newborn
 Corrected reticulocyte count
 RC x PCV pt / PCV normal
 Absolute reticulocyte count
 RC x RBC count
 Reticulocyte production index

33. RETICULOCYTOSIS RETICULOCYTOPENIA
 Acute blood loss
 Hemolytic anaemia
 Response to specific
therapy in nutritional
anemia
 Decreased red cell
production
 Aplastic anemia
 Myelopthisic anemia
 IDA
 ACD
 Ineffective
erythropoiesis
 Megaloblastic
 MDS

34. RED CELL INDICES

35. aka … ABSOLUTE VALUES
 MCV
 MCH
 MCHC

36. MEASURED IN …AUTOMATED HEMATOANALYSER

37. MCV
 in femtoliters (fl)
 Average volume of a single cell
 PCV x 10 / RBC count
 RDW
 Mentzer index

38. MCH
 Picogram (pg)
 Average amount of Hb per cell
 Hb x 10 / RBC count
 Low in microcytic
 High in macrocytic

39. MCHC
 Gm/dl
 Average amount of HB in a given amount of
RBC
 Hb x 100 /PCV
 Low in microcytic hypochromic
 High in HS

40. RDW
 Degree of variation of red cell size

41. RDW HELPS TO DIFFERENTIATE
IDA Β THALASSEMIA MINOR
 Low MCV
 Low MCH
 Low MCHC
High RDW
 Low MCV
 Low MCH
 Normal MCHC
Low RDW
 Target cell
 Basophilic stippling

42. 3 MAJOR TYPES OF ANEMIA…

43. CASE 1
 35 yr F
 Strict vegetarian
 Weakness, paresthesias, muscle weakness,
or difficulty in walking, glossitis
 She had a child with NTD

44. BLOOD PARAMETER
 Hb 8.7gm/dl
 TLC 3800/cmm
 PLT 98000/L


45. ABSOLUTE VALUES
 MCV 116 ___ (tell the units)
 MCH 33 ___
 MCHC 32 ___

46. RETICULOCYTE COUNT
 Low

47. ?

48. MACROCYTIC ANEMIA

49. CAUSES
Oval
 Megaloblastic anemia
 Drug therapy
 MDS
Round
 Alcoholism
 Liver disease
 Hypothyroidism

50. WHAT ELSE CAN BE IN PBS
 Hyper segmented neutrophil
 Howell- jolly body
 Cabot’s ring

51. BM EXAMINATION
 Ineffective erythropoiesis
 Megaloblastic change in all series
 Giant band forms
 Giant metamyelocytes

52. OTHER CAUSES OF MACROCYTOSIS…HOW TO
RULE THEM OUT
 Hemolytic anaemia
 Features of hemolysis in addition with
macrocytosis
 Liver disease
 Target cell will be in the smear
 Myelodysplastic syndrome
 Elderly patients
 Bi/ Pancytopenia
 BM exam- ALIP ( abnormal localization of
immature precursor)

53. …CONT..
 Pregnancy
 Newborn
 Cytotoxic chemotherapy
 Aplastic anaemia

54. MICROCYTIC HYPOCHROMIC
ANAEMIA

55. CAUSES
 Iron deficiency anaemia
 Thalassemia syndrome
 Anaemia of chronic diseases
 Sideroblastic anaemia

56. MICROCYTIC HYPOCHROMIC EVALUATION

57. NORMOCYTIC NORMOCHROMIC ANAEMIA

58. NORMOCYTIC NORMOCHROMIC EVALUATION

59. EVALUATION OF HEMOLYSIS
 Within circulation
 Blackwater fever,
mismatch blood
transfusion, PNH
 Spleen normal
 Plsama Hb% markedly
increased
 Hb in urine +
 Hemosiderin in urine+
 Within RES
 Hb-pathies, Hereditary
haemolytic anaemia,
AIHA
 Size increased
 Mild increased
 Absent
 Absent
 Negative

60. Thank you for your
maintained silence