anaemia classification

8/4/2019 Anaemia classification

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Blood


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Dr. Raghuveer Choudhary Assosiate Professor of Physiology Dr S.N.Medical College Jodhpur


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Anemia is decreased red cell mass affecting tissue

oxygenation Practical - Low Hb* or Low Hematocrit*


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Anemia means a decrease in hemoglobin content,or RBCs count,or both of them below the normal range.

Anemia leads to a decrease in blood ability totransport oxygen to tissue cells.


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Anaemia is labelled when Hb Conc is less13 gm/dl in adult males11.5 gm/dl in adultfemales15 gm/dl in newborns9.5 gm/dl at 3 month of

age

Mild Aneamia- Hb 8-10Gm%Moderate Aneamia- 6-8Gm%Severe Aneamia Hb


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Types & causes of anemia:

I-Blood loss anemia: A-Acute blood loss anemia :

Due to severe hemorrhage.

Plasma volume is replaced rapidly by the fluidspresent in tissue spaces.This leads to marked dilution of the blood.RBCs are replaced within 2-3 weeks.Sufficient iron gives normocytic cells butinsufficient iron will produce microcytic RBCs.


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Types & causes of anemia:I-Blood loss anemia:B-Chronic blood loss anemia :

Due to repeated loss of small amounts of bloodover a long period e.g.:

-Gastrointestinal bleeding (peptic ulcer)/piles-Excessive menstruation.-Hemorrhagic diseases.

Due to depletion in iron stores the newly formedRBCS are microcytic.


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II-Aplastic anemia:It results from destructione of bone marrow.Diminished erythropoisis

It may result from:

1-Excessive exposure to x-rays or gamma rays.2-Chemical toxins e.g. cancer therapy & prolonged exposureto insecticides or benzene.

3-Invasion of bone marrow by cancer cells.

4-Following infection by hepatitis.

Damaged bone marrow don t produce any RBCs, so inaplastic anemia RBCS are normocytic. It is associated with decrease in WBCs & platelets.


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Fanconi anemia congenitalDirect stem cell destruction external radiationDrugs - chloramphenicol, gold, sulfonamides, felbamate

Other Toxins - Solvents, degreasing agents, pesticides Viral infection - parvovirus B19, HIV, otherIdiopathic
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Should be suspected from an inappropriately lowreticulocyte count.Diagnosis can be confirmed by bone marrowexamination.


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III-Hemolytic anemia:It results from increased rate of destruction of RBCs insidethe vascular system.Causes of hemolytic anemia:

A-Hereditary:(intracopuscular defects)1-Membrane abnormalities.e.g.- hereditary spherocytosis,

hereditary elliptocytosis2-Enzyme deficiency e.g. G-6-P Dehydrogenase.( Oxidation

vulnerability)3-Hemoglobin abnormalities.- sickle cell syndromes,

unstable hemoglobins,methemoglobinemia4Glycolytic defects: pyruvate kinase deficiency,5 Thalassaemia


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B-Acquired:(extracorpuscular defects)

1-Incompatible blood transfusion.(Ag-Abreaction),erythroblastosis foetalis2-Parasitic infection e.g. malaria.

3-Toxic agents e.g. snake venom & insectpoisons.4-Thermal e.g. several burns.5 - Microangiopathic:Prosthetic valve6 - Hypersplenism anemia caused by

splenomegaly


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Types & causes of anemia:IV-Dyshemopoietic anemia: Deficiency anemia's-

Which may be due to:

1-Iron deficiency anemia.2-Maturation failure (megaloblastic) anemia:-a-Vitamin B 12deficiency.b-Folic acid deficiency.3-Anemia of endocrine disorders.4-Protein deficiency anemia.5-Anemia of renal failure.


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1. Morphological ApproachRed blood cell size(MCV)Microcytic (Cells Smaller than normal sizei.e. MCV< 80 fl)

Normocytic (Cells Normal sized i.e. MCV = 80-100 fl)Macrocytic (Cells bigger than normalsize i.e. > 100 fl)

Concentration of Hb(MCHC)

Normochromic (Normal HbConcentration)Hypochromic (Decreased HbConcentration- cells paler than normal)


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Normochromic=RBC with normal amount of hemoglobin.

Hypochromic=RBC with low level of hemoglobin.

No hyperchromic RBC.


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Vitamin B12/Folic acid deficiency Second most common type of anemia.Macrocytic anemia, pancytopenia.

Pernicious anaemia autoimmune, Gastric atrophy, VitB12 def.


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Decreased Vit B12 / FolateDecreased DNA SynthesisDelayed maturation of erythroblasts (Nucleus)

Increased cell size (macrocytes)Normal hb content ( Normochromia )Decreased RBC numberDecreased WBC number (pancytopenia) Anemia & Pancytopenia.


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Vitamin B12 and Folic acid:Essential for DNA synthesis (Thymidine triphosphate) Abnormal and diminished DNA

Failure of division and maturationMacrocytic / Megaloblastic anemia


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The presence of macro-ovalocyteshaving an MCV >115 fl,anisocytosis, poikilocytosis andhypersegmented neutrophilssuggests a megaloblasticdisorder

associated with a nutritionaldeficiency, i.e., vitamin B12 orfolate deficiency.


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Essentials of DiagnosisMacrocytic anemia.Macro-ovalocytes and

hypersegmented neutrophilson peripheral blood smear.Serum vitamin B 12 level lessthan 100 pg/mL.


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Other Lab testsHomocysteine Folate def.Methylmalonic acid B12 def.Intrinsic Factor Ab test very specific for

pernicious anemia but only 50% sensitiveParietal cell AB test quite sensitive (90%) butnot specific

Schilling test


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The bone marrow is hypercellular,showing evidence of abnormalproliferation and maturation of multiple

myeloid cell lines.These abnormalities are most evident inthe erythroid precursors with large

megaloblastic erythroblasts present inincreased numbers throughout themarrow.


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Normal Hypercellular Hypocellular


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Similar morphologic abnormalities can beseen in the other myeloid elements, e.g.,large or giant metamyelocytes and othergranulocytic precursors.This ineffective erythropoiesis is

accompanied by intramedullary hemolysis causing an elevatedlactate dehydrogenase and indirect

bilirubin in the serum.However, the reticulocyte count is lowdue to the abnormal maturation process.


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Parietal cells -produce IF

IF

B12

B12

B12+IFIF

Stomach

IF

Ileum -IF receptors

B12B12


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Methylmalonic Acid (MMA) and

Homocysteine Serum ConcentrationsCobalamin and folate are cofactors in severalimportant metabolic pathways in the cell.The hydroxylated form of cobalamin plays animportant role in the metabolism of homocysteine and MMA. The conversion of homocysteine to methionine requires both vitamin B12 and folate as cofactors.


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However, the metabolism of L-methylmalonyl CoA tosuccinyl CoA, an enzymatic

pathway involved in oxidativephosphorylation reactions withinthe cell, only requires

vitamin B12.


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Differentiating cobalamindeficiency from folatedeficiency by measuringserum MMA andhomocysteine levels.Both of these metabolites

are elevated in cobalamindeficiency,


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In folate deficiency patients, serumhomocysteine levels are markedly

increased, while serum MMA levels are not elevated


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Parietal cells -produce IF

IF

B12

B12

B12+IFIF

Stomach

IF

Ileum -IF receptors

B12B12


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