Classification of anemia Functional classification Hypoproliferative destruction infective

Classification of anemia • Functional classification: • • Hypoproliferative destruction (infective hematopoiesis). Clinical classification: • Causes of anemia (blood loss, IDA, hemolysis). • Quantitative classification: • • Hematocrit Hemoglobin Blood cell indices (MCV, MCHC). Reticulocytes count.

Red cell indices MCV (mean corpuscular volume) The average volume of RBC Hct = 10 (fl) RBC count (m/µL) e. g. Hct= 40% RBC=5. 0 (m /µL) MCV= 40/5. 0 10 = 80 fl NR= 80 -96 fl n

MCH (mean corpuscular hemoglobin) n n The average content of Hb in average RBC. It is directly proportional to the amount of Hb and RBC size. MCH = e. g. Hb 10 RBC count (m/µL) Hb = 14 g/dl RBC = 4 (m/µL) MCH= 14/4 10 = 35 pg NR= 27 -32 pg (pg)

MCHC (mean corpuscular hemoglobin concentration) n n Express the average concentration of hemoglobin per unit volume of RBC. It defined as the ratio of the weight of hemoglobin to volume of RBC. MCHC= Hb (g/dl) 100 (%) Hct (%) e. g. Hb = 14 g/dl Hct = 45 % MCHC 14/45 100 = 31% NR= 32 -36%

Symptoms of Anemia Normal or High Hemoglobin/Hematocrit Check other Causes of symptoms e. g. Cardiac Pulmonary Low RBC indices MCV=80 -96 MCV > 98 History of acute blood loss Auto immune Hemolytic anemia Anemia of chronic Diseases Anemia of infection B 12 and folate levels MCV < 80 MCHC < 32 Serum iron and Total Iron binding capacity of Ferritin Low Iron Normal High Iron IDA, chronic diseases, Renal diseases Hb electrophoresis for Thala. BM exam For Sideroblastic anemia Low B 12 PA, GI problems Severe malnutrition. Low folate High or Normal Folate malnutrition GI problems Liver disease MPD Liver Disease

Normal red cell morphology

Hypochromic Macrocytic Hyperchromic Microcytic

IDA Poikiolocytosis Ovalocyte Target cells Stomatocytes Sickle cells Acanthocytes Spherocytes Nucleated RBC