..

..

1
1 1
Hemoglobin Hematocrit (g/dL) Red cell count
(g/dL)
(x106/?L)

Mean -2SD Mean -2SD Mean -2SD

16.5
13.5
51
42
4.7
3.9
(cord blood)
1-3 (capillary) 18.5
14.5
56
45
5.2
4.0
1
17.5
13.5
54
42
3.1
3.9
2
16.5
12.5
51
39
4.9
3.6
1
14.0
10.0
43
31
4.2
3.0
2
11.5
9.0
35
28
3.8
2.7
3-6
11.5
9.5
35
29
3.8
3.1
0.5-2
12.0
11.0
36
33
4.5
3.7
2-6
12.5
11.5
37
34
4.6
3.9
6-12
13.5
11.5
40
35
4.6
4.0
12-18

14.0
12.0
41
36
4.6
4.1

14.5
13.0
43
39
4.9
4.5
18-49

14.0
12.0
41
36
4.6
4.0

15.5
13.5
47
41
5.2
4.5

MCV (fL)
Mean

-2SD

108

98

108
107
105
104
96
91
78
81
86

95
88
86
85
77
74
70
75
77

90
88

78
78

90
90

80
80

- ( 12 )
()
( 12 )
- ( 12)
- (
)
()
-
(multiple myeloma, metastatic cancer)
-


7-8
/

2
2

(hemolysis)

12

amyloidosis

(gum hypertrophy)

lead line

(oral ulcer)
SLE

(petechiae)

Evans syndrome, TTP

SLE

12

systolic murmur at

precordium (grade<3)
5 /

(extravascular hemolysis)

posterior column
sensation

impaired vibratory two

point discrimination sense

12

3
3
1.

( 2)
1.1 (onset)
2

hereditary spherocytosis G-6-PD

3
3

500

500-1000
1000
(hemolysis)
extravascular hemolysis
hereditary spherocytosis


3
1.2 (associated symptoms)






( )
( )

2. 3

2.1
2.1.1) stem cell pure red cell aplasia
myelodysplastic syndrome
2.1.2) 12
erythropoietin
hypothyroidism hypopituitarism
2.1.3) (myelophthisic anemia)

2.2
2.2.1) (acute blood loss)
2.2.2) (hemolysis) 2

(2.2.2.1) RE cell
hereditary spherocytosis autoimmune hemolytic
anemia hemolytic transfusion reaction

(2.2.2.2) G-6PD Paroxysmal nocturnal hemoglobinuria (PNH)

Clostridium
3. 3,4,5

3.1 (Complete Blood Count-CBC)
3

3.1.1) (MCV < 80 fL)

porphyrin ring sideroblastic
anemia
4

anemia of chronic disease

porphyrin ring
sideroblastic anemia

3.1.2) (MCV 80-100 fL)

(reticulocyte count) 2

3.1.3) (MCV > 100 fL)
100 fL 110 fL
, paroxysmal hemoglobinuria, hypothyroidism, chronic liver
disease, (reticulocytosis), 110
fL 12 megaloblastic anemia

 (>140 fL) (red cell autoagglutination)

autoimmune hemolytic anemia (AIHA)
3.2 5
5 4,5,6
RBC morphology
Associated conditions / diseases
Spherocyte
Hereditary spherocytosis, autoimmune hemolytic anemia, G6PD def.
with hemolytic crisis, thalassemias, hemolytic transfusion reaction,
Clostidial sepsis, microangiopathic hemolytic anemia (MAHA), severe
hypophosphatemia, hypersplenism, posttransfusion
Elliptocyte
Hereditary elliptocytosis, thalassemia, severe iron deficiency,
sideroblastic anemia, megaloblastic anemia
Stomatocyte
Hereditary stomatocytosis, liver disease (esp. acute alcoholism), Rh
null blood group, erythrocyte sodium-pump defect
Basophilic stippling
Thalassemia, unstable hemoglobinopathy, pyrimidine 5nucleotidase deficiency, lead poisoning, sideroblastic anemia
Burr cell (echinocyte)
Uremia, pyruvate kinase deficiency, low-potassium red cell,
immediately posttransfusion with aged or metabolically depleted
blood
Acanthocyte (spur cell) Acute hepatic necrosis (spur cell anemia), abetalipoproteinemia,
postsplenectomy, anorexia nervosa, malabsorptive states,
hypothyroidism, McLeod blood group
Target cell
Thalassemia, hemoglobinopathy, obstructive liver disease, iron
deficiency, sideroblastic anemia, postsplenectomy, LCAT deficiency
Tear drop cell
Myelofibrosis, myelophthisis, osteopetrosis, thalassemia,
megaloblastic anemia
Howell-Jolly bodies
Postsplenectomy, splenic hypofunction
Schistocyte
Macrovascular hemolysis (e.g. prosthetic valve, ruptured chordae
tendinae), Microangiopathic hemolytic anemia (e.g. DIC, TTP/HUS,
vasculitis, glomerulonephritis, preeclampsia, malignant
hypertension), severe burns, march hemoglobinuria

Pappenheimer bodies
Hemoglobinopathy, megaloblastic anemia
LCAT=Lecithin:cholesterol acyltransferase; DIC=Disseminated intravascular coagulation;
TTP=Thrombotic thrombocytopenic purpura; HUS=Hemolytic uremic syndrome
3.3 6
(MCV,fL) reticulocyte count 7



(Anemia from acute blood loss and anemia of chronic disease) SLE
(Anemia from
anemia of chronic disease, renal failure, and autoimmune hemolytic anemia)
6

Reticulocyte count

Direct Coombs test Autoimmune hemolytic anemia (AIHA)

Hemoglobin analysis
Serum ferritin iron
study
Urine hemosiderin
PNH
Hams test
PNH
aplastic
Bone marrow study anemia, leukemia,
multiple myeloma myelophthisis
Osmotic fragility
hereditary spherocytosis
G-6-PD level
G-6-PD
methemoglobin

reduction test
reticulocytosis
Creatinine

Liver function,
ultrasound abdomen
Thyroid function
Indirect bilirubin, LDH,
haptoglobin
serum B12 level

(hemolysis)
12

7 MCV Reticulocyte
Absolute Reticulocyte count
MCV
Low (<100,000/mm3)
High (>100,000/mm3)
Low MCV (<80 Iron deficiency
Thalassemias
fL)
Anemia of chronic disease
Treated iron deficiency
Sideroblastic anemia
Normal MCV (80- Anemia of chronic disease
Acute blood loss
99 fL)
Aplastic anemia
Hemolysis
PRCA*
Leukemia
Multiple myeloma
Myelophthisis
Myelodysplasia
Combined nutritional def.
Renal insufficiency
Chronic liver disease
Anemia of endocrine def.
Protein-calorie malnutrition
Early iron deficiency
High MCV (>100 Megaloblastic anemia
Hemolysis
fL)
Hepatic disease
Acute blood loss
Alcoholism/obstructive jaundice
Treated B12 or folate
Myelodysplasia
deficiency
Myelophthisis
Aplastic anemia

Hypothyroidism
*PRCA=pure red cell aplasia
(hemolysis)
(indirect hyperbilirubinemia, haptoglobin ,
LDH ) (reticulocytosis, nucleated red cells)

8
8 hemolysis4
1. Anemia and unconjugated hyperbilirubinemia without reticulocytosis
- Internal bleeding
- Ineffective erythropoiesis
2. Unconjugated hyperbilirubinemia without anemia or reticulocytosis
- Defective bilirubin conjugation : neonate, Crigler-Najjar and Arias syndromes
- Breast milk jaundice
- Gilbert syndrome
3. Anemia and reticulocytosis without hyperbilirubinemia
- Bleeding
- Recovery from aplastic or nutritional (iron, vitamin B12, folate) anemia
4. Leukoerythroblastosis
- Marrow invasion (myelophthisis) : neoplastic disease, granulomas, myelofibrosis,
osteopetrosis
- Severe hypoxia or acidosis (especially in infants)
5. Myoglobinuria
6. Decreased haptoglobin without hemolysis
- Normal neonate
- Congenital haptoglobin deficiency


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