SAN FERNANDO, PAMPANGA

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 MACROCYTIC ANEMIA

THE ORDER PERIPHERAL SMEAR TO EVALUATE FOR

HYPERSEGMENTED NEUTROPHILS THAT INDICATES
THE MEGALOBLASTIC ANEMIA

NON-MEGALOBLASTIC ANEMIA
MEGALOBLASTIC ANEMIA

OBTAIN RETICULOCYTE COUNT

TEST FOLATE AND VITAMIN B12 LEVELS

LOW HIGH

VITAMIN B12 LEVEL LOW FOLATE LEVEL LOW BOTH LEVELS LOW and NORMAL
EVALUATE FOR ALCOHOLISM, EVALUATE FOR
HYPOTHYROIDISM, OR HEMOLYSIS OR
Treat and retest, consider Treat and retest, HEPATIC DISEASE HEMORRHAGE
treating for pernicious provide dietary
anemia or ileal disease counseling
REFER TO PEDIATRIC HEMATOLOGIST
FOR CONSIDERATION OF BONE CAUSE UNKNOWN
NO IMPROVEMENT MARROW DISORDERS
DEFICIENCY DIAGNOSIS EVALUATION
Pernecious anaemia, Nutritional, Schilling’s test, Anti-IF and Anti Parietal
Vitamin B12
Malabsorption cell antibodies
Folate Nutritional, Malabsorption History and examination
Both Malabsorption History and examination
Inherited DNA synthesis defects,
None History
cytotoxic drugs

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 NORMOCYTIC ANEMIAS
(MCV 80-100 um3)

Corrected reticulocyte count

<3% >3 %

 Blood loss <1 week INTRINSIC RBC DEFECT

EXTRINSIC RBC DEFECT
 Early-stage iron deficiency Membrane defects:
 Early-stage anemia  Hereditary spherocytosis  Blood loss >1 week
chronic disease  Hereditary elliptocytosis  Immune hemolytic anemias
 Aplastic anemia  Paroxysmal nocturnal  Micro/macroangiopathic
 Renal disease hemoglobinuria hemolytic anemia
 Malignancy Abnormal hemoglobins:  Malaria
 Sickle cell disease
Deficient enzymes:
 G6PD deficiency
 Pyruvate kinase deficiency

NORMOCYTIC ANEMIA:

TYPE OF NORMOCYTIC PERIPHERAL BLOOD BONE MARROW

ANEMIA
APLASTIC ANEMIA AA is defined by peripheral a hypoplastic bone marrow
blood pancytopenia with a that has fatty replacement

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 hypocellular bone marrow in
which normal hemopoiesis is
replaced to a greater or
lesser extent by fat cells in
the absence of genetic,
malignant or predictable
myelosuppressive causes.
ACQUIRED APLASTIC ANEMIA AA is defined by peripheral
blood pancytopenia with a
hypocellular bone marrow in
which normal hemopoiesis is
replaced to a greater or
lesser extent by fat cells in
the absence of genetic,
malignant or predictable
myelosuppressive causes.
INHERITED APLASTIC ANEMIA
FANCONI’S ANEMIA May look for dark spots on
the skin called café au lait
spots. The most common test
for Fanconi anemia is a blood
test called a chromosomal
breakage test.
PURE RED CELL APLASIA Defined by a normocytic
normochromic anemia with
severe reticulocytopenia and
marked reduction or absence
of erythroid precursors from
the bone marrow. Diamond-
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and that may have relatively
increased nonhematopoietic
elements, such as mast cells
Acquired aplastic anemia
(AA) is characterized by a
hypoplastic, fatty bone
marrow (BM) with profound
reductions in hematopoietic
stem/progenitor cells
(HSCs/HPCs) that lead to
defective mature blood cell
production and peripheral
pancytopenia
Aplastic anemia occurs when
your bone marrow doesn't
make enough red and white
blood cells, and platelets.
Having fewer red blood cells
causes hemoglobin to drop.
FA is a rare, inherited blood
disorder that prevents the
bone marrow from producing
enough new blood cells for
the body to function properly,
or that causes the bone
marrow to make faulty blood
cells.
a bone marrow disorder
characterized by a reduction
of red blood cells
(erythrocytes) produced by
the bone marrow. Signs and
symptoms may include
 Blackfan anemia is a
congenital form of PRCA
DIAMOND BLACKFAN-ANEMIA A bone marrow aspiration
and biopsy (removing a small
amount of the liquid portion of
bone marrow through a
needle) along with genetic
testing can confirm the
diagnosis
MYELOPTHISIC ANEMIA The peripheral blood smear
will show characteristic
leukoerythroblastic reactions
with the presence of
immature myeloid and
nucleated erythrocytes,
including abnormal
erythrocytes such as
schistocytes, and dacrocytes
(teardrop) and
anisopoikilocytosis cells
fatigue, lethargy, and/or
abnormal paleness of the
skin (pallor) due to the
anemia the caused by the
disorder.
DBA the bone marrow cannot
make enough red blood cells
to meet the body's needs.
DBA is characterized by a
shortage of red blood cells
which usually becomes
evident during the first year of
life when the patient develops
anemia
Bone marrow fibrosis often
occurs as a secondary
process as well.
Splenomegaly may develop.
Characteristic changes in
peripheral blood include
anisocytosis, poikilocytosis,
and excessive numbers of
red blood cell and white
blood cell precursors.

MACROCYTIC ANEMIA:

TYPE OF MACROCYTIC
PERIPHERAL BLOOD
ANEMIA
MEGALOBLASTIC ANEMIA Megaloblasts are large
nucleated red blood cell
precursors with no condensed
BONE MARROW MISCELLANEOUS
bone marrow produces Form of anemia
unusually large, structurally characterized by very large
abnormal, immature red blood red blood cells and a

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chromatin.
causes the body to produce
abnormally large red blood cells
that cannot function properly.
FOLATE DEFICIENCY
Red blood cells carry oxygen
around the body using a
substance called hemoglobin.
Well recognized and reversible
Round macrocytes are
commonly seen in a variety of
Macrocytic anemias secondary
chronic illnesses, and round
target-appearing macrocytes
deficiency are characterized by
VITAMIN B12 DEFICIENCY are characteristic of liver
disease such as hepatitis,
obstructive jaundice, and acute
marrow, attributable to flaws in
and chronic alcoholism with liver
disease
Disease conditions can also
limit iron absorption; this can
happen as a result of insufficient
stomach acid, lack of intrinsic
IMPAIRED ABSORPTION factor (IF), celiac disease,
abnormal, immature red blood
inflammatory conditions such as
Crohn's disease, and in
autoimmune diseases and
hormone imbalances.
decrease in the number of
those cells. Anemias are
blood disorders that occur
when the body has fewer
cells (megaloblasts) red blood cells than
normal. Red blood cells
carry oxygen throughout
the body using a protein
called hemoglobin.
the lack of folic acid in the
blood. Folic acid is a B
the red blood cells are
vitamin that helps your
abnormally large. Such cells
body make red blood cells.
are called macrocytes. They
If you don't have enough
are also called megaloblasts,
red blood cells, you have
when they are seen in the
anemia. Red blood cells
bone marrow
carry oxygen to all parts of
your body.
Weakness and fatigue are
cause of bone marrow failure.
common symptoms of
vitamin B12 deficiency.
to folate and/or vitamin B12
They occur because your
body doesn't have enough
typical morphological
vitamin B12 to make red
abnormalities in the bone
blood cells, which transport
oxygen throughout your
both the synthesis and repair
body.
of DNA
Malabsorption is a clinical
term that refers to the
impaired absorption of
bone marrow produces
nutrients. It encompasses
unusually large, structurally
defects that occur during
the digestion and
cells (megaloblasts)
absorption of food nutrients
by, and infections of, the
gastrointestinal tract

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