Introduction to anemia
Nada Mohamed Ahmed ,
MD, MT (ASCP)i
contents
Introduction to RBC’s
RBC cell indices and Haemeglobin
Anemia- Definition
classification of Anemia
Signs and symptoms of Anemia
Diagnosis
Introduction To RBC
 The mature erythrocytes are nonnucleated cells and lack usual cell
organelles.
 The normal RBC is biconcave in
shape,7.2µm in diameter and has a
thickness of 2.4µm at the periphery
and 1µm in the center.
 The biconcave shape helps the RBC to
pass through the smallest capillaries
 90% of the RBC’s weight is
concentrated in the red pigment
hemoglobin and the RBC’s have a
lifespan of 120±30 days.
Functions of RBC
• The most important
function of an RBC
1- is the transportation of
oxygen to tissues.
2- Another important
function of RBC’s is the
transportation of CO2
from the tissues to the
lungs.
Normal Values
• Range of normal RBC count is:5.5±1.0
in Men and 4.8±1.0 ×1012/L in women
• Hemoglobin content being
15.5±2.5(13-18)g/dl in Men and
14.0±2.5(11.5-16.5)g/dl and Women.
• The packed cell volume (PCV) or the
haematocrit is the volume of the
erythrocytes per litre of whole blood
is 40-54% in Men and 37-47% in
Women
•
Based on these normal values
red cell indices have been calculated
,which are of diagnostic importance.
Haemoglobin
• Haemoglobin is a basic protein,GLOBIN
and of iron-porphyrin complex HEME with
a molecular weight of 68,000 dalton and
consists of 4 polypeptides.
RBC Destruction and Recycling
History of Anemia
• The word "anemia" is
composed of two Greek
roots that together mean
"without blood,“
• The ancients readily
recognized the importance
of blood as a life- giving
substance, believing it to
hold the body's vital force
Definition of Anemia :
Low Hb level less than normal range
Less than 13.5 g/dl Adult male
Less than 11.5 g/dl adult female
Less than 15 g/dl neonate
Other definitions RBCs count less than
normal range according to age group
Decreased in hematocrit level (Packed cell
volume pcv) less than normal rang
Red cell indices
• MCV (mean corpuscular volume)
– The average volume of RBC NR= 80-96 fl
=
e.g.
Hct
 10 (fl)
RBC count (m/µL)
Hct= 40%
RBC=5.0 (m /µL)
MCV= 40/5.0  10 = 80 fl
• MCH (mean corpuscular hemoglobin)
– The average content of Hb in average RBC.
– It is directly proportional to the amount of
Hb and RBC size.
MCH =
Hb
 10 (pg)
RBC count (m/µL)
e.g.
Hb = 14 g/dl
RBC = 4.8 (m/µL)
MCH= 14/4  10
= 29 pg
NR= 27-32 pg
• MCHC (mean corpuscular hemoglobin concentration)
• NR= 32-36%
– Express the average concentration of hemoglobin per unit
volume of RBC.
– It defined as the ratio of the weight of hemoglobin to
volume of RBC.
MCHC=
Hb (g/dl)
 100 (%)
Hct (%)
e.g.
Hb = 14 g/dl
Hct = 45 %
MCHC 14/45  100 = 31%
Classification of Anemia
I.
Etiologic Classification
1. Impaired RBC production
2. Excessive destruction
3. Blood loss
II. Morphologic Classification
1. Macrocytic anemia
2. Microcytic hypochromic anemia
3. Normochromic normocytic
anemia
Impaired RBC Production
1. Abnormal bone marrow (Aplastic anemia)
2. Essential factors deficiency
3.Anemia in renal disease : Erythropoietin
Excessive Destruction of RBC(cont.)
Hemolytic anemia
1. Intracorpuscular defect(defect inside the
cell)
1.1 Membrane : Hereditary spherocytosis
Hereditary
ovalocytosis, etc.
1.2 Enzyme : G-6PD deficiency, PK def.,
1.3 Hemoglobin : Thalassemia,sickle cell
anemia
Excessive Destruction of RBC
2 Extracorpuscular defect
1. Mechanical trauma :
.
2. Infection : Clostridium tetani,
malaria parasites.
3.Antibodies : HTR (Hemolytic
transfusion reaction) ,
SLE(Systemic lupus
erythematosus)
Blood Loss
1. Acute blood loss : Accident, GIbleeding
2. Chronic blood loss : Hypermenorrhea
Macrocytic Anemia
MCV
> 94 fl
Megaloblastic anemia
1 . Vit. B12 deficiency
2. Folic acid deficiency : Nutritional
megaloblastic anemia.
Microcytic Hypochromic Anemia
MCV
1.
2.
3.
4.
< 80 fl
Iron deficiency anemia
Thalassemia
Sidroblastic anemia
Anemia due to lead poisoning.
Normocytic Normochromic Anemia
MCV
• 1. Blood loss
82 – 92 fl
• 2. Increased plasma volume : Pregnancy,
• 3. Hemolytic anemia : depend on each cause
• 5. Infiltrate BM : Leukemia, Multiple myeloma,
Myelofibrosis, etc.
• 6. Abnormal endocrine : Hypothyroidism, Adrenal
•
insufficiency, etc.
• 7. Kidney disease / Liver disease / Cirrhosis
Signs and Symptoms
Diagnosis
 Haemoglobin Estimation
 Peripheral blood smear
examination
 Red cell indices
 Reticulocyte count
 Erythrocyte sedimentation
rate ESR
 Special test for special type
of Anemia
 Bone marrow examination