Hematologic parameters &

classification of anemias
Dr.Lubna Humayun
Assistant professor
Pathology department
UCM UOL
 LEARNING OBJECTIVES:
By the end of this lecture the students will be
able to:
• List the normal values of common
hematological parameters.
• Describe the classification of anemias.
Normal hematologic parameters
 Complete blood counts (CBC)
Includes;
• Haemoglobin; Hgb; Hb
• Total Leucocyte Count; WBC count; TLC
• Platelet Count PLT
• Haematocrit; Hct; Packed Cell Volume; PCV
• RBC count
• Differential Leucocyte Count; DLC
• Erythrocyte Sedimentation Rate; ESR
 COUNTS

• Relative Counts;
Expressed in Percentage (%)
• Absolute Counts;
Total numbers. Usually expressed per
liter
Adult Reference Ranges for Blood Cells
Total White cells 4.8–10.8 × 103/μL
4.0—11.0 x109/L

Neutrophils (%) 50–75 ; (× 109/L) 1.4–6.5

Lymphocytes (%)25-50); (× 109/L) 1.2–3.4
Monocytes (%) 1-6; (× 109/L) 0.1–0.6
Eosinophils (%) 1-4; (× 109/L) 0–0.4
Basophils (%) 0-1; (× 109/L) 0–0.2
Red cells (× 1012/L) 4.3–5.5, men; 3.5–5.0, women
Platelets (× 109/L) 150–450 or
150,000-450,000/ μL /cumm
 Adult Reference Ranges for Red Cells
• Hemoglobin Male: (gm/dL) 13–18
Female: (gm/dL) 11.5–15.0
• Hematocrit : (%) 33–52
• Red cell count: Male: (× 1012/L) 4.1– 5.9
Female: (× 1012/L) 3.7–5.2
• Reticulocyte count: (%) 0.5–2.5
• Mean cell volume: (fL) 80–95
• Mean cell hemoglobin: (pg) 26–32
• Mean cell hemoglobin concentration: (gm/dL)
31–36
• Red cell distribution width (RDW): (%)11.5–14.5
 The Platelets : Reported results

• Platelets : 150 – 450x1012/L

• Mean Platelet Volume MPV of 7 – 10 fl.

 Red Cell Indices
• Mean Carpuscular (cell) Volume; MCV
• Mean Carpuscular (cell) Haemoglobin; MCH
• Mean Corpuscular (cell) Haemoglobin
Concentration; MCHC
RBC indices are derived or calculated from;
a. Haemoglobin
b. RBC count
c. Hct; PCV
 Other tests linked with CBC
• RBC morphology
• WBC morphology
• Reticulocyte Count
• Haemoparasites
a. Malarial Parasite
b. Leishmania
c. Filaria
d. Trypanosmia
 Coagulation screen
How to express the result?

• Prothrombin Time ( PT): Time in “seconds”

• International Normalized Ratio (INR)
• Activated Partial Thromboplastin Time (APTT):
Time in “seconds”
• Thrombin Time (TT): Time in “seconds”
Know Normal Ranges!!!

WBC PLT
RBC MPV
HGB Neutrophils
HCT Lymphocytes
MCV Monocytes
MCH Eosinophils
MCHC Basophils
 What you need to know?

• Normal ranges for WBC, Hb, RBC, HCT, MCH,

MCHC, MCV, platelet count, Reticulocyte count.
• WBC count is abnormally high or abnormally
low ?
• Counts of neutrophils, lymphocytes or
eosinophils that is causing the abnormality in
the total WBC
• Variations in normal ranges related to gender,
age and ethnic origin
CLASSIFICATION OF
ANAEMIA
 Classification of anaemia
Functional classification:
Hypoproliferative destruction (infective hematopoiesis).
Clinical classification:
Causes of anemia (blood loss, IDA, hemolysis).
Morphological Classification:
• Normocytic Normochromic
• Microcytic Hypochromic
• Macrocytic.
Quantitative Parameters for classification:
• Hematocrit
• Hemoglobin
• Blood cell indices (MCV, MCH, MCHC).
• Reticulocytes count.
 DEFINITION OF ANAEMIA

“Anaemia is present when the

haemoglobin level in the blood is
below the lower than normal range
for the age and sex of the
individual.”
 CLASSIFICATION OF ANAEMIA
A. BLOOD LOSS ANAEMIA
1. OVERT BLOOD LOSS
• SURGERY
• ACCIDENT
• EPISTAXIS
• RECTAL BLEEDING
• MENORRHAGIA
• RECURRENT BLEEDING FROM ANY OTHER
SITE
2. OCCULT BLOOD LOSS
• GI BLEEDING
• GENTI-URINARY BLEEDING
 CLASSIFICATION OF ANAEMIA
B. IMPAIRED RED CELL PRODUCTION
1. INADEQUATE SUPPLY OF NUTRIENTS
• IRON DEFECIENCY
• VITAMIN B-12 DEFECIENCY
• FOLIC ACID DEFECIENCY
• PROTEIN-CALORI MALNUTRITION
• OTHER LESS COMMON DEFECIENCIES
B. IMPAIRED RED CELL PRODUCTION

2. DEPRESSION OF ERYTHROPOEITIC ACTIVITY

3. ANAEMIAS ASSOCIATED WITH CHRONIC

DISORDERS.
– INFECTION
– CONNECTIVE TISSUE DISORERS
– INFLAMMATORY DISORDERS
– DISSEMINATED MALIGNANCY
– RENAL DISEASE
4. APLASTIC ANAEMIA
B.IMPAIRED RED CELL PRODUCTION

5. ANAEMIA DUE TO REPLACEMENT OF THE BONE

MARROW BY
– LEUKEMIA
– LYMPHOMA
– MYELOPROLIFERATIVE DISORDER
» POLYCYTHEMIA
» ESSENTIAL THROMBOCYTHEMIA
» CHRONIC MYELOID LEUKEMIA
» MYELOFIBROSIS
– MYELOMA
– MYELODYSPLASTIC DISORDERS

6. ANAEMIA DUE TO INHERITED DISORDERS

– THALASSAEMIA
CLASSIFICATION OF ANAEMIA
C. EXESSIVE RED CELL DESTRUCTION
(HAEMOLYTIC ANAEMIA)
1. DUE TO INTRINSIC DEFECTS IN RBCS
a.CONGENITAL
1.MEMBRANE DEFECTS
i. HEREDITARY SPHEROCYTOSIS
ii.HEREDITARY ELLIPTOCYTOSIS
iii.HEREDITARY XEROCYTOSIS
iv.HEREDITARY HYDROCYTOSIS
2.HAEMOGLOBIN DEFECTS
i. HAEMOGLOBINOPATHIES
◊ SICKLE CELL ANAEMIA
◊ OTHER HOMOZYGOUS DISORDERS
◊ Hb D HbC HbE
◊ UNSTABLE HAEMOGLOBIN DISEASE
CLASSIFICATION OF ANAEMIA ….. HAEMOLYTIC ANAEMIA….
ii. THALASSAEMIA
◊  THALASAEMIA
◊  THALASAEMIA

iii.DOUBLE HETEROZYGOUS DISORDER

◊ SICKLE CELL  THALASAEMIA

3. ENZYME DEFECTS
i. NON SPHEROCYTIC CONGENITAL HAEMOLYTIC
ANAEMIA
◊ PYRUVATE KINASE DEFECIENCY OR
OTHER ENZYMES OF EMBDEN MAYER HOF
PATHWAY
◊ DUE TO DEFECIENCY OF G6PD OR OTHER
ENZYMES OF PENTOSE PHOSPHATE
PATHWAY
ii. DRUG INDUCED HAEMOLYTIC ANAEMIA
CLASSIFICATION OF ANAEMIA …… HAEMOLYTIC ANAEMIA…...

b. ACQUIRED
1. PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA

11. DUE TO EXTRINSIC DEFECTS

a. ACQUIRED
1. IMMUNE MECHANISMS
i. AUTOIMMUNE ACQURIED HAEMOLYTIC
ANAEMIA
◊ WARM ANTIBODY
◊ COLD ANTIBODY
ii. HAEMOLYTIC DISEASE OF THE NEW BORN
iii. DRUG INDUCED HAEMOLYTIC ANAEMIA
CLASSIFICATION OF ANAEMIA….. HAEMOLYTIC ANAEMIA…..

2. NON IMMUNE MECHANISMS MECHANICAL

HAEMOLYTIC ANAEMIA
i. CARDIAC HAEMOLYTIC ANAEMIA
ii. MICROANGIOPATHIC HAEMOLYTIC ANAEMIA
iii. MARCH HAEMOLYTIC ANAEMIA

3. MISCELLANEOUS
i. HAEMOLYTIC ANAEMIA DUE TO DIRECT ACTIONS
OF CHEMICAL AND DRUGS
ii. HAEMOLYTIC ANAEMIA DUE TO INFECTION
iii. HAEMOLYTIC ANAEMIA DUE TO BURNS
iv. LEAD POISINING