CLASSIFICATION OF ANAEMIA By GEORGE

CLASSIFICATION OF ANAEMIA

Anaemia is mainly based on the cause but it can also be classified on the basis of Red blood cells morphology on a stained blood or bone marrow smear. classification due to cause of Anaemia 1. Blood loss or Hemorrhagic anaemia This is the anaemia resulting from either acute massive blood loss or chronic blood loss. ie acute massive blood loss including accidents, antepartum and postpartum hemorrhage. Chronic blood loss can be due to GIT lesions, cancers, hypermenorrhea, parasitic infestation e.g hookworm infection. Blood transfusion is a reliable means of rapidly restoring blood volume.

Laboratory diagnosis  Hb is low  PCV is low  MCV, MCH, MCHC are usually normal Microscopic examination  RBCs.Normocytic normochromic.Polychromasia.Erythroblasts  WBCs.Normal in number and morphology.There can be neutrophil leucocytosis with toxic granulation  Platelets.usually normal but as time goes on thrombocytosis exists

Cont… 2.Haemolytic Anaemia This is anaemia due to excessive destruction and breakdown (haemolysis) of Red blood cells either extra vascularly (RBCs are destroyed by macrophages in the spleen, liver and bone marrow.) or intra vascularly (RBCs are destroyed in blood vessels e.g. malaria, incompatible BT, toxic chemicals and drugs). After 120 days RBCs are removed from circulation by the cells of RES. But the important feature of haemolysis is the shortened lifespan of the individual RBCs. i. Hereditary haemolytic Anaemia Here the abnormality is passed from the parents to the child.eg a. sickle cell disease It is an hereditary disease in which the RBCs of a person contain abnormal Hb. Here the amino acid Valine replaces the Glutamic acid of a normal HbA at partition 6 of the globlin molecule.

Laboratory diagnosis Sickle cell disease It is the homozygous state of the a disease HbSS  Hb is low  ESR is low  PCV is low  MCV, MCH, MCHC are normal although MCV may be higher because of polychromatic red cells. (CBC in 12 months old child) HBMCVWBCPlatelets Normal (AA)Normal HbASNormal HbSS6 – 9g/dLNormalNormal or Increased

Microscopic examination  RBCs.Marked Polychromasia.Sickled RBCs.Erythroblasts.Target cells.Howell jolly bodies  WBCs.Normal or Increased in number  Platelets.Normal

Sickled RBCs Normal RBCs

Hereditary haemolytic Anaemia cont… b. Hereditary Spherocytosis RBCs are more spherical and lack the central area of pallor on a stained blood film

Laboratory diagnosis  Hb is low  PCV is low  MCHC and MCH are high  MCV is low Microscopic examination  RBCs.Spherocytes.Polychromasia  WBCs.Normal  Platelets. Normal

Hereditary haemolytic Anaemia cont… c. Hereditary Elliptocytosis Is a membrane defect where the RBCs are oval or elliptical in shape

Hereditary haemolytic Anaemia cont… d. Paroxysmal Nocturnal Haemoglobinuria Is a rare acquired life threatening disease of blood characterized by destruction of RBCs by the complement system. Laboratory diagnosis  Hb is low  PCV is low  MCH, MCHC and MCV may be decreased Microscopic examination  RBCs.Marked Polychromasia.Microcytic cells  WBCs.Abnormal Morphology and distribution  Platelets.Thrombocytopenia

Paroxysmal Nocturnal Haemoglobinuria

ii. Acquired Haemolytic Anaemia Here the abnormality is acquired during life, the person is born normal.eg i. Haemolytic Disease of the Newborn (HDN) It’s due to ABO and rhesus incompatibility between the mother and the fetus. ii. incompatible blood transfusion This is due to ABO mismatch between the donor blood and patients serum. Laboratory diagnosis  Hb is low  PCV is low  MCV is high  MCHC and MCH are normal

Microscopic examination  RBCs.Nucleated.Polychromasia.Schistocytes  WBCs.Usually Normal  Platelets.Normal in number and morphology iii. Auto Immune Haemolytic Anaemia Here the person develops an antibody against own red cells

iv. Plasmodium parasite infection

Laboratory diagnosis  Hb is low  PCV is low  MCV, MCH and MCHC maybe normal Microscopic examination  RBCs.infected with plasmodium  WBCs.Maybe normal in low parasiteamia  Platelets.Decreased

3.Deficiency Anaemia(Nutritional) This is anaemia caused by lack or deficiency of one or more substances necessary for Hb synthesis. eg Iron and materials necessary for growth of blood cells. eg Vitamin B12 or Folic Acid. a. Iron deficiency Anaemia It’s lack of iron in the body due to;  Impaired absorption of iron in the GIT  Insufficient iron in the diet  Hookworm infestation  Depletion of body iron stores Laboratory diagnosis  Hb is low  PCV is low  MCH,MCV and MCHC will be low  RDW is raised

Microscopic examination  RBCs.Marked Hypochromasia.Microcytosis.Target cells.Poikilocytes.Pencil shaped cells.Tear drop cells  WBCs.Normal in number and morphology but it increases and in case of hookworm infestation, eosinophilia is seen.  Platelets.Normal in number and morphology

Iron deficiency Anaemia cont…  Biochemical tests

Iron deficiency Anaemia cont…

3.Deficiency Anaemia(Nutritional) b. Vitamin B12/Folic acid deficiency Anaemia It’s lack of Vitamin B12 or Folic acid due to;  Impaired absorption in the GIT  Insufficient Vitamin B12 and Folic acid in the Diet  Worm infestation especially D.latum  Lack of gastric intrinsic factor and HCL in the stomuch Laboratory diagnosis  Hb is low  PCV is low  MCV is high  MCH and MCHC are Normal

Microscopic examination  RBCs.Anisocytosis.Macrocytes.Ovalocytes.Howell jolly bodies  WBCs.Neutrophils with hypersegmented nuclear lobes are common  Giant Platelets are common

classification due to cause of Anaemia cont… 4. Aplastic anaemia Is anaemia due to replacement of haemopoietic tissues of the red bone marrow by fibrous non haemopoietic tissues. Causes include; Certain drugs Irradiation Diseases such as Viral Hepatitis Bone marrow invasion by abnormal cells such as leukemia Laboratory diagnosis  Hb low (sometimes normal depending on the extent of marrow aplasia)  PCV maybe normal  MCH, MCH and MCHC may also be normal

Aplastic anaemia cont… Microscopic examination  RBCs.Normochromic normocytic.Slight Macrocytes.Decreased Reticulocytes count (less than 1%)  WBCs.Leucopenia  Platelets.Thrombocytopenia

Aplastic anaemia cont… Nomal BMS Aplastic Anaemia BMS

classification due to cause of Anaemia cont… 5. Anaemia of Chronic Diseases This arises due to some chronic illness such as TB, Leukemia, Multiple Myeloma (Myelomatosis) AML

Morphological classification of Anaemia 1. Normocytic Normochromic Anaemia Here the cells stain normally, ie normal colour and shape. Conditions include;.Blood loss Anaemia.Aplastic Anaemia Laboratory diagnosis  Hb ≤ 12 g/dL  MCV 80 – 100  MCHC > 30 Microscopic examination  RBCs.Appear normal

Morphological classification of Anaemia cont… 2. Hypochromic Microcytic Here RBCs are under stained due to loss of Hb and majority are smaller in size than normal. Conditions include;.Iron deficiency anaemia.sideroblastic anaemia. Thalassemias.Anaemia of chronic disease Laboratory diagnosis  MCV is low (< 80)  MCHC is low (< 31)

Hypochromic Microcytic cont… Microscopic examination  RBCs.Anisocytosis.Anisochromasia ( marked variability in colour density of erythrocytes which indicates unequal hemoglobin content of RBCs ).Elliptocytosis.Basophilic stippling.Target cells.Tear drop cells

classification due to cause of Anaemia cont… 3. Normochromic Macrocytic Anaemia Here the RBCs stain normally (pink) but majority are larger in size than normal. Conditions include;.Vitamin B12/ Folic Acid deficiency Anaemia.Some Haemolytic Anaemias.Liver disease. Laboratory diagnosis  MCV is high > 100  MCHC is always normal

Normochromic Macrocytic Anaemia cont… Microscopic examination  RBCs.Ovalocytes.Macrocytes.Howell jolly bodies.Anisocytes.Poikilocytes

CLASSIFICATION OF ANAEMIA END Thanks