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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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Presentation on theme: "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."— Presentation transcript:

1 Evaluation of Anemia By Dr. Stephen Szabo

2 Relevant Lab Parameters Primary Complete Blood Count Complete Blood Count RBC count RBC count MCV MCV Hgb Hgb Reticulocyte Count Reticulocyte Count Creatinine Creatinine LDH and Bilirubin LDH and Bilirubin Peripheral Smear Peripheral Smear Secondary Hgb Electrophoresis Direct Antibody Test Serum Protein Electrophoresis Haptoglobin Iron Panel B12 (MMA, Homocystiene) Bone Marrow Biopsy

3 The Reticulocyte Count The reticulocyte is a young red blood cell that contains residual ribosomal RNA The reticulocyte is a young red blood cell that 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 number*Normal Reticulocyte percent (50,000) Absolute Reticulocyte number is RBC number*Normal Reticulocyte percent (50,000) Absolute Reticulocyte percent Absolute Reticulocyte percent Normal Retic % *(Hct/45) Normal Retic % *(Hct/45) For severe anemia <25% divide Abs Retic percent by 2 (because very immature reticulocytes are being released from the bone marrow) For severe anemia <25% divide Abs Retic percent by 2 (because very immature reticulocytes are being released from the bone marrow)

4 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2005;2005: 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

5 Copyright ©2008 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2008;2008: Figure 1. Polychromasia (arrow) is noted in the peripheral smear of this lymphoma patient

6 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2005;2005: Figure 1. Nucleated red blood cells may be seen in the peripheral blood as part of a reactive process

7 Functional Classification of Anemia I Hgb<12 g/dl CBC Retic Index Normocytic <2 Underproduction Macrocytic or Microcytic <2 Maturation disorder Normocytic >3 to 5 Decreased RBC survival Increased Production

8 Anemia Underproduction Marrow Damage Iron Def Renal Disease Chronic Inflammation Maturation Disorders Iron Def B12 Def Folic Acid Def Types of Myelodysplasia Hemolysis Hemorrhage Blood Loss Autoimmuse disease Membrane disease Hemoglobinopathy

9 How do we define Anemia? The lower limits of normal hemoglobin were defined in 1968 by the WHO using a predominantly European population: The lower limits of normal hemoglobin were defined in 1968 by the WHO using a predominantly European population: Lower Limits of Normal Adult Male 13 g/dl Adult Male 13 g/dl Adult Female 12 g/dl Adult Female 12 g/dl

10 Proposed lower limits of hemoglobin based on age, sex and race GroupHemoglobin White Men White Women Black Men Black Women

11 Profiles for Underproduction Anemia Chronic Inflammation Renal Disease AnemiaMild Minor to Severe Retic Index <2<2 Serum Iron LowNormal TIBCLowNormal FerritenIncreased Generally Normal MCV Normocytic to Microcytic Normocytic

12 Profiles for Iron Def Anemia Iron Store Depletion Iron Deficient Erythropoiesis Iron Deficiency Anemia HemoglobinNormal Slight Decrease Microcytic Serum Iron Normal <60 mcg/dl <40 mcg/dl Percent saturation 20 to 30% <15%<10% Ferriten<20<12<12 TIBC >390>410

13 How to Calculate Total Iron Needed Body Weight (kg)x2.3x(15-pt’s Hgb) mg Body Weight (kg)x2.3x(15-pt’s Hgb) mg

14 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2002;2002: Figure 2. Peripheral smear from a splenectomized patient with recurrent autoimmune hemolytic anemia

15 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2002;2002: Figure 1. Circulating nucleated RBC (arrow) in the peripheral smear of a patient with autoimmune hemolytic anemia (MacNeal Tetrachrome 1000x)

16 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2002;2002: Figure 5. This patient has hereditary elliptocytosis

17 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply. Lazarchick, J. ASH Image Bank 2005;2005: Figure 2. The crystal-like inclusions are more evident at higher magnification of the previous image

18 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2002;2002: Figure 7. Peripheral smear of a patient with severe alcoholic liver disease

19 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2001;2001: No Caption Found

20 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2001;2001: No Caption Found

21 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2001;2001: Figure 1. Note the fragmented schistocytes, burr cells, and helmet cells

22 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2002;2002: Figure 1. Note the profound central pallor of the hypochromic and microcytic RBC

23 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2001;2001: No Caption Found

24 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply. Schrier, S. ASH Image Bank 2001;2001: Figure 2. Note the hypersegmented neutrophil (7-8 lobes)


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