1. Anemia Introduction Dr. Sachin Kale, MD.
Asso. Prof, Dept. of pathology
In charge, Central Laboratory, MGM.

2. Outline Introduction to anemias
Introduction to hematology and hematopoiesis
Introduction to anemias
Iron deficiency anemias
Megaloblastic anemia.
Sickle cell anemia

3. Anemias
Signifies a decrease in Hb or Hct and represents underlying disease than a specific diagnosis
Accepted definitions -
Male: < 13.5 g/dl
Female: < 12.5 g/dl
Pregnancy & Children - ( 6 m – 8 yrs): < 11 g/dl
Preterm infants: < 14 ; Full term infant: < 13.5

4. Anemias
SaO2 ( % of heme groups occupied by O2) and PaO2 ( amount of O2 dissolved in plasma) are normal; since O2 exchange in lungs are normal.
However oxygen content (total amt of O2 available) is decreased owing to reduction in Hb concentraion.

5. Mature RBC Anucleate cells
Devoid of mitochrondria – lack citric acid cycle, beta oxidation of fatty acid, oxidative phosphorylation
Metabolize glucose by anerobic glycosylation – lactate is the end product.
Generate glutathione via pentose phosphate shunt.

6. Mature RBC
Reduce heme iron from ferric (+3) to ferrous (+2) state using methemoglobin reductase system Synthesizes 2,3 bisphosphoglycerate via Rappapor-Luebering shunt. ( used for right shifts in O-D curve)
ABO & Rh antigens on membranes.

7. Mature RBC
Senescent RBCs are removed mainly by extravascular hemolysis – endproduct is lipid soluble unconjugated bilirubin.
Lesser extent – intravascular hemolysis.

8. Anemia: symptoms Tissue hypoxia Dyspena with exertion
Weakness, fatigue, anorexia, insominia, inability to concentrate, and dizziness (CNS hypoxia)

11. Basic pathophysiological categories of anaemia
Blood loss
Impaired red cell production
Inadequate supply of nutrients essential for eythropoiesis, such as: .
iron deficiency
vitamin B 12 deficiency
folic acid deficiency
protein-calorie malnutrition
other less common deficiencies

12. Impaired red cell production
Depression of erythropoietic activity
Anaemia associated with chronic disorders. such as:
infection
connective tissue disorders
inflammatory disorders
disseminated malignancy
Anaemia associated with renal failure
Aplastic anaemia
Anaemia due to inherited disorders, such as thalassaemia

13. Impaired red cell production
Anaemia due to replacement of normal bone marrow by:
Leukaemia
Lymphoma
myeloproliferative disorders
Myeloma
myelodysplastic disorders

14. Excessive red cell destruction
Due to intrinsic defects in red cells
Due to extrinsic effects on red cells

15. General evidence of hemolysis
Evidence of increased HB breakdown:
Jaundice and Hyperbilirubinemia
Evidence of compensatory erythroid hyperplasia:
Reticulocytosis
Evidence of damage to red cells:
Spherocytosis
Fragmentation RBCs
Heinz bodies

16. Classification of anemias
Microcytic anemias: ( MCV < 80 fl)
Iron deficiency (most common)
Thalassemia
Anemia of chronic disease
Sideroblastic anemia

17. Classification of anemias
Macrocytic anemia (MCV > 100 fl)
B12 deficiency
Folate deficiency
Alcoholic liver disease
Hypothyroidism

18. Normocytic anemia ( MCV 80 – 100 fl)
Reti count: (< 2%)
Acute blood loss
Early iron deficiency
Aplastic anemia
Anemia of chronic disease
Renal disease

19. Normocytic anemia ( MCV 80 – 100 fl)
Reti count: (> 3%) ( Intrinsic RBC defect)
Membrane defects
Congenital spherocytosis/elliptocytosis
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Abnormal hemoglobins:
Sickle cell disease variants
Enzyme deficiencies
G6PD & Pyruvate kinase deficiency.

20. Normocytic anemia ( MCV 80 – 100 fl)
Reti count: (> 3%) ( Extrinsic RBC defect)
Autoimmune hemolytic anemias ( warm and cold)
Paroxysmal cold hemoglobinuria
Microangiopathic hemolytic anemia

21. Work up of anemic patient

27. Chipmunk facies

29. RBCs in health and disease

42. Understanding CBC: the complete blood count
Haematocrit is 3 times the HB value: Rule of 3.
RBC count usually parallels HB and Hct,
In thallasemias RBC count is normal to increased even though Hb is low.
RDW: Red cell distribution width
WBC count: Total and differential
Blood film:

43. RBC indices MCV: volume of average red cell (fl or um3)
MCV = Hctx1000/RBC count ( in millions per ul)
MCH: content (wt) of Hb of average red cell
MCH = Hb (g/l)/RBC ( in millions per ul)
MCHC: average concentration of Hb in given volume of packed cells.
MCHC: Hb(g/dl)/Hct

44. X’s Edition

45. Question 1

46. All of the following cause microcytic anemia except
Iron deficiency anemia
Thalasemia
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Alcoholic liver disease
Anemia of chronic disease

47. All of the following cause microcytic anemia except
Iron deficiency anemia
Thalasemia
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Alcoholic liver disease
Anemia of chronic disease

48. Question 2

49. Hereditary spherocytosis
All of the following cause normocytic anemia with reti count < 2%, except
Aplastic anemia
Hereditary spherocytosis
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Acute blood loss
Anemia of renal disease

50. Hereditary spherocytosis
All of the following cause normocytic anemia with reti count < 2%, except
Aplastic anemia
Hereditary spherocytosis
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Acute blood loss
Anemia of renal disease

51. Question 3

52. Which of the following is True
MCV = Hctx1000/RBC count
MCH = Hb (g/l)/RBC
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
MCHC: Hb(g/dl)/Hct
All of the above

53. Which of the following is True
MCV = Hctx1000/RBC count
MCH = Hb (g/l)/RBC
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
MCHC: Hb(g/dl)/Hct
All of the above

54. Question 4

55. Check up. CBC = Low MCV, Low Hb, WBCs: N
26 yr, female, routine
Check up. CBC = Low MCV, Low Hb, WBCs: N

57. You expect further studies to reveal
Positive Sickle screen
Increased HbA2 & F
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Normocytic ane. Increased reti
Low Sr. Ferritin

58. You expect further studies to reveal
Positive Sickle screen
Increased HbA2 & F
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Normocytic ane. Increased reti
Low Sr. Ferritin

59. Question 5

60. Which of the following is present in both IDA & Thalassemia
Low Ferritin concentration
Microcytic RBC Indices
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Abnormal Hb electrophoresis
All of the above

61. Which of the following is present in both IDA & Thalassemia
Low Ferritin concentration
Microcytic RBC Indices
Germ cell tumors
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Abnormal Hb electrophoresis
All of the above

62. A well executed CBC followed by its proper interpretation has its worth in gold and a shrewd clinician make use of this simple and cheap test for diagnosing hematological and even non-hematological disorders..
Dr. M. B Agrawal.

63. “ Mind is like a Parachute - it works only when it is open “
“Eyes can only see,
what mind can think! “ 54

64. Thank you!