INTRODUCTION TO ANEMIA

ANEMIA (a Quantitative hematologic Physiologic Response to Anemia

disorder)
• Chemical and physical response
• Associated with decreased Red Cell o Compensations:
Mass (RCM) ▪ Shift to the right (↓ O2
o RCM: synonymous to affinity, ↑ 2,3- DPG)
circulating RBCs in the body ▪ Selective redistribution of
o Increased RCM: Polycythemia blood flow in areas with
and Erythrocytosis highest oxygen demand
• From Greek word “anaimia” meaning ▪ Increased cardiac output
“without blood” and RR
• Functional definition: Decreased in
oxygen carrying capacity of the blood Physiologic Response to Anemia
because of decrease RCM • Hematologic response
• Used to denote conditions association o Slower but more effective
with decreased RBCs and decreased o Kidney will Increased EPO (6-
Hb concentration which leads to 8x) takes 1 week
hypoxia ▪ Presence of "shift
• Classic symptoms of anemia: Fatigue reticulocytes" or Stress
and shortness of breath reticulocytes
o ↓ RCM • Larger (release
o ↓ Hb from bone
• Other symptoms marrow)
o Increased heart rate, RR • Immature retic
o Headache • 2-3 days before
o Chest pain it becomes
• In reference to hemoglobin levels mature – they
o Polycythemia and help because
erythrocytosis: in relation to these cells
hematocrit levels though they ae
o Suffix cytosis: Increase in the not yet fully
number of a specified type of mature they
cells have hemoglobin
o Suffix Polycythemia: Increase already where
new cell in the blood esp. RBC; oxygen can
Hypervolemia & hyper viscosity already bind for
▪ Absolute: True ↑ in the delivery of
RCM oxygen
▪ Relative: 2nd to • Increased RPI
change in plasma; it
(Retic Production
might be due to
Index) – useful
increase in the
tool in assessing
plasma volume of
if the bone
the blood
marrow is
responding
o Categories
adequately to
▪ Hypo-proliferative
anemia
anemia
▪ Maturation disorders
• Ineffective erythropoiesis
▪ Hemolytic disorders
o Refers to the production of
▪ Blood loss
erythroid precursor cells that
are defective
 INTRODUCTION TO ANEMIA
o Defective RBC precursors
undergo apoptosis (natural
Two widely used classification schemes:
cell death)
Morphology of red blood cells and
o RBC production is high (↓ cells
pathophysiological conditions responsible for
in the circulation)
patients’ anemia
o Ex. Megaloblastic anemia

• Insufficient erythropoiesis CLASSIFICATION

o Refers to a decrease in the
number of erythroid Morphologic classification
precursors in the bone
marrow o Established using RBC
o Decreased RBC production indices and direct
examination of
LABORATORY DIAGNOSIS morphology using
peripheral blood smear
• Complete blood count with RBC o Anemia is classified
indices according to RBC size and
o CBC hemoglobin content
▪ Hematocrit • The MCV is the average
▪ Hemoglobin volume(size) of the RBC,
▪ RBC count expressed in femtoliters (fL), or
o RBC indices 10-15:
▪ MCV o MCV= Hct(%) x 10/RBC
▪ MCH count (x 1012/L)
▪ MCHC o Normal: 80-100 fL
• Reticulocyte count – whether the o Microcytic: < 80
bone marrow is responding to o Macrocytic >100
anemia
• Peripheral blood film
examination
o Color
o RBC inclusions; shape
o Anisocytosis - red blood
cells of varying sizes on
your blood smear
o Poikilocytosis - red blood • MCH is the average weight of
cells of varying shapes on hemoglobin in an RBC,
your blood smear expressed in picograms (pg), or
o Bone marrow 10-12 g:
examination- if hindi nila o MCH= Hb (g/dL) x 10/ RBC
ma pinpoint ang mismong count (x 1012/L)
cause ng anemia o Normal range: 26-32 pg
OTHER TESTS
• Urinalysis
• Occult blood test
• Serum haptoglobin
(intravascular hemolysis)
• Lactate dehydrogenase
• Bilirubin
• Renal and hepatic function test
 INTRODUCTION TO ANEMIA
• MCHC is the average ▪ MCV up to 150 fL
concentration of hemoglobin in ▪ Caused by
each individual erythrocyte. The asynchrony between
units used are grams per nuclear and
deciliter (formerly given as cytoplasmic
percentage): development as a
o MCHC= Hb (g/dL) x 100/ result of impaired
Hct (%) DNA synthesis
o Normal range: 32-36 g/dL; o Macrocytic anemia (non-
Normochromic → pallor of megaloblastic)
1/3 ▪ MCV <115 fL
o Hypochromic: <32; pallor ▪ Related to
>1/3 membrane changes
Note: Hyperchromic – misnomer; no owing to disruption
such thing as that except spherocytes of the cholesterol-
to- phospholipid
ratio
o Normocytic Anemia
▪ MCV 80-100 fL
▪ RBC morphology
must be examined to
rule out dimorphic
(big and small cell)
population
▪ May be due to
premature
CLASSIFICATION destruction and
shortened survival of
• Morphologic classification: MCV RBCs
o Microcytic anemia + • Characterized
hypochromic by elevated
▪ MCV <80 fL (<6 um reticulocyte
in diameter) count
▪ MCHC<32 g/dL ▪ May be due to
(increased central decrease production
pallor) or RBCs
▪ Caused by • Characterized
conditions that result by decreased
in reduced reticulocyte
hemoglobin count
synthesis
o Macrocytic anemia
▪ MCV >100 fL (>8 um
in diameter)
▪ Caused by
conditions that result
in megaloblastic and
non-megaloblastic
red cell development
in the bone marrow
o Macrocytic anemia
(Megaloblastic)
 INTRODUCTION TO ANEMIA
SITC: Sideroblastic anemia; Iron erythropoietic
deficiency anemia; Thalassemia; activity of the bone
Chronic inflammation marrow
o Reticulocyte
• MCV: represents the mean size ▪ Any nonnucleated
of the given heterogeneous RBC RBC that
population contains two or
☺ Does not reflect size variation more particles
with the population of blue—
stained
granulofilamentous
Red cell Distribution Width or RDW:
material after
index of variation of red cell volume
supravital staining:
☺ Size distribution measurement
 Anisocytosis – if the red • In a slide drop
blood cell is malalki or blood (whole
maliliit blood; EDTA)
+ New
methylene
• RDW: coefficient of variation of blue (2-3
RBC volume expressed in drops w/o
percentage smearing) →
o Indicated the variation in incubate @RT
RBC volume for 3-10 mins
o Used in conjunction with = then smear
MCV ▪ Normallly: 0.5-
• RDW + MCV 2.0% in the
o Subclassification: circulation
o Normal RDW: ▪ Number of
homogeneous reticulocyte/1000
o Increased RDW: (RBCs observed) x
heterogeneous 100 = percentage
reticulocytes
• Example:
reticulocyte
(%) =
15/1000 x 100
= 1.5%
• Or the number
of reticulocyte
counted can
PHYSIOLOGIC CLASSIFICATION be multiplied
by 0.1
(100/1000) to
o Based on the ability of the bone
marrow to respond anemia with
increased erythropoiesis
o Assesses reticulocyte count and
RPI
o Reticulocyte count
▪ Serve as an
important tool to
assess
 INTRODUCTION TO ANEMIA
obtain the
result.
• Adjustment in the reticulocyte count
due to the presence of shift
reticulocytes

• Reference range: An adequate

bone marrow response usually is
indicated by an RPI that is greater
than 3. An inadequate
erythropoietic response is seen
when RPI is less than 2.
• < 2.0
o Hypo proliferative
a. Normocytic,
Normochromic
b. Bone marrow
examination ex.
Aplastic anemia
o Maturation Disorder
a. Microcytic: low MCV;
nucleus mature, and
cytoplasm may
problema
• SIT-C: iron
deficiency,
heme problem,
or globin or
hemoglobin
problem→
Require iron
studies and Hb
electrophoresis
b. Macrocytic: depends
on the type of
megaloblastic or non;
delay of nuclear
Reticulocyte production index maturation compared
with cytoplasmic
o Useful when there is maturation
polychromasia→ pertains to • Megaloblastic:
150 fL –vitamin
RBC that has a bluish inch?
Under the microscope using B12/ folate def.
wright stain
• Non
megaloblastic <
115 fL—liver
disorder
 INTRODUCTION TO ANEMIA
c. RPI >3.0
• Normo, Normo
(slightly increased
in MCV)
o Hemolytic
anemia—
caused by
hereditary or
acquired
either intrinsic
or extrinsic
defect →
Blood film for
detection of
Poikilocytoses
o Blood loss

ETIOLOGIC CLASSIFICATION

• Focuses on the principal underlying

pathophysiologic mechanisms
• Not reliable

 Useful approach: taking patient

history and performing physical
examination