….. foundation of clinical medicine

Shashidhar Venkatesh MurthyA/Prof & Head of PathologyCollege of Medicine & Dentistry

Clinical Pathology: RBC 15: Anemia Summary

Pathogenetic Classification of Anemia: Decreased Production:

Nutrient Deficiency. Iron def (IDA) / Megaloblastic (MBA)

Hemopoietic cell defect: Anemia of chronic disorders (ACD) Aplastic anemia (AA). Dysplastic anemia. Myelodysplastic Syndromes

Increased loss / destruction: Blood loss anemia – Acute / Chronic - bleeding. Hemolytic anemia – Congenital / Acquired.

Acquired / External injury. Immune AIHA (Warm/Cold) Mechanical, Drugs, Parasites

Congenital / Internal RBC defect Defective Membrane (Spherocytic an) Defective Hemoglobin (Sickle & Thal.) Deficient Enzyme (G6PD)

2

•Cell Mem•Hb.•Enzymes

Top 6 Anemias:1. IDA & Megaloblastic2. ACD & Aplastic An.3. IHA – Warm & Cold.

2

2

Anemia: Summary

4

MCV90

MCV110

DNA: B12, Folate

Hb: Iron

Megaloblastic anemia

Iron Deficiency anemia

Aplastic anemia Dysplastic anemia

Hemolytic anemiaImmuneMechanicalInfectionDrugsDefective*

Haemolytic An. Introduction Anemia due to Increased RBC destruction life span (<120d) - Abnormal forms Bilirubin Unconj. Jaundice (N. urine) Increased RBC production - ↑ Reticulocytes Acute: Pallor, Jaundice (normal urine) Chronic: Splenomegaly, pigment gall stones. Intravascular & Extravascular Hemolysis*.

Unconj. Jaundice

ImmuneMech.Infection

Porphyrin Bil. Unconj

GlobinsIron

Bil. Conj

Jaundice

Splenomegaly

Pigment Gall stones

Pallor

Iron Deficiency

Megaloblastic

Hemolytic

Normal

MCV

Microcytic Normocytic Macrocytic

Iron studies - Ferritin

Low Normal/high

IDA ACD / Thalassemia

Reticulocyte count

high low ACD / Aplastic anemia

Hemolytic anemia or blood loss

Measure B12 + folate

Megaloblastic

Normal Low

Anemia clinical DiagnosisHistory & Exam:Cong / Acq.?Acute / Chronic?Hemolysis?

< 80 80-100 >100

Sideroblastic anemia: Group of disorders anemia with sideroblasts

(+ve iron). Suggesting lack of Iron utilization. Microcytic Hypochromic anemia.(Macrocytic/dimorphic)

Two major types: Congenital: X-Linked, mitochondial etc. Acquired : Myelodysplastic Syndrome (MDS)

Copper & Vit. B6 deficiency. Lead poisoning Alcoholism, Drugs, Idiopathic.

Porphyria: Excess porphyrin secretion. Acute abdominal pain Neuropathy etc.

Iron

Iron stain: blue

Polycythemia: (high Hb) Relative or spurious erythrocytosis

Dehydration: Diarrhea, vomiting, diuretics, excess alcohol. etc.

Absolute erythrocytosis (True ): Secondary: Tissue Hypoxia: Smoking (CO),

High altitude, Lung disease. Cardiac shunts, High O2 affinity Hb. High Erythropoietin – Paraneoplastic Syndromes, Androgen therapy.

Primary - Polycythemia Rubra vera:Myeloproliferative disorder: Neoplastic proliferation of erythroid cells in bone marrow – old age, hepatosplenomegaly.

10 Hb, skin flushing & Hepatosplenomegaly

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Thalassemia Minor

Sickle

Thalassemia Major

Normal