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Evaluation of Anemia By Dr. Stephen Szabo.

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1 Evaluation of Anemia By Dr. Stephen Szabo

2 Relevant Lab Parameters
Primary Complete Blood Count RBC count MCV Hgb Reticulocyte Count Creatinine LDH and Bilirubin 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 Normal Reticulocyte percent is 0.5 to 1.7% Absolute Reticulocyte number is RBC number*Normal Reticulocyte percent (50,000) Absolute Reticulocyte percent 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)

4 Maslak, P. ASH Image Bank 2005;2005:101299
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 Maslak, P. ASH Image Bank 2005;2005:101299 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

5 Maslak, P. ASH Image Bank 2008;2008:8-00010
Figure 1. Polychromasia (arrow) is noted in the peripheral smear of this lymphoma patient Maslak, P. ASH Image Bank 2008;2008: Copyright ©2008 American Society of Hematology. Copyright restrictions may apply.

6 Maslak, P. ASH Image Bank 2005;2005:101325
Figure 1. Nucleated red blood cells may be seen in the peripheral blood as part of a reactive process Maslak, P. ASH Image Bank 2005;2005:101325 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

7 Functional Classification of Anemia I

8

9 How do we define Anemia? 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 Female 12 g/dl

10 Proposed lower limits of hemoglobin based on age, sex and race
Group Hemoglobin White Men 20-59 13.7 60+ 13.2 White Women 12.2 Black Men 12.9 12.7 Black Women 20-49 11.5 50+

11 Profiles for Underproduction Anemia
Chronic Inflammation Renal Disease Anemia Mild Minor to Severe Retic Index <2 Serum Iron Low Normal TIBC Ferriten Increased Generally Normal MCV Normocytic to Microcytic Normocytic

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

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

14 Maslak, P. ASH Image Bank 2002;2002:100394
Figure 2. Peripheral smear from a splenectomized patient with recurrent autoimmune hemolytic anemia Maslak, P. ASH Image Bank 2002;2002:100394 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

15 Maslak, P. ASH Image Bank 2002;2002:100394
Figure 1. Circulating nucleated RBC (arrow) in the peripheral smear of a patient with autoimmune hemolytic anemia (MacNeal Tetrachrome 1000x) Maslak, P. ASH Image Bank 2002;2002:100394 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

16 Figure 5. This patient has hereditary elliptocytosis
Schrier, S. ASH Image Bank 2002;2002:100344 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

17 Lazarchick, J. ASH Image Bank 2005;2005:101384
Figure 2. The crystal-like inclusions are more evident at higher magnification of the previous image Lazarchick, J. ASH Image Bank 2005;2005:101384 Copyright ©2005 American Society of Hematology. Copyright restrictions may apply.

18 Schrier, S. ASH Image Bank 2002;2002:100344
Figure 7. Peripheral smear of a patient with severe alcoholic liver disease Schrier, S. ASH Image Bank 2002;2002:100344 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

19 Schrier, S. ASH Image Bank 2001;2001:100248
No Caption Found Schrier, S. ASH Image Bank 2001;2001:100248 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.

20 Schrier, S. ASH Image Bank 2001;2001:100248
No Caption Found Schrier, S. ASH Image Bank 2001;2001:100248 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.

21 Schrier, S. ASH Image Bank 2001;2001:100249
Figure 1. Note the fragmented schistocytes, burr cells, and helmet cells Schrier, S. ASH Image Bank 2001;2001:100249 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.

22 Schrier, S. ASH Image Bank 2002;2002:100325
Figure 1. Note the profound central pallor of the hypochromic and microcytic RBC Schrier, S. ASH Image Bank 2002;2002:100325 Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

23 Schrier, S. ASH Image Bank 2001;2001:100231
No Caption Found Schrier, S. ASH Image Bank 2001;2001:100231 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.

24 Figure 2. Note the hypersegmented neutrophil (7-8 lobes)
Schrier, S. ASH Image Bank 2001;2001:100231 Copyright ©2001 American Society of Hematology. Copyright restrictions may apply.


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