Classification of anemia Functional classification: Hypoproliferative destruction (infective hematopoiesis). Clinical classification: Causes of anemia (blood loss, IDA, hemolysis). Quantitative classification: Hematocrit Hemoglobin Blood cell indices (MCV, MCH, MCHC). Reticulocytes count.

Red cell indices MCV (mean corpuscular volume) The average volume of RBC Hct =  10 (fl) RBC count (m/µL) e.g. Hct= 40% RBC=5.0 (m /µL) MCV= 40/5.0  10 = 80 fl NR= 80-96 fl

MCH (mean corpuscular hemoglobin) The average content of Hb in average RBC. It is directly proportional to the amount of Hb and RBC size. Hb MCH =  10 (pg) RBC count (m/µL) e.g. Hb = 14 g/dl RBC = 4 (m/µL) MCH= 14/4  10 = 35 pg NR= 27-32 pg

MCHC (mean corpuscular hemoglobin concentration) Express the average concentration of hemoglobin per unit volume of RBC. It defined as the ratio of the weight of hemoglobin to volume of RBC. Hb (g/dl) MCHC=  100 (%) Hct (%) e.g. Hb = 14 g/dl Hct = 45 % MCHC 14/45  100 = 31% NR= 32-36%

Hemoglobin/Hematocrit Symptoms of Anemia Normal or High Hemoglobin/Hematocrit Check other Causes of symptoms e.g. Cardiac Pulmonary Low RBC indices MCV > 98 MCV < 80 MCHC < 32 MCV=80-96 History of acute blood loss Auto immune Hemolytic anemia Anemia of chronic Diseases Anemia of infection B12 and folate levels Serum iron and Total Iron binding capacity of Ferritin Low Iron IDA, chronic diseases, Renal diseases Normal Hb electrophoresis for Thala. High Iron BM exam For Sideroblastic anemia Low B12 PA, GI problems Severe malnutrition. Low folate Folate malnutrition GI problems Liver disease High or Normal MPD Liver Disease

Normal red cell morphology

Hypochromic Hyperchromic Macrocytic Microcytic

IDA Target cells Stomatocytes Sickle cells Poikiolocytosis Acanthocytes Spherocytes Nucleated RBC Ovalocyte