Anemia

anemia is define as decrease in Hb concentration below the lower limit of normal value according to the age and sex of the individual is call anemia. anemia can be classify by different ways some are as in this presentation

1. CLASSIFICATION OF
ANEMIA
Muhammad Asif Zeb
Lecturer Hematology
IPMS-KMU

2. Definition of Anemia
Decrease in Hb concentration below the
lower limit of normal value according to the
age and sex of the individual is know as
anemia
Hgb:
Women: <11.5
Men: < 13.7
Hct:
Women: < 36
Men

3. May be due to:
Erythrocyte loss (bleeding)
Decreased Erythrocyte production
low erythropoietin
Decreased marrow response to erythropoietin
Increased Erythrocyte destruction
(hemolysis

4. Measurements of Anemia
Hemoglobin = grams of hemoglobin per 100 mL of
whole blood (g/dL)
Hematocrit = percent of a sample of whole blood
occupied by intact red blood cells
RBC = millions of red blood cells per microL of whole
blood
MCV = Mean corpuscular volume
If > 96 → Macrocytic anemia
If 76 – 96→ Normocytic anemia
If < 76 → Microcytic anemia

5. Classification of Anemia
Based on
Morphological classification
Severity
Etiological or pathophysiological
classification

6. Morphological classification

Classification of Anemia on the Basis of MCV
Microcytic anemia(MCV<76)
Normocytic anemia(MCV=76 -96)
Macrocytic anemia(MCV>96)

7. Normochromic Normocytic
Anemia
Chronic inflammatory disease—
(1)infection (2)collagen vascular disease
(3)inflammatory bowel disease
Recent blood loss
Malignancy/Marrow infiltration
Chronic renal failure
Marrow aplasia/hypoplasia
HIV infection

8. Normochromic Normocytic

9. Macrocytic Anemia
MCV > 96


Megaloblastic
 Vit. B12 deficiency
 Folic acid deficiency :
 Abnormal Metabolism of B12 or folic acid
Non megaloblastic
Hemolysis
Myelodysplastic syndrome
Chronic liver disease
Hypothyroidism

10. Microcytic Hypochromic
Anemia
MCV < 76
MCHC < 31


Iron deficiency
Thalassemia
Sideroblastic anemia
Anemias of chronic disease.

11. Iron Deficiency Anemia

12. Mild anemia
With hemoglobin level 9-12 g/dl

Moderate anemia
With hemoglobin level 6-9g/dl

Severe anemia
With hemoglobin level <6g/dl

Severity

13. Etiological Classification
Acute Blood loss
Chronic blood loss
 Increase destruction
 Decrease production

14. Anemia due to increase Destruction of Red
Blood Cells
Inherited casues
Hemoglobinopathies
Sickle Cell Anemia
Thalassemia
Hb C disease
Membrane disorders
Hereditary spherocytosis
Hereditary eleptocytosis
Enzyme disorders
G6PD deficiency anemia
Pyruvate kinase deficiency anemia

15. Anemia due to increase Destruction
of Red Blood Cells
Acquire disorder
Immunological disorders
Non immunological disorders

16. Immunological disorders

alloimmune Hemolytic Anemia
 HDN
 Blood transfusion related hemolytic
anemia
Autoimmune Hemolytic Anemi a
 Warm-antibody mediated
 IgG antibody binds to erythrocyte surface
 most common
 Diagnosed by POSITIVE Coomb’s Test (detectgs IgG or complement on the cell
surgace)
 Can be caused drugs
 Treated with corticosteroids or splenectomy if refractory
 Cold agglutinin Disease
 IgM antibodies bind to erythrocyte surface
 Does not respond to corticosteroids, but usually mild.

17. Non immunological hemolytic anemia

Mechanical :
March hemolytic anemia
Artificial heart wall
MAHA (Microangiopathic HA)e.g TTP,HUS,DIC

 Chemical/Physical, e.g sever burns
 Infection : Clostridium tetani, malaria, CMV
 Hypersplenism

18. Impaired RBC Production
1. Abnormal bone marrow
Aplastic anemia
Myelophthisis : Myelofibrosis, Leukemia,
Cancer, metastasis ‘
2. Essential factors deficiency
Deficiency anemia : Fe, Vit. B12, Folic acid, etc

3. Stimulation factor deficiency
Anemia in chronic disease
Anemia in hypopituitarism
4. Decrease Erythropoietin production
Anemia of renal failure