Classification of Anemia ( Adults ). Teoman SOYSAL Prof. MD. Definition of anemia. Anemia: A reduction in red cell mass O 2 -carrying capacity It is expressed in terms of reduction in the concentration of Hb (or RBC or Hct%) compared to values obtained from a reference population.
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Teoman SOYSAL Prof. MD
(2 SD below normal)
Parameter Female Male
Corrected Rtc: Patient Hb/Normal Hb x Rtc %
Reticulocytosis: > 100.000 /mm3
WBC: x10E3/mm3 Hb:g/dL
Increased plasma volume Hct: Low
Acute blood loss(early) Hct:unchanged
Chronic anemia Hct: Low
Eg: Low Hb, high RBC, low MCV
Hb: 10 g/dL (anemia)
RBC: 6.5 million/mm3 (erythrocytosis)
MVC : 70 fL
(due to their greater oxygen demand and compensatory actions).
Erythropoiesis tissues , leading to tissue hypoxia.
Angiogenesis and vascular tone
EPO producing cells
Muscle heart liver kidney
Decreased O2 consumption
Compensating mechanisms in anemia tissues , leading to tissue hypoxia.
eg :Blood flow of skin, subcutaneous fluid , pigment changes
Pallor (paleness): even for the same level of Hb.
or over major peripheral arteries
or jugulary veins
Clinical symptoms and findings of anemia (3) even for the same level of Hb.Cardiovascular System(2)
Clinical symptoms and findings of anemia (6) even for the same level of Hb.
(these symptoms may indicate underlying disorder that might indeed be a cause of anemia)
These should remind GIS disease as a cause of anemia
(eg:a bleeding lesion-ulcer/malignancy etc)
Clinical symptoms and findings of anemia (8) even for the same level of Hb.
Acute post-hemorrhagic anemia even for the same level of Hb.
Hemolytic anemia (except thalassemia and some other Hb disorders)
Pure red cell aplasia
Bone marrow infiltration
Chronic disease anemia
Hypovitaminosis CNormocytic Anemias
Anemia of acute bleeding even for the same level of Hb.
Diseases infiltrative to the bone marrow
ScurvyNon-megaloblastic Macrocytic Anemias
Pathogenic classification even for the same level of Hb.(Causes of anemia)
Defective erythroid stem cell
Can be classified as;
1- Abnormalities of RBC interior
a. Enzyme defects
b. Hemoglobinopathies & Thalassemia M
2-RBC membrane abnormalities
a. Hereditary spherocytosis, elliptocytosis etc
b. Paroxysmal nocturnal hemoglobinuria
c. Spur cell anemia
3- Extrinsic factors
b. Antibody : immune hemolysis
c. Traumatic & Microangiopathic hemolysis
d. Infections , toxins , etc
(None of these tests are routine screening tests)
(tests should be chosen individually-do not order routinly )
Serum iron high Serum iron normal/high Serum iron low
Marrow for iron Hemoglobin studies Ferritin level
Low Normal / High
Sideroblastic anemia Thalassemia İron deficiency Anemia of Abnormal Hb chronic disease
Retic. normal / low Retic. high
Bone marrow morphology hemolysis acute blood loss
Hypoplastic infiltration dysplastic
Secondary anemiaeg. Inflammation aplastic anemia leukemia myelodysplasia
liver disease myelofibrosis
Renal failure metastases
response to anemia treatment
Macrocytic anemia (MCV: high) mechanisms
Retic. High Retic. Normal/low
Acute blood loss or
Hemolytic anemia normoblastic dysplastic(MDS) folate or B12 levels
(Other macrocytic anemias)
folate Vit B12