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“No doubt knowledge is valuable,
but above it is Character”
Knowledge without character is dangerous!
….. foundation of clinical medicine
Shashidhar Venkatesh MurthyA/Prof & Head of Pathology
College of Medicine & Dentistry
Clinical Pathology:
RBC Disorders: Deficiency Anemia
CPC : Term2 Week1 - Haem 1/2.
System : Haematology - RBC Disorders.
Topic : 1: Anemia Intro 2: IDA & ACD 3: MBA 4: Haemolytic 5: Others.
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 cell an.)
Deficient Enzyme (G6PD)3
2
Top 6 Anemias:
1. Iron Def. A
2. Megaloblastic
3. Anem. Of Chronic Dis.
4. Aplastic An.
5. Immune Hemolytic – Warm
6. Immune Hemolytic - Cold2
Proerythroblast
(Pronormoblast)
Basophilic
Normoblast
Polychromatophilic
Normoblast
Orthochromatophilic
Normoblast
Reticulocyte
Erythrocyte
BLAST Early Intermediate Late Retic. RBC
Anemia Pathogenesis:
4
DNA: B12, Folate
B12/Folate Metabolism:
R Binders, Stomach, IF, Colon,
Methionine, Homocysteine – DNA
synthesis – cell division.
Megaloblastic anemia
Hb: Iron Iron Metabolism: “limited”,10%,
Recycle, Ferritin, Transferrin,
Hepcidin, forms Hb in cytoplasm.
Iron Deficiency anemia
Hemolytic anemia
Immune
Mech.
Infection
Aplastic anemia
Dysplastic anemia
Our destiny is in our hands,
What we think and do in the present
determines what shall happen to us in the
future.
-- Christian D. Larson
Iron Deficiency - Megaloblastic
6
Causes:
Bleeding, Nutrition,
Increased needs.
Pathogenesis:
Iron - Hb - MCV
Morphology:
Microcytic, Hypochromic
Pencil cells.
Clinical Features:
glossitis, chelitis, stomatitis.
koilonychia, dysphagia
Causes:
• Nutrition, gastritis, intestinal
disorders, Cancer therapy.
Pathogenesis:
• DNA Cells - all cells.
Morphology:
• Macrocytic, Normochromic
• Pancytopenia*
Clinical Features:
• glossitis, chelitis, stomatitis.
• Mild Jaundice & Bruising
Iron Deficiency Anemia:
8
1.Microcytic, Hypochromic – excess cell division, low Hb.
2.Anisopoikilocytosis. – varying supply, abnormal hemopoiesis.
3.Pencil forms. - ? cause
L
Megaloblastic Anemia:
10
1. Oval Macrocytes, Pancytopenia: cell division.
2. Anisopoikilocytosis: Hemolysis.
3. Hypersegmented neutrophils: Large cells / Megaloblasts
(in bone marrow).
Megaloblastic Bone Marrow Normal
Hypersegmented
Neutrophils
Macrocyte
Megaloblast
Pernicious Anemia: Vit B12
Autoimmune atrophic gastritis in aged.
IF & Parietal cell antibody (Type I,II,III)
Reduced Tetra-hydrofolate (FH4)
Decreased DNA synthesis.
Other causes of Vit B12 def. (not pernicious)
Gastrectomy
Achlorhydria
Chronic Pancreatitis
Ileal resection
Mal absorption syndromes.
Tapeworm infestation
Malignancy, pregnancy, hyperthyroidism etc.
Clinical:
MBA+ neurological deficits (spinal dorsal tract)
Loss of proprioception.
B12 Animal/bacteria
Folate Green Veg
Nothing can stop the man with the right
mental attitude from achieving his goal;
nothing on earth can help the man with the
wrong mental attitude!
-- Thomas Jefferson
Haemopoiesis in deficiency anemias
13
Macrocytic, pancytopeniaMicrocytic hypochromic
Iron Deficiency Normal Megaloblastic
Anemia of Chronic Disease:
Etiology:
Chronic Infections,
inflammations, malignancy
&
anemia of renal disease*.
Pathogenesis:
IFN, TNF, IL block iron
transfer from macrophage
store to RBC.
Erythropoietin*.
Morphology:
Mild Microcytic,
Hypochromic.
Clinical Features:
Mild anemia, resistant to
iron therapy.
Aplastic Anemia: BM Failure
15
Dysplasia Normal BM Aplasia
Clinical Features:
1. RBC - Anemia,
2. WBC - Infections
3. PLT - Bleeding
Stem cell damage• Drugs, Immune
• Viral Infections.
Stem Cell Cancer:
Myelodysplastic Sy.
Leukemia
Normocytic Pancytopenia
Learning Objectives: Diseases of RBC
Anaemia: Overview, Classification, pathogenesis,
diagnosis, clinical features & complications. - common
Study TOP 10 ANEMIA
Major (detailed)
1. Iron Deficiency anemia.
2. Megaloblastic anemia.
3. Imm. Hemolytic (Warm/Cold)
4. Anemia of Chronic Disease.
5. Aplastic Anemia
Minor (brief note)
1. Myelodysplastic Syndrome
2. Sickle Cell Anemia
3. Thalassemia syndromes.
4. G6PD deficiency anemia.
5. Hereditary Spherocytosis.