HEMATOLOGY LECTURE

Anemias
(Chapter 19 of Rodaks Hematology)

MECHANISMS OF ANEMIA
- ineffective erythropoiesis
o production of defective erythroid precursor cells
o causes cell to undergo apoptosis before
maturation
o body EPO to compensate
useless if precursors are still defective
o RBC circulating in blood is low
- inefficient erythropoiesis
o decrease in number of erythroid precursor cells
o associated with iron, EPO, of cells due to
autoimmune reaction, infection by parvovirus
B19, and infiltration of bone marrow with
granulomas and malignant cells
o RBC production is low
- chronic blood loss
o induces iron deficiency
- acute blood loss
o slow production of RBCs by bone marrow
LAB DIAGNOSIS OF ANEMIA
- complete blood count (CBC) - routine
o RBC count
o MCV

reference range: 20-115 x 109/L

corrected reticulocyte count

retic
x RBC count
100

retic x Hct
45

reticulocyte production index

better indication than corrected retic count

corrected retic count

maturation time

reticulocyte counts determine the cause of

anemia
o retics
hemolytic anemia
acute blood loss
o retics
chronic blood loss
insufficient/ineffective erythropoiesis
peripheral blood film examination describes size,
shape, variations and inclusions of RBCs
o

RBC ABNORMALITIES
Appearanc
Abnormality
e
macrocyte
microcyte

spherocyte

Associated Disease
macrocytic anemias
microcytic anemias
hereditary spherocytosis,
immune hemolytic
anemia

elliptocyte
hereditary
elliptocytosis/ovalcytosis,
IDA, thalassemia,
myelophthisic anemia
ovalocyte

Hgb x 10
RBC count

reference range: 26-32 pg

MCHC

Hct x 10
RBC count

reference range: 80-100 fL

MCH

/sqg

decrease in oxygen carrying capacity of blood

caused by decrease in RBCs, Hgb and Hct
classic symptoms are fatigue and shortness of
breath
o patient history and physical examination are
important preliminary components of diagnosis
physiological adaptations occur due to anemia
o in acute blood loss
blood flow is redirected to the brain, heart
and muscles
o in chronic blood loss
in 2,3-BPG to increase delivery of O2 to
tissues
in EPO

Hgb x 100
Hct

reference range: 32-36 g/dL

o RDW (in automated analyzers only)
reticulocyte count must be performed in every
patient suspected with anemia
o absolute reticulocyte count

stomatocyte

hereditary
stomatocytosis, Rh
deficiency

sickle cell

sickle-cell anemia, sicklecell-beta-thalassemia

Hb C crystal

Hb C disease

Hb SC
crystal

mitotic spindle
remnants

Hb H

precipitated globin chains

Hb SC disease

target cell
(codocyte)

hemoglobinopathies,
thalassemia

schistocyte

microangiopathic
hemolytic anemia

helmet cell
(keratocyte)

acanthocyte

spur cell anemia,

neuroacanthocytosis

Burr cell
(echinocyte)

uremia, pyruvate kinase

deficiency

Teardrop
cell
(dacryocyte
)

primary myelofibrosis,
myelophthisic anemia,
thalassemia,
megaloblastic anemia

RBC INCLUSIONS
Inclusion

Composition

Associated
Disease

Diffuse
basophilia

RNA

hemolytic anemia

basophilic
stippling

precipitated
RNA

Howell-Jolly
body

DNA

Heinz body
Pappenheimer
bodies

Cabot ring

denatured Hgb
iron

lead poisoning,
thalassemia,
hemoglobinopathie
s, megaloblastic
anemia,
myelodysplastic
anemias
megaloblastic
anemia, hemolytic
anemia,
thalassemia,
myelodysplastic
anemia
G6PD deficiency
sideroblastic
anemia,

hemoglobinopathie
s, thalassemias,
megaloblastic and
myelodysplastic
anemias
megaloblastic
anemia,
myelodysplastic
anemia
Hb H disease

CLASSIFICATION OF ANEMIAS ACCORDING TO MCV

1. Microcytic Anemias (MCV < 80 fL)
o sideroblastic anemia
o iron deficiency anemia
o anemia of chronic inflammation
o thalassemia
2. Macrocytic Anemias (MCV > 100 fL)
o Nonmegaloblastic anemias
aplastic anemia
chronic liver disease
alcoholism
o Megaloblastic anemia
vitamin B12 deficiency
folate deficiency
3. Normocytic Anemias (MCV 80-100 fL)
o Reticulocyte Count
acute blood loss
hemolytic anemias
o Normal or Reticulocyte Count
aplastic anemia
anemia of renal disease
myelophthisic anemia
parvovirus B19 infection
anemia of chronic inflammation
CLASSIFICATION OF ANEMIAS ACCORDING TO
PATHOPHYSIOLOGY
1. Anemia by Decreased RBC Production
o HSC failure
aplastic anemia
o disruption of DNA synthesis
megaloblastic anemia
o disruption of Hgb synthesis
iron deficiency anemia
thalassemia
sideroblastic anemia
anemia of chronic inflammation
o disruption of erythroid precursor proliferation
anemia of renal failure
anemia of marrow infiltration
2. Anemia by Increased RBC Destruction
o membrane defects
hereditary spherocytosis
hereditary elliptocytosis
o enzyme deficiency
G6PD deficiency
pyruvate kinase deficiency

globin abnormality
sickle cell anemia
hemoglobinopathies
immune causes
warm-type autoimmune hemolytic anemia
paroxysmal cold hemoglobinuria
cold agglutinin disease
hemolytic transfusion reaction
hemolytic disease of the newborn

non-immune causes
microangiopathic hemolytic anemias
(thrombotic thrombocytopenic purpura,
hemolytic uremic syndrome, HELLP
syndrome)
macroangiopathic hemolytic anemia
infection (malaria, babesiosis)
blood loss
acute blood loss anemia