MORPHOLOGIC CLASSIFICATION OF ANEMIA Flashcards
presence of abnormal erythroblast in BM w/ delayed maturation
MEGALOBLASTIC ANEMIA
Macrocytic normochromic anemia
MCV
MCHC
MCV is >96 fL;
MCHC is NORMAL
Causes of Megaloblastic Anemia (5)
- Vitamin B12 deficiency – pernicious anemia
- Folic Acid Deficiency – Nutritional Megaloblastic Anemia
- Abnormalities of Vit B12 or folate metabolism
- Inherited disorders of DNA synthesis
- Drug-induced disorders of DNA synthesis
pernicious anemia
Vitamin B12 deficiency
Nutritional Megaloblastic Anemia
Folic Acid Deficiency
Macrocytic normochromic anemia Laboratory Findings
- Red cells are macrocytic – MCV is >95 fL and often as high as 120-140 fL (Normal: 80-96 fL)
- Macrocytes are typically oval shape
- Reticulocytes count is low in relation to the degree of anemia
- Total white cell count and platelet counts may be moderately reduced, especially in severely anemic patients
Macrocytic normochromic anemia peripheral smears (2)
- Normal RBC in morphology despite the:
–Drop of Hgb, Hct and RBC count - Increased bone marrow activity
–increased of Reticulocyte count)
–w/o increased red cell or hgb breakdown
shows macrocytic, normoblastic cells
NON-MEGALOBLASTIC ANEMIA
NON-MEGALOBLASTIC ANEMIA causes (6)
- Accelerated erythropoiesis
- Increased membrane surface area
–1 RBC = 23 Potassium - Obscure causes (hypoplastic & aplastic anemias)
- Alcohol
- Liver disease
- Cytotoxic drugs (e.g. metronidazole)
Small RBC size; Decreased Hemoglobin
Microcytic hypochromic anemia
Microcytic hypochromic anemia
MCV
MCHC
MCV is <80 fL
MCHC is <30%
Microcytic hypochromic anemia CAUSES (4)
- Iron deficiency (IDA)
- Disorder of globin synthesis as in thalassemia
- Disorders of porphyrin & heme synthesis as in sideroblastic anemia
- Other disorders of iron metabolism
Disorder of globin synthesis
thalassemia
Disorders of porphyrin & heme synthesis
sideroblastic anemia
Microcytic hypochromic anemia Peripheral Smear (4)
● Anisocytosis & Poikilocytosis
● Microcytic – since many are smaller than the nucleus of the lymphocyte
● Hypochromic – with increased central pallor
● Presence of elliptocytic & pencil-shaped forms
Normocytic normochromic anemia
MCV
MCHC
MCV is 80-90 fL (normal)
ALL Normal
Normocytic normochromic anemia CAUSES (9)
1.Recent blood loss
2.Overexpansion of plasma volume as in pregnancy
3.Hemolytic diseases
4.Hypoplastic BM (aplastic anemia)
5.Infiltrated BM (leukemia)
6. Endocrine abnormality
7.Chronic disorders
8.Renal disorders
9. Liver diseases
Normochromic, normocytic anemia w/ Effective Erythropoiesis
INCREASED Reticulocyte Count (3)
a. Acute Blood Loss
b. Hemolytic Anemia
c. Response to specific therapy in nutritional anemia
● Very acutely, with hypovolemia
● May have normal blood count
● Will become anemic w/ volume replenishment
Acute Blood Loss
Increased reticulocyte production cannot keep pace with loss of RBCs peripherally
Hemolytic Anemia
Normocytic normochromic anemia LABORATORY FINDINGS (6)
1.Plasma volume and red cell volume are REDUCED in proportionate amount
2.Normal Hct
3.Reduced platelet count
4.Reduced plasma fibrinogen
5.Neutrophilic leukocytosis is present
6.Normocytes and normochromic cells are present
CLASSIFICATION OF ANEMIA ACCORDING TO CAUSE (3)
I. Anemia due to Impaired Red Cell Production
II. Anemia due to Blood Loss
III. Anemia due to Accelerated Red Cell Destruction
