Anaemia

Question 1

Anaemia algorithm

Answer 1

Look for MCV,

Then RDW, Retic

Question 2

MCV LOW

Answer 2

1- Retics LOW or Normal   -    RDW Normal
    # IDA ( High RDW )
    # Thalassemia traits 
    # Chronic disease
    # Lead poisoning
    # Sidroblastic anaemia

2- Retics High                  -    RDW High
    # thalassemia syndromes 
       ( SB thalassemia, Hb H disease )
    # Hb C disorders
    # Hb E disorders

Further diagnostic tests

• Iron study
• Hb electrophoresis
• Lead level

Question 3

MCV Normal

Answer 3

1- Retics LOW or Normal   -    RDW Normal
    # Chronic Disease
    # Transit erythroblastpenia of childhood
    # Anaemia of Chronic disease
    # Acute inflammation
    # Acute hemorrhage 
    # Malignancy

2- Retics High                  -    RDW High
    # Immune hemolysis
    # RBCs membrane disorders: HS, HE
   # RBCs Enzymes defects: G6PD, PK deficiency 
   # Microangiopathic hemolysis: HUS, TTP, DIC
   # Sickle cell anaemia 

Further diagnostic tests

• other disease ( infection, renal, liver, metabolic )
• Coombs test, Osmotic fragility
• Enzyme assay ( G6PD, PK )
• Hb electrophoresis

Question 4

MCV High

Answer 4

1- Retics LOW or Normal   -    RDW Normal
   # Folate and Vita B12 deficiency.
   # BM failure ( Aplastic anaemia, Fanconi anaemia, DBA) 
   # Myelodysplastic syndrome
   # Hypothyroidism
   # Drug induced ( anticonvulsant )

2- Retics High                  -    RDW High
   # Active haemolysis with brisk reticulocytosis.

Further diagnostic tests 
- Vit B12, Folate, TFT
- BM aspirate and Biopsy
- Evaluate for haemolysis 
   ( LDH, Haptogloubin, bilirubin, peripheral blood smear )