Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood

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1 How deal with a case of Anemia What is anemia? Anemia is a medical condition in which the red blood cell count and hemoglobin is less than normal for age and sex. Most common hematologic disorder by far Almost always a secondary disorder

2 What causes anemia? Any process that can disrupt the normal life span 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 bone marrow.

3 Anemia is caused essentially through two basic pathways. 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.

4 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).

5 According to thes indices,anemia can classify to:- 1-microcytic hypochromic (low MCV and MCH) 2-Normocytic normochromic (normal MCV and MCH) 3- Macrocytic (high MCV)

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7 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 normocytic anemia) - Globin synthesis defect -alpha-, and beta-thalassemia - HbE syndrome - HbC syndrome - and various other unstable hemoglobin diseases - Sideroblastic defect - Hereditary sideroblastic anemia - Acquired sideroblastic anemia, including lead dtoxicity it - Reversible sideroblastic anemia

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10 Macrocytic anemia Megaloblastic anemia the most common cause of macrocytic anemia, is due to a deficiency of either vitamin B12 12, folic acid (or both). Pernicious anemia is caused by a lack of intrinsic factor

11 Non Megaloblastic Macrocytic anemia -Chemotherapy - liver diseaseds - hypothyroidism - Alcohol - Pregnancy

12 Normocytic anemia Normocytic anaemia occurs when the overall hemoglobin levels are always decreased, but the red blood cell size (Mean corpuscular volume) remains normal. Causes include: - Acute blood loss - Anemia of chronic disease - - Aplastic anemia Hemolytic anemia (bone marrow failure)

13 Dimorphic anemia When two causes of anemia act simultaneously, e.g., macrocytic hypochromic, due to hookworm infestation leading to deficiency of both iron vitamin B12 transfusion or folic acid or following a blood more than one abnormality of red and 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.

14 Anemia History and Exam Reticulocyte count Blood film MCV Ferritin WBC, diff, platelets

15 1st Test RETICULOCYTE COUNT

16 MCVlow/MCHlow Reticulocyte Normal/low High Hb. electrophoresis Thalassemia Other abnormal hemoglobin

17 Normal/low Serum iron Low High Ferritin Low Normal/high BM iron IDA ACD Sideroblastic anemia

18 MCV Normal/MCH normal Reticulocyte count 1-Low/normal BM morphology Normal Abnormal Hypoplastic Infiltration/fibrosis 2 nd anemia Aplastic anemia leukemia -Inflammations metastases - renal disease myelobibrosis -Liver disease Endocrine def.

19 2- Reticulocyte count high Acute blood loss hemolysis rather than Thalassemia

20 MCV high Reticulocyte count High Norma/Low BM morphology AIHA Megoloblastic Non megaloblastic Vit B12 def Alcohol Folate def Liver disease hypothyroidism MDS

21 Figure 1-3. Overview of anemia diagnostic work-up using WHO anemia definitions.