Classification of Anaemia By, Mosaab A. Omar

What is Anaemia? Definition of Anaemia Anemia is reduced Haemoglobin concentration in blood more than the amount appropriate for that age, sex, race and physiological status. Normal ranges of Hb Men: Hb 13.5 -17.5 g/dL Women: Hb 11.5-16 g/dL Infants : Hb 14 – 20 g/dL

Classification of anaemia Blood loss Normocytic Macrocytic Microcytic On the basis of cause Blood loss Inadequate production of normal blood cells Excessive destruction of blood cells On the basis of morphology of RBC Normocytic Macrocytic Microcytic

Classification according to Morphology of RBC The average size of RBC (MCV) provides a convenient and informative framework to categorize the various types of anaemia

Normocytic Normochromic Anaemia The primary cause - reduction of number of RBCs.   Eg: Endocrine disorders (hypopituitarism, hypothyroidism and hypoadrenalism) Haematological disorders(aplastic anaemia ,haemolytic anaemias) Acute blood loss Anaemia of chronic diseases

Normal Put a normal BP Normocytic

Bone marrow disorders(Aplastic anaemia) Normocytic anaemia can be presented with elevation of reticulocyte count or a reduction of reticulocyte count. Elivated reticulocyte count Normal or low reticulocyte count Blood loss anaemia Haemolytic anaemia Bone marrow disorders(Aplastic anaemia) Chronic disease Kidney disease

Microcytic Anaemia Many RBCs smaller than normal (MCV<80fL) The RBCs are usually hypochromic (MCH<27pg) Increased zone of central pallor Cells are various in shape & size

Normal Microcytic Put a normal BP Try to find a better picture of microcytic BP Microcytic

Iron deficiency anaemia due to inadequate iron for Hb synthesis) Microcytic Anaemia Iron deficiency anaemia Serum Ferritin level > 50µg/L due to inadequate iron for Hb synthesis) Due to other reasons Thalassaemia trait (α or β) Anaemia of chronic disease Sideroblastic anaemia(Inherited) Lead poisoning

Sideroblastic anaemia Bone Marrow Picture

Macrocytic Anaemia The average size of RBCs are larger than normal(>100fL) {MCHC is normal or high} Can be divided in to 2 types Megaloblastic anaemia Non megaloblastic anaemia FL (femtoliters)

Normal Macrocytic

A. MEGALOBLASTIC ANAEMIA B. Non megaloblastic anaemia Macrocytic Anaemia A. MEGALOBLASTIC ANAEMIA Vitamin B12 deficiency Folate deficiency Abnormal metabolism of folate and vit B12 B. Non megaloblastic anaemia Liver disease Alcoholism Post splenoctomy Neonatal macrocytosis Stress erythropoiesis

Increase destruction Impaired production Anaemia (hypoproliferative) (on the basis of cause) (Haemorrhagic) Blood loss Impaired production (hypoproliferative) Increase destruction (Haemolytic)

Reduced RBC Production Stem cell defects - Aplastic anaemia Nutritional deficiency - Fe deficiency anaemia Erythropoietin deficiency - Chronic renal faliure Hormone deficiency - Hypothyroidism Inhibitory effects of Cytokines - Chronic diseases Unsuitable microenvironment - Secondary deposits

Increased Loss (Anaemia due to haemorrhage) Acute blood loss Chronic blood loss

Haemolytic Anaemia Inherited Aquired Red cell membrane defects Hb abnormalities Metabolic disorders of RBC Aquired immune Non immune

Inherited haemolytic anaemia 1)Red cell membrane defects Eg: Hereditary spherocytosis Hereditary Elliptocytosis Hereditary Stomatocytosis

Eliptocytosis Spherocytosis Stomatocytosis

Inherited haemolytic anaemia 2)Hb abnormalities Eg: Thalassaemia Sickle Cell Anaemia

Thalassaemia Target cells

Sickle Cell Anaemia

Inherited haemolytic anaemia 3)Metabolic disorders of RBCs Eg: Glucose-6-phosphate Dehydrogenase deficiency Pyruvate Kinase deficiency

Aquired haemolytic anaemia (Immune) Eg: Autoantibodies Drug induced Antibodies Allo Antibodies

Aquired haemolytic anaemia (Non immune) Eg: MAHA – Micro Angiopathic Haemolytic Anaemia(due to abnormal micro vessels) Parasites – Malaria Burns – Abnormal vessels

Malaria

Special thanks