貧血的診察
男人
＜4.5
女人
＜4.0
紅血球數 (red blood cells)
(×106 per mL)
血色素
(Hemoglobin; gm/dl) ＜14
血球容積比(Hematocrit)
＜41
＜12
＜37
貧血
MCV
＜80
Figure 2.
Figure 3.
Microcytic anemia
Normocytic anemia
Iron def. Anemia(RBC↓,
Cirrhosis of liver
ferritin↓,SI↓,TIBC↑)
Acute bleeding
Chronic diseases
Sideroblastic anemia
Lead poisoning
Thalassemia(RBC↑)
＞100
80-100
Figure 4.
Macrocytic anemia
Hemorrhage
Hemolysis
Chr. renal insuff.
Hypothyroidism
Addisson`s disease
RA，SLE
Folic deficiency
Vit.B12 deficiency
Chronic inflammation
Hemolytic anemia(hepatoglobin↓,LDH↑,
indirect bilirubin↑,Coombs’test +)
Bone marrow disorders
Figure 1. 貧血的診察原則以 MCV 值來鑑別貧血的可能原因,history
taking 也 是 很 重 要 ; 需 看 morphology, reticulocyte, 或 排 除
leukemia 時請送 CBC-H
Microcytic and/or hypochromic anemia
Serum iron
Decreased
Normal
Increased
Hemoglobin
electrophoresis
Thalassemia
Hemoglobinopathies
Bone marrow
sideroblastic Fe
increased
Sideroblastic
anemia
Ferritin
Increased Decreased
Iron
deficiency
Chronic
disease
Congenital
Acquired
Figure 2. Flow sheet for diagnosis of hypochromic, microcytic anemia. Dashed line
indicated that hyperferremia may be found in thalassemia.
Normocytic,normochromic anemia
Increased
Reticulocyte decreased
History,course,blood smear,
bile pigmens
Screen for renal,hepatic and endocrine disease
Serum iron
Endocrine Uremia Cirrhosis Negative Normal
Disease
of liver screen
or high
Hypothyroidism
Hyperthyroidism
Addison’s disease
Eunuchoidism
Panhypopituitarism
Chronic disorders
Early iron deficiency
Bone marrow
aspiration and biopsy
Hypoplastic Infiltration
Anemia
Heomolytic Hemorrhagic
Anemia
anemia
Low
Masked
megaloblastic
anemia
Leukemia
Myeloma
Dyserythropoiectic
Myelofibrosis
anemia
Metastasis
Myelodysplastic
anemia
Figure 3. Algorithm for ivestigation of a patient with normocytic, normochromic
anemia. By means of a reticulocyte count, anemia associated with a increased rate of
erythropoiesis can be detected. When the rate of erythropoiesis is normal or low,
screening tests for disease of the kidneys, liver and endocrine system as well as iron
metasbolism studies are recommended. If these procedures are not helpful, bone
marrow aspiration and biopsy are indicated.
Macrocytic anemia
Blood and marrow morphology
Megaloblastic
Non- megaloblastic
Clinical data, serum vitamins
B12
Normal
Deficiency
Congenital
disease
Drug
Reticulocyte
increased decreased
Folate
Deficiency
Hemolytic
Hemorrhage
Diet
Good
Schilling test
with intricnsic factor
Corrected
Pernicious
anemia
Gastric
resection
Ingestion of
corrosives
Inert intrinsic
Drug-induced
malabsorption
Jejunal resection
Not corrected
Tropical sprue
Gluten sensitivity
Small bowel bacteria
Fish tapeworm
Familial B12 malabsorption
Drug-induced malabsorption
Ileal disease
Alcohosim
Hepatic disease
Hypothyroidism
Myelophthisic
COPD
Poor
Dietary deficiency
Pregnacy
Infancy
Certain blood disease
factor
Figure 4. The approach to a diagnostic problem in macrocytic anemia.
(Reference: Wintrobe’s Clinical Hematology 10th edition)