How deal with a case of

What is anemia? Anemia is a medical condition in which the count and is less than normal for age and sex . • Most common hematologic disorder by far • Almost always a secondary disorder What causes anemia?

Any process that can disrupt the normal • life sppyan of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the . Anemia is caused essentially through two • basic ppyathways. Anemia is either caused: 1-by a decrease in production of red blood cell or hemoglobin, or

2-by a loss or destruction of blood. • Classification of anemia

There are two major approaches: the • "kinetic" approach which involves evaluating production, destruction and loss and the "morphologic" approach which groups anemia by red blood cell size. The morphologic approach uses a quickly available and cheap lab test as its starting point (the MCV and MCH). AdihidiAccording to thes indices ,anem ia can c liflassify to:-

1-microcytic hypochromic (low MCV and MCH) 2-Normocytic normochromic (normal MCV and MCH) 3- Macrocytic (high MCV)

Microcytic anemia Is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies: - Heme synthesis defect -Iron deficiency anemia -Anemia of chronic disease (more commonly presenting as ) - Glo bin syn thes is de fec t -alpha-, and beta- - HbE syndrome - HbC syndrome - and various other unstable hemoglobin diseases - Sideroblastic defect - Hereditary - AididbltiiildiAcquired sideroblastic anemia, including ldtiitlead toxicity - Reversible sideroblastic anemia

, 12 anemia, vitamin B . ) , factor or both

( () is caused by a lack of intrinsic factor intrinsic anemia anemia folic acid

Pernicious anemia is due to a deficiency of either the most common cause of macrocytic Megaloblastic Macrocytic Non Megaloblastic Macrocytic anemia

-Chemotherapy - liver diseaseds - - - Pregnancy Normocytic anemia

Normocytic anaemia occurs when the overall • hemoglobin levels are always decreased, but the red blood cell size () remains normal. Causes include: - Acute blood loss - Anemia of chronic disease - (bone marrow failure) • - Dimorphic anemia When two causes of anemia act simultaneously, e.g., macrocytic hypochromic, due to hookworm infestation leading to deficiency of both iron and vitamin B12 or folic acid or following a blood transfusion more than one abnormality of red cell indices may be seen. Evidence for multiple causes appears with an elevated RBC distribution width (RDW), which suggests a wider-than-normal range of red cell sizes. Exam

latelets

te count p

y ,

and

diff , ,,p Ferritin History and Exam • MCV • • • • Reticuloc • WBC

Anemia t T

st Tes 1 COUN

RETICULOCYTE MCVlow/MCHlow

Reticulocyte

Normal/low High

Hb. electrophoresis

Thalassemia

Other abnormal hemoglobin Normal/low

SiSerum iron

Low High

Ferritin •

Low Normal/high BM iron

IDA ACD Sideroblastic anemia • MCV Normal/MCH normal

Reticulocyte count

1-Low/normal

BM morphology

Normal Abnormal

Hypoplastic Infiltration/fibrosis 2nd anemia Aplastic anemia leukemia -Inflammations metastases - renal disease myelobibrosis •

-Liver disease Endocrine def. 2- Reticulocyte count high

Acute blood loss rather than Thalassemia MCV high Reticulocyte count

High Norma/Low

BM morphology

Megoloblastic Non megaloblastic • Vit B12 def Alcohol def Liver disease hypothyroidism MDS AIHA • Figure 1-3. Overview of anemia diagnostic work-up using WHO anemia definitions.