2. Introduction
• Anemia is a decrease in the RBC count, Hgb and/or HCT
values as compared to normal reference range.
Common physical symptoms
• Fatigue
• Shortness of breath
• Jaundice
3. Cont….
Smear examination will reveal the appearance of RBCs
(anisocytosis and poikilocytosis and inclusions)
Reticulocyte count
○ Shows the bone marrow response to decreases in RBCs
4. Cont….
Anemia's may be classified by combinations of different
criteria
A. Morphology
○ RBC indices are used to gauge size and hemoglobinization
1. Normocytic/normochromic
2. Microcytic/hypochromic
3. Macrocytic/normochromic
5. Cont….
B. Function
○ Defects leading to RBC decreases
1. Proliferation: RBCs are not produced at normal rates
2. Maturation: RBCs are produced in the marrow but may not
mature appropriately.
3. Survival: RBCs are produced appropriately but are
lost/destroyed prematurely
6. Diagnosis Of anemia
• The diagnosis of anemia and determination of its
cause are made by using a combination of
information received from
• The patient history
• The physical examination and ,
• The laboratory investigation
7. Cont….
1. Patient history
The patient’s history including symptoms can reveal some
important clues as to the cause of the anemia.
Patient history includes,
Dietary habits
medications
Exposure to chemicals and toxins
Symptoms and their duration such as, Fatigue, muscle
weakness, Headache, Vertigo, Syncope and others.
8. Cont….
2. Physical Examination
Physical examination of the patient helps the physician detect
the adverse effects of a long-standing anemia.
Signs of anemia obtained by physical examination
Skin pallor
Pale conjunctiva
Hypotension
Jaundice
Hepatomegaly
Splenomegaly
9. Cont….
3. Laboratory Investigation
After the physical examination and patient history, a health
care provider who suspects the patient has anemia orders
laboratory tests.
The initial screening test is the complete blood count (CBC),
which includes
• red blood cell (RBC) count,
• hemoglobin, Hematocrit and RBC indices
• Reticulocyte Count
10. Cont….
Erythrocyte Count, hematocrit, and hemoglobin
The erythrocyte count, hematocrit, and hemoglobin are
determined to screen for the presence of anemia.
A decreased concentration in one or more of these parameters,
based on the individual’s age and sex, should be followed by
other laboratory tests to help establish criteria for diagnosis.
11. • The Centers for Disease Control and Prevention (CDC)
recommended cutoff values for a diagnosis of anemia
according to age and sex
12. Cont….
Erythrocyte indices
abnormal morphology is characteristic of distinct types of
anemia.
The erythrocyte indices (MCV, MCH, MCHC) give important
clues as to the pathophysiology of the anemia.
For instance, microcytic hypochromic cells are highly
suggestive of iron-deficiency anemia.
Whereas macrocytic normochromic cells are associated with
vitamin B12 or folate deficiency.
The indices are used in the morphologic classification of
anemia.
13. Cont….
Reticulocyte Count
The peripheral blood reticulocyte count indicates the degree of
effective bone marrow erythropoietic activity.
It is also helpful in directing the initial investigation of anemia
that assists in classification of anemia.
Increased numbers of polychromatophilic erythrocytes on
indicates an increased reticulocyte count.
Reticulocyte count (%) = Reticulocyte number X 100
RBC number
14. Cont….
The reference interval it is about 0.5– 2.5%.
Amount of reticulocyte count increase during blood loss and
hemolytic anemia.
Blood Smear examination
Although doing so is not always necessary.
Reviewing the stained blood smear assists in diagnosing the
type of anemia in about 25% of the cases.
Some shapes and sizes are particularly characteristic of
specific underlying hematologic disorders
