1. The document discusses various types of anemia, their causes, pathogenesis, morphology, and clinical features. It focuses on decreased red blood cell production due to nutrient deficiencies like iron and B12/folate, and increased red blood cell destruction in hemolytic anemias. 2. The most common types are said to be iron deficiency anemia, megaloblastic anemia, anemia of chronic disease, and aplastic anemia. Diagnosis involves measuring hemoglobin, MCV, reticulocyte count, and nutrients like iron, B12 and folate. 3. Treatment depends on the underlying cause but improving nutrition, iron supplementation, and identifying causes of blood loss or destruction are

1. Any fool can know.
The point is to understand !
-- Albert Einstein
Without Pathology, Medicine is quackery…!

2. DS3102: Clinical Haematology
Pathology of
RBC disorders (anemia)
Dr. Shashidhar Venkatesh Murthy
A/Prof. & Head of Pathology
Less  More

3. 3
Anemia Introduction:
“Anemia is, decreased red cell mass affecting
tissue oxygenation”
 Low Hb* or Low HCT *
 Types:
• Failure of production – Deficiency anemia (iron)
• Excess destruction – Hemolytic anemia. (immune)
 What is ‘polycythemia’ ? ( RBC)
 What is spurious / false anemia? ( Plasma)
O2 in - CO2 out
RBC
Hb + Enz
Membrane

4. Normal Blood Film:
RBC
Hb + Enz +
Membrane
RBC
WBC
WBC
RBC
WBC

5. Anemia diagnosis:
120
Haemoglobin – 150 - 140 ±25 g gm/L
PCV/HCT - 0.47 ±0.07, 0.42 ±0.05 % lit/lit (%)
Packed Cell Volume 45
RBC count - 5.5 ±1, 4.8 ± 1 x1012/L
MCH - Hb/RBC - 30 ± 3 pg/RBC pg picogram (wt)
• Average Hb in RBC
MCV - PCV/RBC 90 ±10 – fl fl femto litres (vol)
5
Mean Cell Hb 30
Mean Cell Vol 90
Plasma
WBC & PLT
PCV / HCT

6. When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are….!
-- Christian D. Larson
Fake it until you make it…!
-- Mohd. Ali. Boxer.

7. Clinical Features of Anemia & their
Pathogenesis.

8. Anemia: Clinical Presentation
 Extreme fatigue (tiredness)
Decreased oxygen supply to tissues.
 Chest pain (only in severe anemia)
Myocardial ischemia.
8

9. Anemia: Clinical Presentation
 Pale skin
Less Hb / RBC
 Dizziness or lightheadedness
Decreased oxygen supply to Brain.
9
RBC: Bring in O2, Take out CO2

10. Anemia Clinical Presentation:
 Shortness of breath, light headedness.
Decreased O2, Increased Co2.
 Fast heart rate (tachycardia)
Tissue hypoxia – Hypothalamus –
sympathetic stimulation.
10

11. Epithelial damage:
 Brittle nails
Fast dividing cells (epith)
also need iron / nutrition
Cytochrome enzymes
 Stomatitis, Glossitis, Esophagitis.
11

12. The mind uncontrolled and unguided
will drag us down; and
the mind controlled and guided will
save us, free us.
-- Swami Vivekananda

13. 13
Classification of Anemia: Pathogenesis
 Decreased Production:
• Nutrient Deficiency.
• Iron def., Megaloblastic (B12/Folate)
• Stem cell Deficiency :
• Anemia of chronic disorders (ACD).
• Aplastic anemia – bone marrow defect.
 Increased loss / destruction:
• Blood loss anemia – Acute / Chronic - bleeding.
• Hemolytic anemia – Congenital / Acquired.
• Acquired – Immune Haemolytic anemia (AIHA)
• Congenital – Sickle, thalassemia etc.
Top 5 Anemias
1. Iron Deficiency.
2. Megaloblastic.
3. An. of Chronic Dis.
4. Aplastic.
5. Haemolytic - AIHA

14. BLAST Early Intermediate Late  Retic.  RBC
Proerythroblast
(Pronormoblast)
Polychromatophilic
Basophilic
Normoblast
Normoblast
Reticulocyte
Orthochromatophilic
Normoblast
Erythrocyte
Anemia Pathogenesis:
DNA: Megaloblastic Anemia
Hb: Iron
B12, Folate
Iron Deficiency anemia
Hemolytic anemia
Immune
14
Aplastic anemia

15. Laboratory Diagnosis: Normal
15
WBC Scattergram
RBC Histogram
Neutrophil
RBC
Neutrophil
Lymphocyte

16. 16
Classification of Anemia:
 Decreased Production:
• Nutrient Deficiency.
• Iron def., Megaloblastic (B12/Folate)
• Stem cell Deficiency :
• Anemia of chronic disorders (ACD) – Iron transfer defect.
• Aplastic anemia – bone marrow defect.
 Increased loss / destruction:
• Blood loss anemia – Acute / Chronic - bleeding.
• Hemolytic anemia – Congenital / Acquired.
• Acquired / External RBC defect
– Immune AIHA (Warm/Cold), Mechanical, Drugs & Parasites
• Congenital / Internal RBC defect
– E.g. Sickle cell anemia, Thalassemia.
Top 5 Anemias
1. Iron Deficiency.
2. Megaloblastic.
Most common anemias

17. 17
Haemopoiesis in deficiency anemias
Microcytic hypochromic Macrocytic, pancytopenia
Iron Deficiency Normal Megaloblastic

18. Iron Deficiency - Megaloblastic
 Causes:
• Bleeding, Nutrition,
Increased needs.
 Pathogenesis:
•  Iron - Hb - MCV
 Morphology:
• Microcytic,
Hypochromic
• Pencil cells.
 Clinical Features:
• koilonychia, glossitis,
stomatitis.
18
 Causes:
• Nutrition, gastritis,
intestinal disorders,
Cancer therapy.
 Pathogenesis:
• Abn. DNA*  all cells.
 Morphology:
• Macrocytic,
Normochromic
• Pancytopenia*
 Clinical Features:
• Jaundice mild, glossitis,
chelitis, stomatitis.

19. Whatever you think, that you will be.
If you think yourselves weak,
weak you will be.
If you think yourselves strong,
strong you will be!
-- Swami Vivekananda

20. Microcytic Anemia (IDA)
Normal
20

21. Iron Deficiency Anemia:
21
L
1.Microcytic, Hypochromic – excess cell division, low Hb.
2.Anisopoikilocytosis. – varying supply, abnormal hemopoiesis.
3.Pencil forms. - ? cause

22. 22
Macrocytic Anemia (Meg.):
Normal
H
N

23. Megaloblastic Anemia:
Megaloblastic Bone Marrow Normal
Macrocyte
Hypersegmented
Neutrophils
Megaloblast
1. Oval Macrocytes, Pancytopenia – Less cell division.
2. Anisopoikilocytosis – Ineffective hempoiesis, Hemolysis.
3. Hypersegmented neutrophils. - Megaloblasts (in marrow).
23

24. Anemia of Chronic Disease:
 Causes:
• Chronic Infections,
inflammations, malignancy &
anemia of renal disease*.
 Pathogenesis:
• Inflammatory mediators (IFN,
TNF) block iron transfer from
store to RBC
• Also decrease erythropoietin
prod.
 Morphology:
• Mild Microcytic, Hypochromic.
 Clinical Features:
• Mild anemia, resistant to iron…
24 IDA ? IDA / ACD ACD

25. “No doubt knowledge is valuable,
but above it is Character”
Knowledge without character is dangerous!

26. Aplastic A: BM Failure: immune, drugs, cancer..
Stem cell damage
• Drugs, Immune
• Viral Infections.
26
Dysplasia Normal BM Aplasia
Clinical Features:
Anemia, Infections & Bleeding.
1. RBC - Anemia,
2.  WBC - Leukopenia
3.  PLT - Thrombocytopenia
Leukemia
Normocytic Pancytopenia

27. Our destiny is in our hands,
What we think and do in the present
determines what shall happen to us in
the future.
-- Christian D. Larson

28. 28
Mechanism & Types of Anemia :
 Decreased Production:
• Nutrient Deficiency.
• Iron, B12 / Folate
• Hemopoietic cell defect:
• Anemia of chronic disorders (ACD) – low erythropoietin.
• Aplastic, Hypoplastic – Drugs, Disease, Destruction.
• Dysplastic & Neoplastic proliferative anemias.
 Increased loss / destruction:
• Blood loss anemia – bleeding, parasites,
• Hemolytic anemia – Congenital / Acquired.
• Acquired / External RBC defect
– Immune (Warm/Cold), Mechanical, Drugs & Parasites
• Congenital / Internal RBC defect
– Defective Membrane (HS), Hb (Sickle, Thal) or Enzyme (G6PD)

29. Hemolytic anemia (acquired):
 Causes:
• Antibody to RBC – commonest (cold / warm)
• Idiopathic, Drugs, infections, malaria, trauma.
 Pathogenesis:
• Damage  Hemolysis  Jaundice.
 Morphology:
• Spherocytes (warm) / RBC clumps (cold).
 Clinical Features:
• anemia, Jaundice. Splenomegaly in chronic.
• Diagnosis: Coomb’s test (detects Ab on RBC)
29
COLD
IgG
WARM
IgM
COLD
WARM

30. Congenital Hemolytic An.:
1. Membrane Disorders
• Hereditary Spherocytosis (HS)
2. Enzyme Deficiencies.
• G6PD Def.
3. Hemoglobin Disorders
• Globin deficiency: Thalassemia
• Globin abnormal: Sickle cell an.
30
RBC
• Cell Mem.
• Enzymes
• Hemoglobin
Hemolysis
Jaundice
Clinical Features
Thalassemia

31. Reticulocyte: Immature RBC
Reticulocyte
RBC
(Bluish, Large, high MCV)
RNA network within RBC –
stained by methylene blue.
Reticulocytes (Immature RBC)  Increased RBC production
Reticulocytosis  Hemolytic anemia/bleeding 5-7 days
31
Polychromatophil
Spherocyte
Nucleated RBC

32. Never say No, never say, ‘I cannot’, for
you are infinite. Even time and space
are as nothing compared with your
nature. You can do anything and
everything.
-- Swami Vivekananda

33. Anemia
Diagnosis:

34. MCV
Anemia
Clinical Diagnosis
Microcytic Normocytic Macrocytic
Measure Ferritin
Low Normal/high
Iron def
Anemia
Anemia of
chronic disease/
Congenital Hb dis.
Reticulocyte count
Normal Low
high low Anemia of chronic disease
Renal failure
Marrow failure
Hemolytic anemia
or blood loss
Measure B12 + folate
Megaloblastic
anemia
34

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36. The power of thought is not a
compelling force. It is a building
force, and it is only when used in
the latter sense that desirable
results can be produced.
-- Christian D. Larson

37. The pessimist waits for better times,
and expects to keep on waiting; the
optimist goes to work with the best
that is at hand now, and proceeds to
create better times.
-- Christian D. Larson