Yan Yu, 2012 (www.yanyu.

ca)
Anemia ([Hgb] < 120g/L)
(Average MCV, CBC, and reticulocyte count assists with diagnosis!)

Microcytic Normocytic Macrocytic

(MCV < 80fL) (MCV 80-100fL) (MCV > 100fL)
(↓ heme or globin synthesis) (RBCs lost, or less RBCs produced) (↓DNA synthesis, ↓ cell division)
Lead poisoning
(basophillic
stippling, Rule out Reticulocytosis
sideroblasts) Normal/high WBCs Low WBCs
(↑ #s of reticulocytes in blood, due to hemolysis or
acute bleeding, may ↑ MCV)
Iron deficiency
(Ferritin low, Reticulocytes: High
Fe low, TIBC high, Fe/TIBC Low/inappropriately reticulocytes High Low/normal Normal blood smear Abnormal blood
<18%, normal (Polychromatic reticulocytes reticulocytes Drugs (can often mimic smear Dysplasia (i.e.
Low retics -↑ w/ Tx, macrocytes) (marrow is fine) B12/folate deficiencies) Myelodysplasia –
(marrow is fine) bi-lobed
hypochromic RBCs, spoon Anemia of Chronic  Look at blood neutrophils)
nails, pica, stomatitis, disease/inflammation smear!
glossy tongue) (Ferritin high, Marrow aplasia,
Splenomegaly/ Oval macrocytes, RBCs in Rouleaux
Assoc w/ celiac Fe low, TIBC low, Fe/TIBC Early Fe deficiency Hypersplenism (10
suppression, or
>18% (low-normal)) ↓ EPO (Hypothyroid (↓ infiltration Hyper-segmented formation (multiple
Thalassemia and 20) neutrophils, low retics myeloma) – false ↑ in MCV
TSH), renal failure) (pancytopenia)
MCV <73fL (very low!) Cancer (i.e. multiple B12/Folate deficiency (but ↑ after Tx), due to RBC agglutination
Ferritin/Fe/TIBC all normal, myeloma) pancytopenia,
Mediterranean/African/SE Asian megaloblastic anemia in Target cells, normal WBCs
Pregnancy (RBC dilution)
marrow Liver disease (more lipids in RBC
Abnormal Hb membrane)
↑HbA2, HbE (unstable
Normal HbA B-globin mut’n)
β-thal Low RBC folate, Low Serum B12
Normal RBCs: RBC spherocytes/ Abnormal RBCs  High Hcy only
minor High Hcy, high MMA,
↑ ↑ HbH (β4), HbH Acute bleed schistocytes: infarct spleen  (alcoholic?) (red tongue)
bodies, worse hemolysis Autoimmune or Sickle cells, target Folate deficiency, ↑ B12 deficiency,
anemia Hereditary spherocytosis cells, howell-jolly need, malabsorption
↑HbA2, ↑ HbF, malabsorption, ↑ need
HbH disease (3 α- Microangiopathic bodies Corrected w/ IF
NO HbA; hemolytic anemia Hemoglobinopathy (pernicious anemia:
globin gene
Hemolysis (MAHA): DIC, TTP, HUS (HbS, HbE, HbC) antibodies against
deletions) Not corrected w/ IF
triad, erythroid (HbE can be microcytic) IF/parietal cells)
bone expansion ↑ HbH (β4)
β-thal major α-thal trait (2 α- parasites
globin gene 4 α-globin gene
In >50yr old with normocytic/macrocytic No terminal ileum
deletions) deletions = hydrops
anemia, high calcium, bone pain, renal (Crohn's, celiac, deficiency, pancreatic disease Low stomach acid
fetalis; Hb Barts (γ4)!
issues/low albumin multiple myeloma resections) ↑ need, (no proteases) (esp in elderly)
Yan Yu, 2012 (www.yanyu.ca)
Anemia ([Hgb] < 120g/L)
Treatments

Microcytic Normocytic Macrocytic

(MCV < 80fL) (MCV 80-100fL) (MCV > 100fL)

Lead poisoning Rule out Reticulocytosis

(lead chelation)
Normal/high WBCs Low WBCs (pancytopenia)

Iron deficiency
oral iron (high dose, low Low/normal
compliance) retics High retics High retics Low/normal Normal blood smear Abnormal blood
IM/IV iron (for low oral (polychromasia) retics remove offending drug smear
tolerance, permanent iron Dysplastic (i.e.
malabsorption) Anemia of CD Myelodysplasia)
treat underlying disorder
Splenomegaly/
Erythropoiesis-stimulating agents (ESAs): Folate Deficiency
Hypersplenism RBCs in Rouleaux
EPO, darbepoietin oral supplement
Thalassemia treat underlying Infiltrative (acute formation (stacked like
transfusion (rarely needed) rarely parenternal
Dx: Ethnicity, family Hx, blood spleen issue leukemia) chips – multiple myeloma)
smear (HbH bodies), HPLC, Hgb  chemo/
electrophoresis hormonal cancer tx Aplastic anemia
stop causative agents & Target cells, normal WBCs
supplement B12/Folate. fix liver disease
HbE
Suppress T-Cells w/
Antithymocyte Globulin,
β-thalassemia
α-thal trait steroids, cyclosporin B12-deficiency
seen only after 6 mon Normal RBCs: RBC spherocytes/ Sickle-cell Anemia (HbSS):
No Tx Stem cell transplant
of life (after γ-globins Acute bleed, schistocytes: Sx: 1) vaso-occlusion of supportive care IF-treatment
stop being made) HbH disease AutoImmune or spleen, hands/feet, liver,
hemolysis (transfuse, antibiotics, etc)
 High HbA2, HbF No Tx For pernicious
Hereditary brain, bones...; 2) hemolysis
anemia
spherocytosis – RBCs abnormal; 1+2  3) Not corrected w/ IF
Microangiopathic end-organ damage
β-thal major hemolytic anemia Dx: HPLC, Hgb
β-thal (MAHA) electrophoresis IM B12 injections Oral B12 (high dose,
smear: target cells, Minor Tx: prevent infection w/ (replenish stores) 1000ug)
nucleated RBCs B/B0 abx, hydration, pain control, (1% not absorbed
Tx: lifelong or B/B+ O2 (↓ sickling), transfusion, through IF pathway)
transfusion w/ iron no Tx
chelation (IV or oral) avoid hypoxia, immunization
re encapsulated bacteria.