:

..

Hgb:
: <12.0
: < 13.5

Hct:
: < 36
: <41

= gr . 100 mL (g/dL)
= .

RBC = . microL
MCV =

> 100
80 100
< 80

RDW =

( -SD ) 100
. 11-15%
, RBCs

RNA
1-2 1-2 RNA

..=0,2-2%

= % x Ht /45

=45-75.000/l

Hgb Hct 36
48 (
)

)
()

)



-
- - .

)
(, )

(, )
/ :

,

, .


11-12 g/dL

B12

/



Gastric bypass

[ /. -
, ]

Pica
( - , , )

, ,
,
.

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

 B12

-12 < 200 pg/mL

B12 DNA

:
( Schilling test)

-
.,
-
PPI
12 . ,

 12

, , ,
12

, .

/
, ,
,
.
,
, (
)

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

 12- .
Vitamin B 12
Deficiency

Folate Deficiency

MCV

> 100

> 100

Smear

Macrocytosis with
hypersegmented
neutrophils

Macrocytosis with
hypersegmented neutrophils

Pernicious anemia

Yes

NO

Homocystine

Elevated

Elevated

Methylmalonic Acid

Elevated

NORMAL

, (
, )
o
,
.

.

Fe


(il-1, TNF)
.

.

-:

, , ,

-:

, , ,

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

, ,
WBC,
Parvovirus B19, EBV, CMV

(, , , Ca ,
, )

(,
), , -tear drop
RBC.

 (PRCA)

.
Parvovirus B19,
(CMV, HIV, HBV)
: ,
.
:
, , ().

,
G6PD,

(, ,
) Coombs (+)
(, , ,
..., .)

Glucose-6-phosphate
dehydrogenase (G6PD)

X-linked ()

stress
, .

, ,
,
.

,
,

IgM

,EBV,

.

IgG


Coombs (
IgG
)

(TTP)

Malaria
Babesiosis
Sepsis

LDH


< 25 mg /dL

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

, .

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

Malaria

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

Babesiosis

Sandoz Atlas: Clinical Haematology, A.V.Hoffbrad,J.E.Pettit

?, ?
?
? G6PD?

, ,

,
,


2
?

WBC , :
!

(), , , ,
, - (, , ),

parvovirus B19 IgG, IgM

, HIV

, :
TTP !

( )
, E. Coli O157:H7
, , TTP

>100.000/l

<50.000/l

MCV
RDW


3 -

?!
()
()?
mayer ,

/?

, , ?
, LDH,
,
? ? ?
Coombs ?
,
. (, ,
, )

 A E (>100.000/l)
,
LDH, A.
Coombs :

/


Hb Heinz

()

PNH

 A E (>100.000/l)
,
LDH, A.
Coombs :

,
(, HIV. )

( ,
,
)

 A E (>100.000/l)
,
LDH, A.

Coombs :

(.
. bite cells, ,
b .)

.
()

(,
Hb,
,
)

.
(,EBV,)


3 -
,
MCV RDW?
MCV < 80,
A MCV 80-100,

MCV > 100,

 M A E (<50.000/l)
MCV < 80

CRP

CRP

Hb
..

< 20

< 50

= 50-100

> 150

2 , F

,
,
.

sR/

DMT1

>2
<1

 M A E (<50.000/l)
MCV
< 30

> 30

CRP

CRP

.
TSH, ,
,
B12 Fe,
.

,
, PRCA

 A E (<50.000/l)
MCV > 100
12 ,O O ..

12 .., O O

(, , ,
,
.)

/

. .

Birmer.

12 & O O ..

..

,
.

(,
,)

12

 (MCV)
(RDW).

MCV < 80

OM
RDW : ..

RDW :

RDW :

O
MCV : 80-100

A
MCV > 100

,
.
O /
,

( )
..

./ .

( )
..(
)

( )

.

(F)

( )

( )

Fe 3+ ph
( C) Fe2+

A Fe .

: , , P450, )
Fe :
Fe ,

Fe = . 60-150

= . 40-200
(TIBC)
= . 300-360
.
.

= . 20-50%
<15%
>60%

Fe , TIBC =

Fe , TIBC =
Fe .., ., TIBC .. MCHC ..32-36
+ Hb =
Fe , ,+
=
Fe
,

Fe

per os,..


(Transferrin Receptors-TfR)

( TfR)

TfR -


(serum Transferrin Receptors-sTfR)

sTfR

,
( - , )
.. sTfR + CRP + = ( sTfR )

sTfR

sTfR/ >2

- , .

sTfR/ <1

DMT-1 (DIVALENT METAL Transporter)

Heme Oxygenase 1
Fe-ATPaseIron Transporter ..

.
(Hepcidin)

 /

1

12
.

Fe
12 .

Fe

.

Fe.

Fe
.

Brissot P, et al. Blood Rev. 2008;22:195-210.

5
2

Fe
6

Fe
4

 Fe

H
Fe

.

12
.

12 ..

Fe

.

Fe.

Fe
5
3

Ganz T, et al. Am J Physiol Gastrointest Liver Physiol. 2006;290:G199-G203.

 per os
:

,


IRIDA

IRIDA

.
Fe per-os.
O IRIDA ,

. .
TMPRSS6 Matriptase 2,
.

.

.

.
Rouleaux ( ).

.

,
, .
:
, .

(/ ).