Classification of Anaemia

By,Manuji WeerasingheChathuran PereraRidma PereraBuddima PereraPraneeth Madusanka Perera

What is Anaemia?

Definition of AnaemiaAnemia is reduced Haemoglobin concentration in blood more than the amount appropriate for that age, sex, race and physiological status.

Normal ranges of HbMen: Hb 13.5 -17.5 g/dL Women: Hb 11.5-16 g/dLInfants : Hb 14 – 20 g/dL

Classification of anaemiaOn the basis of cause

Blood loss

Inadequate production of normal blood cells

Excessive destruction of blood cells

On the basis of morphology of RBCNormocytic

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 lossAnaemia of chronic diseases

Put a normal BP

Normal

Normocytic

Normocytic anaemia can be presented with elevation of reticulocyte count or a reduction of reticulocyte count.

Elivated reticulocyte count

• Blood loss anaemia

• Haemolytic anaemia

Normal or low reticulocyte count• 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 pallorCells are various in shape & size

Put a normal BP

Try to find a better picture of microcytic BP

Normal

Microcytic

Microcytic Anaemia

Iron deficiency anaemia

Serum Ferritin level > 50µg/L

due to inadequate iron for Hb synthesis)

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

Normal

Macrocytic

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

Anaemia(on the basis of cause)

Blood loss(Haemorrhagic)

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

Red cell membr

ane defects

Hb abnormalities

Metabolic

disorders of RBC

Aquired

immune Non immune

Inherited haemolytic anaemia

1)Red cell membrane defects

Eg:Hereditary spherocytosisHereditary ElliptocytosisHereditary Stomatocytosis

Spherocytosis

Eliptocytosis

Stomatocytosis

Inherited haemolytic anaemia

2)Hb abnormalities

Eg:ThalassaemiaSickle 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:AutoantibodiesDrug induced AntibodiesAllo 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 to,Dr.Champa Wijewickrama