Download - Evaluation of Anemia By Dr. Stephen Szabo. Relevant Lab Parameters Primary Complete Blood Count Complete Blood Count RBC count RBC count MCV MCV Hgb Hgb

Evaluation of AnemiaEvaluation of Anemia

ByBy

Dr. Stephen SzaboDr. Stephen Szabo

Relevant Lab ParametersRelevant Lab Parameters

PrimaryPrimary Complete Blood CountComplete Blood Count

RBC countRBC count MCVMCV HgbHgb

Reticulocyte CountReticulocyte Count CreatinineCreatinine LDH and BilirubinLDH and Bilirubin Peripheral SmearPeripheral Smear

SecondarySecondary Hgb ElectrophoresisHgb Electrophoresis Direct Antibody TestDirect Antibody Test Serum Protein Serum Protein

ElectrophoresisElectrophoresis HaptoglobinHaptoglobin Iron PanelIron Panel B12 (MMA, B12 (MMA,

Homocystiene)Homocystiene) Bone Marrow BiopsyBone Marrow Biopsy

The Reticulocyte CountThe Reticulocyte Count

The reticulocyte is a young red blood cell The reticulocyte is a young red blood cell that contains residual ribosomal RNAthat contains residual ribosomal RNA

Normal Reticulocyte percent is 0.5 to 1.7%Normal Reticulocyte percent is 0.5 to 1.7% Absolute Reticulocyte number is RBC Absolute Reticulocyte number is RBC

number*Normal Reticulocyte percent number*Normal Reticulocyte percent (50,000)(50,000)

Absolute Reticulocyte percentAbsolute Reticulocyte percent Normal Retic % *(Hct/45)Normal Retic % *(Hct/45) For severe anemia <25% divide Abs Retic percent For severe anemia <25% divide Abs Retic percent

by 2 (because very immature reticulocytes are by 2 (because very immature reticulocytes are being released from the bone marrow)being released from the bone marrow)

Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

Maslak, P. ASH Image Bank 2005;2005:101299

Figure 1. Using special stains such as methylene blue or brilliant cresyl blue, reticulocytes stain with dark blue granules whereas mature erythrocytes evenly stain pale blue


Maslak, P. ASH Image Bank 2008;2008:8-00010

Figure 1. Polychromasia (arrow) is noted in the peripheral smear of this lymphoma patient



Figure 1. Nucleated red blood cells may be seen in the peripheral blood as part of a reactive process

Functional Classification of Functional Classification of Anemia IAnemia I

Hgb<12 g/dlCBC

Retic Index

Normocytic <2

Underproduction

Macrocytic or Microcytic<2

Maturation disorder

Normocytic>3 to 5

Decreased RBC survivalIncreased Production

Anemia

UnderproductionMarrow Damage

Iron DefRenal Disease

Chronic Inflammation

Maturation DisordersIron DefB12 Def

Folic Acid DefTypes of Myelodysplasia

HemolysisHemorrhageBlood Loss

Autoimmuse diseaseMembrane diseaseHemoglobinopathy

How do we define Anemia?How do we define Anemia?

The lower limits of normal The lower limits of normal hemoglobin were defined in 1968 by hemoglobin were defined in 1968 by the WHO using a predominantly the WHO using a predominantly European population:European population:

Lower Limits of NormalLower Limits of Normal Adult Male 13 g/dlAdult Male 13 g/dl Adult Female 12 g/dlAdult Female 12 g/dl

Proposed lower limits of Proposed lower limits of hemoglobin based on age, sex hemoglobin based on age, sex

and raceand race GroupGroup HemoglobinHemoglobin

White MenWhite Men

20-5920-59 13.713.7

60+60+ 13.213.2

White WomenWhite Women

20-5920-59 12.212.2

60+60+ 12.212.2

Black MenBlack Men

20-5920-59 12.912.9

60+60+ 12.712.7

Black WomenBlack Women

20-4920-49 11.511.5

50+50+ 11.511.5

Profiles for Profiles for Underproduction AnemiaUnderproduction Anemia

Chronic Chronic InflammationInflammation

Renal DiseaseRenal Disease

AnemiaAnemia MildMild Minor to SevereMinor to Severe

Retic IndexRetic Index <2<2 <2<2

Serum IronSerum Iron LowLow NormalNormal

TIBCTIBC LowLow NormalNormal

FerritenFerriten IncreasedIncreased Generally Generally NormalNormal

MCVMCV Normocytic to Normocytic to MicrocyticMicrocytic

NormocyticNormocytic

Profiles for Iron Def AnemiaProfiles for Iron Def Anemia

Iron Store Iron Store DepletionDepletion

Iron Deficient Iron Deficient ErythropoiesiErythropoiesiss

Iron Iron Deficiency Deficiency AnemiaAnemia

HemoglobinHemoglobin NormalNormal Slight Slight DecreaseDecrease

MicrocyticMicrocytic

Serum IronSerum Iron NormalNormal <60 mcg/dl<60 mcg/dl <40 mcg/dl<40 mcg/dl

Percent Percent saturationsaturation

20 to 30%20 to 30% <15%<15% <10%<10%

FerritenFerriten <20<20 <12<12 <12<12

TIBCTIBC 360-390360-390 >390>390 >410>410

How to Calculate Total Iron How to Calculate Total Iron NeededNeeded

Body Weight (kg)x2.3x(15-pt’s Hgb) Body Weight (kg)x2.3x(15-pt’s Hgb) + 500 mg+ 500 mg



Figure 2. Peripheral smear from a splenectomized patient with recurrent autoimmune hemolytic anemia



Figure 1. Circulating nucleated RBC (arrow) in the peripheral smear of a patient with autoimmune hemolytic anemia (MacNeal Tetrachrome 1000x)


Schrier, S. ASH Image Bank 2002;2002:100344

Figure 5. This patient has hereditary elliptocytosis


Lazarchick, J. ASH Image Bank 2005;2005:101384

Figure 2. The crystal-like inclusions are more evident at higher magnification of the previous image



Figure 7. Peripheral smear of a patient with severe alcoholic liver disease



No Caption Found



Figure 1. Note the fragmented schistocytes, burr cells, and helmet cells



Figure 1. Note the profound central pallor of the hypochromic and microcytic RBC



No Caption Found



Figure 2. Note the hypersegmented neutrophil (7-8 lobes)

Download - Evaluation of Anemia By Dr. Stephen Szabo. Relevant Lab Parameters Primary Complete Blood Count Complete Blood Count RBC count RBC count MCV MCV Hgb Hgb

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