2.anemia classification system class.pptx

Blood and anemia

1. Hematology II ANEMIA By/ E braheem Al- nawd BSc. Medical Laboratory MSc. Clinical Biochemistry

2. Introduction to anemia Definition of anemia Anemia from the Greek word ( an- haîma ) meaning " without blood ", is a deficiency of red blood cells ( RBCs), Hct % and/or hemoglobin below the normal values. Functionally, it is the inability of the blood to supply the tissue with adequate O 2 for proper metabolic function . N ormal V alues: Parameter s Female Male RBC (x10 12 /L ) 3.6- 5.0 4.2-5.4 Hb (g/dL) 1 1.5- 16 1 3-17 Htc (%) 37-47 42-52% - Diagnosis of anemia is made by patient history, physical examination, signs and symptoms , and hematological laboratory findings .

3. Age or gender group Hb threshold (g/dl) Newborns 14.0 Children (0.5–5.0 yrs ) 11.0 Children (5–12 yrs) 11.5 Teens (12–15 yrs) 12.0 Women, non-pregnant (>15yrs) 11.5 Women, pregnant 11.0 Men (>15yrs) 13.0 Normal ranges of Hb at different ages: Factors affecting Hb level: Age, sex, race, altitude, Physical Health, Nutrition, life style, occupation, customs of populations, etc.

4. Lack of required nutrients: I ron , Vit . B12, folic acid, etc. Loss of blood: Hemorrhage, Hemolysis. Chronic Disease: Renal, liver, GIS, Endocrine, etc. Genetic Abnormalities: Thalassemia, Sickle cell anemia, etc. Inadequate production of red blood cells: aplastic anemia, acute leukemia, etc. Causes of Anemia

5. General symptoms of anemia: Weakness , malaise, tiredness and lethargy Pale skin and mucus membranes (pallor) H eart problems: (tachycardia, palpitation, etc.) CNS : (Headache, Faintness or dizziness, etc.) Loss of appetite ( anorexia ). Dyspnea Others Symptoms of anemia

6. Other symptoms related to the type of anemia Hair , mucus membranes, skin and/or nail problems ( in iron deficiency ) Neural problems (in megaloblastic anemia due to ↓ B12 ) J aundice, Splenomegaly ( in hemolytic anemia ) Bone deformities ( in thalassemia major ) Leg ulcers, abdominal pain ( in sickle-cell disease ). Others

7. Classification of anemia Have a variety of ways - depending on criteria used: A- Morphologic classification: Normocytic: MCV= 80-100fL Microcytic : MCV < 80 fL Macrocytic: MCV > 100 fL B- Pathogenic (clinical): (underlying mechanism) Decreased RBC production ( Hypoproliferation ) Increased RBC destruction (hemolysis) Blood loss (bleeding) Relative (increased plasma volume) C- Other classifications

8. A- Morphologic classification 1- Normocytic Anemias Acute post-hemorrhagic anemia Hemolytic anemia (except some Hb disorders) Aplastic anemia Bone marrow infiltration Endocrin diseases Renal failure Liver disease Chronic disease anemia ( some diseases) Protein malnutrition

9. A- Morphologic classification 2- Microcytic anemias Iron deficiency anemia Thalassemia Sideroblastic anemia Lead poisoning Anemia of chronic diseases (some diseases ) & inflammatory

10. A- Morphologic classification 3- Macrocytic anemias Megaloblastic : Vit B12 deficiency (as Pernicious A.), Folic acid deficiency, other. Non-megaloblastic : Liver diseases, Alcoholism, MDS, BM diseases , some HA , acute bleeding, Hypothyroidism, others.

11. B- Pathogenic classification (Causes of anemia) 1- Anemias caused by d ecreased RBC production A) Decreased Hb production : IDA, thalassemia, lead poisoning, sidroblastic anemia B) Defective DNA synthesis : Vit B12 deficiency, Folic acid deficiency, other. C) Stem cell defects : Pluripotent stem cell defects : Aplastic anemia , Leukemia or MDS. Defective erythroid stem cell : Pure red cell aplasia , Anemia of CRF, Endocrin e disease anemia , etc. D) Other less defined reasons : C hronic diseases, BM infiltration, nutritional defects.

12. Can be classified as; Hemolysis due to intracorpuscular defects Hemolysis due to extracorpuscular defects Or Hereditary hemolytic diseases Acquired hem olytic diseases Or Intravascular hemolysis Extravascular hemolysis 2- Anemias caused by increased RBC destruction (hemolytic anemias) B- Pathogenic classification (Causes of anemia)

13. 3. Blood loss anemia a ) Acute bleeding: - Sudden hemorrhage, Trauma , surgery, vascular disruption. b) Chronic bleeding: Similar to iron deficiency anemia GI bleeding, hemorrhoids, menstrual blood loss, chronic injury, etc. 4. Relative (increased plasma volume ): - Dilution: e.g. excessive intravenous fluids administration, pregnancy B- Pathogenic classification

14. According to Hb level (severity), a nemia is classified as: According to duration, anemia is classified as: Acute: sudden Chronic: develop and last during months – years. Pathophysiological classification: (depending on Reticulocytes Production Index ( RPI)): Hypoproliferative : (when there is a proliferation defect ), RPI < 2 Ineffective: (when there is a maturation defect ), RPI = 2-3 Hyperproliferative : (when there is a survival defect) (Hemolytic or acute blood loss), RPI > 3 C- Other Classification s of anemia

15. RBC parameters Parameter female male Red blood cells: RBC (x10 12 /L ) 3.6 - 5.0 4.2-5.4 Hemoglobin: Hb (g/dL) 11.5- 16 1 3-17 Packed cell volume: PCV (Hematocrit: Htc ) (%) 37-47 42-52 Male & female Mean cell volume: MCV (fl) 78-97 Mean cell hemoglobin: MCH (pg) 27-32 Mean cell hemoglobin concentration: MCH C (g/dL) 3 2-35 Red cell distribution width: RDW (%) 11.5-14.5 Reticulocytes : Ret (% / n) 0.5-2.5 % ( 50-100x10 9 /L ) Reference values

16. RBC morphology changes in anemia In peripheral blood smear, RBCs are studied microscopically for: Size: microcytic, normocytic, macrocytic, Anisocytosis , Dimorphic. Color ( Hb content): Hypochromic, normochromic, hyperchromic . Shape: Ovalocytes , target cells, schistocytes , tear drops, crenated cells, sickle cells, etc. Inclusion bodies: Heinz B., Howell Jolly B., Cabot ring, etc. These changes in RBC morphology may assist in the identification of the type & the cause of anemia.