INTRODUCTION OF

ANAEMIA

DR. KIRAN AAMIR

FCPS Haematology
Associate Professor Pathology
LUMHS, Jamshoro
 Anaemia

A reduction in O2-carrying capacity of blood

due to reduction in the concentration of Hb
(or RBC or Hct%) with reference to that age
and sex.
Normal Adult Red Cell Indices
Classification of Anemia

Pathophysiological

Morphological
Pathophysiological Classification
(Causes of anemia)

Blood Loss

Decrease RBC production

Increase RBC destruction

Hereditary Acquired
Membrane Immune
Hereditary spherocytosis Autoimmune
hereditary elliptocytosis Warm antibody type
Cold antibody type
Metabolism
Alloimmune
G6PD deficiency, Haemolytic transfusion reactions
pyruvate kinase deficiency Haemolytic disease of the newborn
Haemoglobin Allografts, especially stem cell transplantation
Thalassaemia Drug associated
Genetic abnormalities (Hb S, Hb C, unstable) Non-immune
Red cell fragmentation syndromes
March haemoglobinuria,Infections
Chemical and physical agents
Secondary
Liver and renal disease
Paroxysmal nocturnal haemoglobinuria
 Morphological Classification Of Anaemia
Microcytic, Hypochromic Normocytic, Normochromic

MCV <80 MCV 80–95 fL

MCH <27 pg MCH ≥27 pg
Iron deficiency Anaemia of chronic disease
Thalassaemia After acute blood loss
Lead poisoning Renal disease,Mixed deficiencies,Bone
Sideroblastic anaemia marrow failure (e.g.post-chemotherapy,
Anaemia of chronic disease infiltration by carcinoma, etc.)
 Macrocytic
MCV >95 fL

Megaloblastic
vitamin B12 or
folate deficiency

Non Megaloblastic
Alcohol, liver disease,
myelodysplasia,Aplastic
anaemia
Hypothyroidism
Approach To
Diagnose
Anaemia
 Symptoms
► Shortness of breathing on
exercise
► Palpitation
► Weakness, lethargy, head aches
► Symptoms of cardiac failure,
angina pectoris or intermittent
claudication or confusion
 General Sign
 Pallor of mucous
membrane/ conjunctiva
 Tachycardia
 Cardiomegaly
 Systolic flow murmur
 Specific Sign
Iron Deficiency Anemia
• Koilonychia
• angular cheilosis

Megaloblastic Anemia
• Glossitis
• NTD

Hemolytic or megaloblastic anaemia

• Jaundice
 Specific Sign
 Leg ulcer with sickle cell

 Bone deformities with thalassaemia major

 Excess infection and spontaneous bruising

may occur in bone marrow failure
 Laboratory Investigations

CBC: Hb, RBC,Hct ,MCV,

MCH,RDW,WBCs,Platelets
Red cell morphology ( peripheral smear)

Reticulocyte count
Normocytic Normochromic Microcytic /Hypochromic
Macrocytosis

Round
Megaloblastic Anaemia
 Elliptocytes

IDA Target cells

Fragmented RBCs
Ovalocyte Spherocytes Sickle cells
 Lab. investigation of anaemia
► Serum iron ► S. vitamin B12 concentration
Men and women 10–30 mmol/l (0.6–1.7 mg/l) 180–640 ng/l
► Total iron-binding capacity
► Serum folate concentration
47–70 mmol/l (2.5–4.0 mg/l)
3–20 mg/l (6.8–45 nmol/l)
► Transferrin saturation 16–50%
► Red cell folate concentration

► Serum ferritin concentration 160–640 mg/l (0.36–1.45 mmol/l)

Men 15–300 mg/l

Women 15–200 mg/l
 Lab. Investigation of Anaemia
Red cell enzymes

Hb electrophoresis

Coombs tests

Liver, renal, endocrine functional tests

Urinalysis
• Hemosiderin

Occult GI bleeding / parasites etc