MORPHOLOGIC CLASSIFICATION OF ANEMIA

Question 1

presence of abnormal erythroblast in BM w/ delayed maturation

Answer 1

MEGALOBLASTIC ANEMIA

Question 2

Macrocytic normochromic anemia
MCV
MCHC

Answer 2

MCV is >96 fL;
MCHC is NORMAL

Question 3

Causes of Megaloblastic Anemia (5)

Answer 3

1. Vitamin B12 deficiency – pernicious anemia
2. Folic Acid Deficiency – Nutritional Megaloblastic Anemia
3. Abnormalities of Vit B12 or folate metabolism
4. Inherited disorders of DNA synthesis
5. Drug-induced disorders of DNA synthesis

Question 4

pernicious anemia

Answer 4

Vitamin B12 deficiency

Question 5

Nutritional Megaloblastic Anemia

Answer 5

Folic Acid Deficiency

Question 6

Macrocytic normochromic anemia Laboratory Findings

Answer 6

1. Red cells are macrocytic – MCV is >95 fL and often as high as 120-140 fL (Normal: 80-96 fL)
2. Macrocytes are typically oval shape
3. Reticulocytes count is low in relation to the degree of anemia
4. Total white cell count and platelet counts may be moderately reduced, especially in severely anemic patients

Question 7

Macrocytic normochromic anemia peripheral smears (2)

Answer 7

1. Normal RBC in morphology despite the:
   –Drop of Hgb, Hct and RBC count
2. Increased bone marrow activity
   –increased of Reticulocyte count)
   –w/o increased red cell or hgb breakdown

Question 8

shows macrocytic, normoblastic cells

Answer 8

NON-MEGALOBLASTIC ANEMIA

Question 9

NON-MEGALOBLASTIC ANEMIA causes (6)

Answer 9

1. Accelerated erythropoiesis
2. Increased membrane surface area
   –1 RBC = 23 Potassium
3. Obscure causes (hypoplastic & aplastic anemias)
4. Alcohol
5. Liver disease
6. Cytotoxic drugs (e.g. metronidazole)

Question 10

Small RBC size; Decreased Hemoglobin

Answer 10

Microcytic hypochromic anemia

Question 11

Microcytic hypochromic anemia
MCV
MCHC

Answer 11

MCV is <80 fL
MCHC is <30%

Question 12

Microcytic hypochromic anemia CAUSES (4)

Answer 12

1. Iron deficiency (IDA)
2. Disorder of globin synthesis as in thalassemia
3. Disorders of porphyrin & heme synthesis as in sideroblastic anemia
4. Other disorders of iron metabolism

Question 13

Disorder of globin synthesis

Answer 13

thalassemia

Question 14

Disorders of porphyrin & heme synthesis

Answer 14

sideroblastic anemia

Question 15

Microcytic hypochromic anemia Peripheral Smear (4)

Answer 15

● Anisocytosis & Poikilocytosis
● Microcytic – since many are smaller than the nucleus of the lymphocyte
● Hypochromic – with increased central pallor
● Presence of elliptocytic & pencil-shaped forms

Question 16

Normocytic normochromic anemia
MCV
MCHC

Answer 16

MCV is 80-90 fL (normal)
ALL Normal

Question 17

Normocytic normochromic anemia CAUSES (9)

Answer 17

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

Question 18

Normochromic, normocytic anemia w/ Effective Erythropoiesis
INCREASED Reticulocyte Count (3)

Answer 18

a. Acute Blood Loss
b. Hemolytic Anemia
c. Response to specific therapy in nutritional anemia

Question 19

● Very acutely, with hypovolemia
● May have normal blood count
● Will become anemic w/ volume replenishment

Answer 19

Acute Blood Loss

Question 20

Increased reticulocyte production cannot keep pace with loss of RBCs peripherally

Answer 20

Hemolytic Anemia

Question 21

Normocytic normochromic anemia LABORATORY FINDINGS (6)

Answer 21

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

Question 22

CLASSIFICATION OF ANEMIA ACCORDING TO CAUSE (3)

Answer 22

I. Anemia due to Impaired Red Cell Production
II. Anemia due to Blood Loss
III. Anemia due to Accelerated Red Cell Destruction