ANEMIA

Microcytic Hypochromic MCV<100 fl

Macrocytic Hyperchromic MCV>100 fl

Normocytic Normochromic MCV 80-100 fl

*Target Cells

Alkohol Abuse

B or Folate Deficiency

Liver Disease

Thalasemia

Iron Deficiency Anemia

Alumunium Toxicity

Acute Blood Loss

Anemia of Renal Failure

Infection Malignancy

SI, TIBC, Feritin

Hb- Electropholisis Transferrin Saturation < 15 % ( S. Iron / TIBC x 100 ) * Serum Ferritin < 30 ng/ml

Blood Urea Creatinine

Hb A ( Two Fold ) Hb F ( Modest Elevation)

Thalasemia Minor ( Confirmed )

Iron Deficiency Anemia ( Confirmed )

Renal Failure ( Confirmed )

* As a rule, target cells are not seen with iron deficiency. When present, they suggest a globin chain product defect, one of the Thalasemia. They may also be seen in the presence of liver disease

Approach to the patient with anemia 1 up to date

General Approach to Anemias

Anemia is present in adults : In males, hematocrit is less than 41% (hemoglobin < 13.5

g/dL) In females, hematocrit is less than 37% (hemoglobin < 12 g/dL) Poor diet may result in folic acid deficiency and contribute to iron deficiency. Bleeding is much more commonly the cause of iron deficiency in adults. Physical examination includes attention to signs of primary hematologic diseases (lymphadenopathy, hepatosplenomegaly, or bone tenderness). Mucosal changes such as a smooth tongue suggest megaloblastic anemia, iron deficiency

General Approach to Anemias

Anemias are classified according to : Pathophysiologic basis, ie, whether related to diminished

production or accelerated loss of red blood cells Cell size Microcytic anemia : o iron deficiency o Thalassemia o anemia of chronic disease. A severely microcytic anemia (mean cell volume [MCV] < 70 fL) : Iron deficiency Thalassemia. Macrocytic anemia : Megaloblastic (folate or vitamin B12 deficiency) Nonmegaloblastic causes, in particular myelodysplasia and the use of antiretroviral drugs.

Classification of anemias by pathophysiology

DECREASED PRODUCTION Hemoglobin synthesis: iron deficiency, thalassemia, anemia of chronic disease DNA synthesis: megaloblastic anemia Stem cell: aplastic anemia, myeloproliferative leukemia Bone marrow infiltration: carcinoma, lymphoma Pure red cell aplasia

INCREASED DESTRUCTION
Blood loss Hemolysis (intrinsic) Membrane: hereditary spherocytosis, elliptocytosis Hemoglobin: sickle cell, unstable hemoglobin Glycolysis: pyruvate kinase deficiency, etc Oxidation: glucose-6-phosphate dehydrogenase deficiency Hemolysis (extrinsic) Immune: warm antibody, cold antibody Microangiopathic: thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, mechanical cardiac valve, paravalvular leak Infection: clostridial Hypersplenism

Classification of anemias by mean cell volume

MICROCYTIC Iron deficiency Thalassemia Anemia of chronic disease MACROCYTIC Megaloblastic Vitamin B12 deficiency Folate deficiency Nonmegaloblastic Myelodysplasia, chemotherapy Liver disease Increased reticulocytosis Myxedema NORMOCYTIC Many causes