Types of Anaemia

and How to
Remember Them
with Sophie Broughton
 Contents

Introduction Classifications Microcytic Normocytic

Anaemias Anaemias

Macrocytic
Recap Clinical Cases
Anaemias
Introduction
What is Anaemia?
v Low RBC count
v Clinically measured as haemoglobin concentration
in blood

WHO Definition:
v Men: <130g/L
v Women: <120g/L
v Pregnant women: <110g/L
v Children:
v 6-59 months: <110g/L
v 5-11 years: <115g/L
v 12-14 years: <120g/L
 FBC Most Important:
v Hb (haemoglobin)
v MCV (mean corpuscular volume)
Looking at Red Blood Cells
v Reticulocyte count

Less Important:
v MCH (mean corpuscular haemoglobin)
v MCHC (mean corpuscular haemoglobin concentration)
v RCC (red cell count)
v HCT or PCV (haematocrit or packed cell volume)
v RDW (red blood cell distribution width)
Classifications
Mechanisms

Morphology
 Erythropoiesis
Bone Marrow ~ 3 weeks Peripheral Blood ~ 120 days
Megakaryocyte
Erthroid
Progenitor Erythroblast Red Blood Cell

Proerythroblast Reticulocyte
Morphology
1 2 3

Microcytic Normocytic Macrocytic

<80 fL 80-100 fL >100 fL
Microcytic
Anaemias
What causes microcytosis?
Insufficient haemoglobin production

vInadequate heme production

v Iron deficiency anaemia
v Anaemia of chronic disease
v Hereditary sideroblastic anaemia

vAbnormalities in globin chain synthesis

v Haemoglobinopathies
 T – thalassaemia
TAILS A – anaemia of chronic disease
I – iron deficiency anaemia
L – lead toxicity
S – sideroblastic anaemia
Further Ferritin:
Investigations Low:
v Iron deficiency
Other studies: Normal:
v Serum iron v Haemoglobinopathy
v Transferrin
High:
v Transferrin saturation
v Anaemia of chronic disease
v Haemoglobin electrophoresis
v Sideroblastic anaemia
(if haemoglobinopathy
suspected)
Normocytic
Anaemias
What causes anaemia in
normocytosis?
v Decreased blood volume
v Decreased production of red blood cells
v Increased destruction of red blood cells (i.e. haemolysis)
 H – haemolytic anaemia
HABE A – acute blood loss
B – bone marrow failure / infiltration
Ø aplastic anaemia

E – early phases of iron deficiency anaemia or anaemia of

chronic disease
More on Haemolytic Anaemias
Intrinsic Causes:
v Haemoglobinopathies (most commonly sickle cell anaemia)
v Enzyme deficiencies (pyruvate kinase deficiency, G6PD deficiency
v Membrane defects (paroxysmal nocturnal haemoglobinuria, hereditary spherocytosis)

Extrinsic Causes:
v Mechanical destruction (eg prosthetic heart valves)
v Autoimmune (eg SLE, EBV)
v Infections
Further
Investigations Reticulocyte Count:
v Low / normal: consider iron studies,
serum B12 / folate
Other studies:
v Direct Coombs test v High: look at bilirubin
v LFTs v Low: bleeding (think GI bleeds etc.)
v High: haemolysis
v eGFR
v TFTs
Macrocytic
Anaemias
What causes macrocytosis?
Megaloblastic anaemias:
Two causes:
Result of impaired DNA synthesis and/or repair
1. Megaloblastic anaemias
2. Normoblastic anaemias
Normoblastic anaemias:
Normal DNA synthesis
v Liver problems: increased deposition of
cholesterol in membranes of RBCs
v Hypothyroidism: thyroid hormones stimulate
growth of RBCs through erythropoietin
Erythropoiesis
Megakaryocyte
Erthroid
Progenitor Erythroblast Red Blood Cell

Proerythroblast Reticulocyte

v DNA synthesis up to early erythroblast

v Requires maturation factors
v Deficiencies in these cause inefficient DNA replication / stops
cells dividing normally
v Resultant cells are larger & abnormal
Normoblastic
H – hypothyroidism
HAL A – alcoholism
L – liver disease
Megaloblastic
Folate Deficiency:
v Dietary causes
v Malabsorption eg Coeliac disease
v Pregnancy
v Drugs (trimethoprim, phenytoin, methotrexate, 6-MP, sulfa drugs)

B12 Deficiency:
v Dietary causes
v Pernicious anaemia
 H – hypothyroidism
H A L F B12 A – alcoholism
L – liver disease
F – folate deficiency
B – B12 deficiency
 Further Investigations
Peripheral Blood Smear:

Non-megaloblastic: Megaloblastic:

Reticulocyte count:
Serum B12 and folate
If high, look at bilirubin
Recap
 Recap
Microcytic Normocytic Macrocytic

T H H
A A A
I B L
L E F
S B12
 Table of Recap
Microcytic Normocytic Macrocytic
Thalassaemia Haemolytic anaemia Hypothyroidism

Anaemia of chronic Acute blood loss Alchoholism

disease
Iron deficiency anaemia Bone marrow failure / Liver disease
infiltration
Lead poisoning Early anaemia of chronic Folate deficiency
disease or iron deficiency
Sideroblastic anaemia B12 deficiency
Additional Resources

v LearnHaem website
v OSCEStop (interpreting FBCs)
v AMBOSS webpage on anaemia
v Youtube videos