Is a sign of disease
Not a final diagnosis

The goal of the diagnostic
evaluation is to determine
the cause of anemia

Reduction in the hemoglobin concentration or
red blood cells per cubic millimeter below the
range of values occurring in healthy persons.

ANEMIA (WHO criteria)
Age

Hb (g/dl)

6 mo - < 5 yrs

< 11

> 5 yrs

< 12

   Biconcave shaped disc with no nucleus Large surface area facilitates the uptake of O2 and CO2 25 trillion RBC’s in the human body .

NORMAL BLOOD SMEAR .

cobalt Vitamins – B12. patethoic acid. Mangenese. Stem cell factor. folate. B6. C. E Amino acids Hormones – GM-CSF. riboflavin.     Erythropoetin Metals . thiamine. thyroxine and androgens .Fe.

Hematopoiesis .

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white cell. and platelets) Usually indicates bone marrow involvement.It is important to establish :  A single cell line problem (red blood cells) Or  A multiple cell line problem (red cell. immunologic disorders. peripheral destruction of cells .

Marrow failure b. Abnormalities of cytoplasmic maturation d. Disorders of effective red cell production a. Impaired erythropoietin production c. Dyserythropoietic. .1. Abnormalities of nuclear maturation e.

i. f. g. c. b. Defects of hemoglobin Defects of the red cell membrane Defects of red cell metabolism Antibody-mediated Mechanical injury to the erythrocyte Thermal injury to the erythrocyte Oxidant-induced red cell injury Paroxysmal nocturnal hb-uria Hypersplenism . Disorders of increased red cell destruction a. h. d.2. e.

3. Blood Loss .

4. 5. . 2.1. Determination of underlying cause of anemia by additional test. BMP (if required). Detailed history and physical examination Complete blood count. Determination of morphologic characteristics and RDW. 3.

Maternal history 2. Patient history . Family history 3.1.

    Pregnancy/delivery complications Anemic during pregnancy Pica/ nonfood product ingestion Drug ingestion .

       Anemia Jaundice Splenomegaly Gallstones Cancer Transfusion Bleeding disorders .

Endocrinopathy. Liver disease . Evidence of chronic disease/ infection. Medications. Easy bruising/blood loss. Prematurity.          Anemia (acute or chronic) Acute or recent infection. Diet history. Hyperbilirubinemia.

 Normal HR more chronic process  Jaundice hemolytic process  Splenomegaly inherited hemolytic anemia.Several clues to the etiology :  Tachycardia acute process with poor compensation. malignancy. portal hypertension .

BLOOD SMEAR  Microcytic Anemia (MCV<80fl)  Normocytic Anemia (MCV 80100 fl)  Macrocytic Anemia (MCV >100 fl) .

94 80 .Age (yrs) 1 .121 70 .84 73 .85 75 .5 – 2 2–4 5–7 8 – 11 12 – 14 15 – 17 18 – 19 MCV (fl) 95 .3 days 0.100 .90 78 .91 78 .87 77 .

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ANEMIA MCV MICROCYTIC NORMOCYTI C Reticulocyte count Iron Deficiency High Coombs Test Negative Thalassemia Bilirubin Chronic Normal High disease Hb-pathy Lead Membrane defect Hemolyti Hemorrhag poisoning c infection e Secondary : drugs. MACROCYTI C Positive Autoimmune Isoimmune Coombs test .

ANEMIA MCV MICROCYTIC NORMOCYTIC MACROCYTI C Reticulocyte  Leukocyte & Platelets Low Normal Malignancy Pure red cell aplasia Diamond Blackfan Transient erythroblastopenia Aplastic Anemia Increased Infection .

ANEMIA MCV MICROCYTIC MACROCYTIC Folate deficiency Vit B12 defic. Aplastic anemia Preleukemia Liver disease NORMOCYTI C .

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5 – 14.RDW (Red cell distribution width) = variation of the erythrocyte volume distribution. anisocytosis (++) Reticulocyte = indicator of bone marrow activities Anisocytosis = variation in size Poikilocytosis = variation in shape .5%) Normal RDW = homogen. (N = 11. slight anisocytosis RDW  = heterogen.

RDW. retyculocytes. Look at : RBC count (erytrocyte count).  hipokrom poikilositosis. blood smear Erytrocyte RDW Trait Thal  N ADB Thal N /    Retic  Slide poikilositosis (+) N / anisositosis (+). anisositosis (++) hipokrom .

       Defects of hemoglobin : sickle cell Defects of the red cell membrane : spherocytosis Defects in red cell metabolism : G6PD. pyrivate kinase deficiency Immune hemolysis Physical / chemical damage to red cells Infectious agent-induced damage : malaria Paroxysmal nocturnal hb-uria (PNH) .

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Hb electrophoresis .   History P.blood smear .Coombs test .elevated reticulocyte count . Lab : .osmotic fragility .E.specific enzyme assay .