1. Classification of Anaemia
By,
Mosaab A. Omar

2. What is Anaemia? Definition of Anaemia
Anemia is reduced Haemoglobin concentration in blood more than the amount appropriate for that age, sex, race and physiological status.
Normal ranges of Hb
Men: Hb g/dL
Women: Hb g/dL
Infants : Hb 14 – g/dL

4. Classification of anaemia Blood loss Normocytic Macrocytic Microcytic
On the basis of cause
Blood loss
Inadequate production of normal blood cells
Excessive destruction of blood cells
On the basis of morphology of RBC
Normocytic
Macrocytic
Microcytic

5. Classification according to Morphology of RBC
The average size of RBC (MCV) provides a convenient and informative framework to categorize the various types of anaemia

6. Normocytic Normochromic Anaemia
The primary cause - reduction of number of RBCs.
Eg: Endocrine disorders (hypopituitarism, hypothyroidism and hypoadrenalism)
Haematological disorders(aplastic anaemia ,haemolytic anaemias)
Acute blood loss
Anaemia of chronic diseases

7. Normal
Put a normal BP
Normocytic

8. Bone marrow disorders(Aplastic anaemia)
Normocytic anaemia can be presented with elevation of reticulocyte count or a reduction of reticulocyte count.
Elivated reticulocyte count
Normal or low reticulocyte count
Blood loss anaemia
Haemolytic anaemia
Bone marrow disorders(Aplastic anaemia)
Chronic disease
Kidney disease

9. Microcytic Anaemia Many RBCs smaller than normal (MCV<80fL)
The RBCs are usually hypochromic (MCH<27pg)
Increased zone of central pallor
Cells are various in shape & size

10. Normal Microcytic Put a normal BP
Try to find a better picture of microcytic BP
Microcytic

11. Iron deficiency anaemia due to inadequate iron for Hb synthesis)
Microcytic Anaemia
Iron deficiency anaemia
Serum Ferritin level > 50µg/L
due to inadequate iron for Hb synthesis)
Due to other reasons
Thalassaemia trait (α or β)
Anaemia of chronic disease
Sideroblastic anaemia(Inherited)
Lead poisoning

12. Sideroblastic anaemia
Bone Marrow Picture

13. Macrocytic Anaemia
The average size of RBCs are larger than normal(>100fL)
{MCHC is normal or high}
Can be divided in to 2 types
Megaloblastic anaemia
Non megaloblastic anaemia
FL (femtoliters)

14. Normal
Macrocytic

15. A. MEGALOBLASTIC ANAEMIA B. Non megaloblastic anaemia
Macrocytic Anaemia
A. MEGALOBLASTIC ANAEMIA
Vitamin B12 deficiency
Folate deficiency
Abnormal metabolism of folate and vit B12
B. Non megaloblastic anaemia
Liver disease
Alcoholism
Post splenoctomy
Neonatal macrocytosis
Stress erythropoiesis

16. Increase destruction Impaired production Anaemia (hypoproliferative)
(on the basis of cause)
(Haemorrhagic)
Blood loss
Impaired production
(hypoproliferative)
Increase destruction
(Haemolytic)

17. Reduced RBC Production
Stem cell defects Aplastic anaemia
Nutritional deficiency Fe deficiency anaemia
Erythropoietin deficiency Chronic renal faliure
Hormone deficiency Hypothyroidism
Inhibitory effects of Cytokines Chronic diseases
Unsuitable microenvironment Secondary deposits

18. Increased Loss (Anaemia due to haemorrhage)
Acute blood loss
Chronic blood loss

19. Haemolytic Anaemia Inherited Aquired Red cell membrane defects
Hb abnormalities
Metabolic disorders of RBC
Aquired
immune
Non immune

20. Inherited haemolytic anaemia 1)Red cell membrane defects
Eg:
Hereditary spherocytosis
Hereditary Elliptocytosis
Hereditary Stomatocytosis

21. Eliptocytosis
Spherocytosis
Stomatocytosis

22. Inherited haemolytic anaemia 2)Hb abnormalities
Eg:
Thalassaemia
Sickle Cell Anaemia

23. Thalassaemia
Target cells

24. Sickle Cell Anaemia

25. Inherited haemolytic anaemia 3)Metabolic disorders of RBCs
Eg:
Glucose-6-phosphate Dehydrogenase deficiency
Pyruvate Kinase deficiency

26. Aquired haemolytic anaemia (Immune)
Eg:
Autoantibodies
Drug induced Antibodies
Allo Antibodies

27. Aquired haemolytic anaemia (Non immune)
Eg:
MAHA – Micro Angiopathic Haemolytic Anaemia(due to abnormal micro vessels)
Parasites – Malaria
Burns – Abnormal vessels

28. Malaria

29. Special thanks