Hb pattern

20 18 16 14 12 10 8 6 4 2 0 term 1-3d 2w 1m 6m-2y 2-6y 6-12y 12-18y

criteria

AGE
CHILDREN 6 MONTHS - 6 YEAR CHILDREN 6 YEARS TO 14 YEARS ADULT MALES ADULT NON PREG FEMALES

Hb in g/dL
<11

<12
<13 <12

ADULT FEMALES

<11

PCV (Hematocrit)

Volume of RBCs Volume of whole blood

NORMAL ranges between 36-56

MCV
 Mean volume of an RBC

 NORMAL 80-100 Fl

MCH
 Mean amount of Hb in an RBC

 NORMAL 27-31 pg

MCHC
 Amount of Hb per unit volume of RBCs

 NORMAL

32-36 g/dL

RDW
 Spectrum of variation in the size of RBCs
 Anisocytosis  NORMAL 11.5-14

Reticulocyte count
 Differentiate anemia due to increased

destruction from anemia due to decreased production
 Assess response to therapy
 NORMAL newborn 2-6%

children 0.5-2%

Corrected reticulocyte count
 Corrected Retic Count = Retic % X (Patient's HCT/Normal HCT)

The normal corrected reticulocyte percentage is 1 - 2%.

TC, DC, platelet count
Other cell lines also affected  Megaloblastic anemia  Aplastic anemia  AML, ALL  Myeloproliferative diseases  Metastatic disease

PERIPHERAL SMEAR
RBC  Size  Color  Shape  Inclusion bodies  Immature cells WBC & PLATELETS

Microcytic hypochromic
 Reduced iron availability/ utilization

Iron deficiency, anemia of c/c diseases
 Reduced heme synthesis

lead poisoning, sideroblastic anemia
 Reduced globin synthesis

thalassemia & other hemoglobinopathies

Macrocytic anemia
 Abnormal nucleic acid maturation

cobalamine & Folate deficiency, drugs zidovudin, hydroxyurea
 Any condition causing reticulocytosis

hemolytic disease, c/c hemorrhage
 Alcohol, hypothyroidism, CLD

 Abnormal RBC maturation

MDS, a/c Leukemia, LGL

NORMOCYTIC NORMOCHROMIC
 A/C blood loss

 Anemia of c/c diseases
 CKD

others

iron deficiency parameters
 Depletion of stainable iron in bone marrow  Dec serum ferritin levels (<15mcg/ml)
 Inc RDW (>14.5)  Low serum iron (<75mcg/dl)  Inc TIBC (>470MCG/DL)

 low transferrin saturation (<14%)  inc red cell protoporphyrin

Peripheral smear

hyper segmented neutrophils & macro ovalocytes

Yes

no

likely Megaloblastic

likely non Megaloblastic

Bone marrow examination to confirm Megaloblastic anemia Response to vit B12 / folic acid therapy

Megaloblastic marrow & Anemia improves

Continue vit B12 / Folate non Megaloblastic marrow or no improvement

investigate for : intrinsic factor drug induced

If no hyper segmented neutrophils & macro ovalocytes

reticulocyte count

Decreased

increased

Hypothyroidism Liver disease

Hemolysis hemorrhage

When peripheral smear points towards an hemolytic etiology – •Osmotic fragility testing •Coombs test •Sickling test •Hb electrophoresis •Serum bilirubin & urine urobilinogen •LDH •Haptoglobin

When nutritonal anemia is suspected
- Iron status - B12 level - Folate level

 If other cell lines also affected

Initial management may depend on the severity of anemia & general condition of the patient

Definitive treatment of anemia depends on the etiology , so correct diagnosis of the cause is important

 Dietary counseling

 If nutritional anemia – correct Fe , vitB12 & folic

acid
 Parasitic infestations

 Fe deficiency anemia – oral iron preparations, par enteral iron & blood transfusion in severe cases

During an acute attack of hemolysis – maintain fluid balance & renal output

Thalassemia – blood transfusion & iron chelation therapy

Hereditary spherocytosis – splenectomy performed after 6 yrs of age with pre- surgical immunizations for Hib , strep. Pneumoniae & neisseria meningitidis