This document defines anemia and provides a classification system. It begins by defining anemia as a low level of hemoglobin (Hb) and describes the functions of blood. It then outlines symptoms of anemia and discusses red blood cell indices used in evaluation. Three main classifications of anemia are described: morphological (based on cell appearance), pathological (based on cause), and etiological (based on specific cause). Various types of anemia are listed under each classification, such as iron deficiency under morphological and blood loss under acquired etiological anemia. Normal reference ranges for red blood cell parameters are also provided.

2. ANEMIA
DEFINITION &
CLASSIFICATION

3. Anemia
 Low level of Hb according to
age and sex….

4. DEFINITION
 Functions of blood
 Transport of nutrients
 Transport of gases
 Haemostasis
 Defence
 Composition of blood
 Cells (RBC, WBC, Platelets)
 Plasma (Colloids, Crystalloids, Water)

5. Symptoms of Anemia
Hemoglobin/HematocritNormal or High
Check other
Causes of symptoms
e.g. Cardiac
Pulmonary
Low
RBC indices
MCV < 80
MCHC < 32
Serum iron and Total
Iron binding capacity
of Ferritin
Low Iron
IDA, chronic
diseases, Renal
diseases
Normal
Hb
electrophoresis
for Thala.
High Iron
BM exam
For
Sideroblastic
anemia
MCV=80-96
History of acute blood loss
Auto immune Hemolytic anemia
Anemia of chronic Diseases
Anemia of infection
MCV > 98
B12 and folate levels
Low B12
PA, GI
problems
Severe
malnutrition.
Low folate
Folate
malnutrition
GI problems
Liver
disease
High or Normal
MPD
Liver Disease

6. Red cell indices
MCV: Mean Corpuscular volume
The average volume of RBC
MCV= ( HCT / RBC ) X10
MCV= Resut ( fl)
Normal Value: 76-96 fl

7. Red cell indices
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 / RBC ) X10
MCH= Resut ( pg)
Normal Value: 27-32 pg

8. Red cell indices
MCHC (mean corpuscular hemoglobin concentration)
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 / Hct ) x 100
Normal Range : 32-36%

9. DEFINITION
 PYSIOLOGICAL DEFINITION
 Decrease in oxygen carrying capacity of blood.
 ANALYTICAL (PATHOLOGICAL) DEFINITION
 Reduction in total circulating red cell mass
 Reduction in Haemoglobin concentration and/or
Haematocrit

10. RED BLOOD CELLS
These are blood cells produced in the
bone marrow from a pleuripotent
haemopoietic stem cell by processes of
division, differentiation and maturation
and released in the circulation to function
mainly to transport oxygen from lungs to
other tissues of the body.

11. RED BLOOD CELL

12. MEASUREMENT OF
RED BLOOD CELL MASS AND
INDICES
 Haemoglobin (Hb)
 Haematocrit (Hct)
 [Packed Cell Volume (PCV)]
 Total Red Blood Cell Count (TRBC)
 Mean Cell Volume (MCV)
 Mean Cell Haemoglobin (MCH)
 Mean Cell Haemoglobin Concentration (MCHC)
 Red Cell Distribution Width (RDW)

13. NORMAL VALUES
PARAMETER ADULT MALE ADULT FEMALE
Hb 13-17 g/dl 12-16 g/dl
TRBC 4.5-6.5 X 1012/l 4.2-6.0 X 1012/l
Hct/PCV 40-54%/ 36-49%
MCV 76-96 fl
MCH 27-32 pg
MCHC 31.5-34.5 g/dl

14. CLASSIFICATION
 MORPHOLOGICAL CLASSIFICATION
Based on appearance of RBC under the microscope OR red
blood cell indices
 PATHOLOGICAL CLASSIFICATION
Based on abnormality of anatomical, biochemical or
physiological abnormality
 ETIOLOGICAL CLASSIFICATION
Based on specific causative process/agent

15. MORPHOLOGICAL CLASSIFICATION
Normocytic normochromic anaemia

16. MORPHOLOGICAL CLASSIFICATION
Hypochromic Microcytic Anaemia

17. HYPOCHROMIC MICROCYTIC
ANAEMIA
 Iron deficiency anaemia
 Thalassaemia minor
 Sideroblastic anaemia
 Anaemia of chronic disorders

18. MORPHOLOGICAL CLASSIFICATION
Macrocytic anaemia

19. MACROCYTIC ANAEMIA
 Megaloblastic anaemia
 Aplastic anaemia
 Myxoedema
 Chronic Obstructive Pulmonary Disease
 Liver Disease
 Myelodysplastic syndromes

20. PATHOLOGICAL CLASSIFICATION
 Blood loss
 Acute
 Chronic
 Decreased production
 Disturbance of proliferation and differentiation
 Of stem cells
 Of erythroblasts
 Defective Hb synthesis
 Increased destruction
 Intracarpuscular (Intrinsic) defects
 Extracarpuscular (Extrinsic) defects

21. ETIOLOGICAL CLASSIFICATION
 Hereditary
 Blood loss – Hereditary Intestinal bleeding
 Decreased production – Pure Red Cell aplasia
 Increased destruction – Membrane, Enzyme and Hb defects
 Congenital
 Defective production – Congenital dyserythropoietic
anaemia,Congenital sideroblastic anaemia
 Increased destruction – Cardiac defects, vascular defects
 Acquired

22. ACQUIRED ANAEMIAS
 Blood loss
 Acute
 Chronic
 Ulcerative lesions of GIT
 Female reproductive system
 Parasites – Ankylostoma duodenale, Schistosoma haematobium

23. ACQUIRED ANAEMIAS
 Increased destruction of RBC
 Membrane defect (PNH)
 Mechanical trauma (Microangiopathies)
 Antibody mediated (Immune haemolytic anaemia)
 Parasites (malaria, Aroya fever)

24. ACQUIRED ANAEMIAS
 Decreased production
 Deficiency anaemias
 Iron deficiency
 Vitamin B12 and Folate deficiency
 Bone marrow disease/infiltration
 Miscellaneous
 Pyridoxin responsive anaemia
 Sideroblastic anaemia

25. Thank U