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THE ANEMIASInadequate Construction
Vs
Excessive Destruction
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Levels Of Anemia• Hemoglobin less than 11
• Hemoglobin les than 9: Moderate
• Hemoglobin less than 7: Severe
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Hypoxia• Low PO2
• Oxygen Content= Hemoglobin + PO2
• Acute signs/symptoms:
• Chronic signs/symptoms:
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Cyanosis• Five grams of hemoglobin are FULLY
desaturated
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Two ways to approach Anemia…
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(1) Check RETICULOCYTE COUNT
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ANEMICLow RETICULOCYTE count• Hypoproliferative
• (1) Something is MISSING
from the bone marrow or…
• (2) Bone marrow is
suppressed
High RETICULOCYTE count• Hyperproliferative
• Hemolytic Anemia– Intravascular
– Extravascular
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Hemolytic AnemiaIntravascular Hemolysis
• Vasculitis in progress
• Schistocytes– Burr Cells
– Helmet Cells
• Low Haptoglobin
Extravascular Hemolysis
• Abnormal membrane structure
• Splenomegaly
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Extravascular Hemolysis• Mcc: Autoimmune hemolysis: Do coombs test
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Drugs that cause extravascular Hemolysis
• Penicillins• Cephalosporins• Sulpha• Dapsone• Alpha Methyl Dopa
• PTU• HIPPPE
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Paroxysmal Nocturnal Hemoglobinuria
• First described in military recruits
• RBCs are sensitive to hemolysis by acidosis
• HAMS test
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Hereditary Spherocytosis• Autosomal Dominant
• SPECTRIN defect
• Osmotic fragility test
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Hereditary Elliptocytosis• Autosomal Dominant
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Some RBCs can talk…
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…Here is what they have to say
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Reticulocyte
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Spherocyte
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Elliptocyte
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Schistocyte
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Tear Drop Cell
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Target Cell
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Heinz Body
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Basophilic Stippling
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Acanthocytes
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Anisocytosis
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Poikylocytosis
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The second way to approach Anemia
• Check a CBC with differential
• MCV
• MCH
• MCHC
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Microcytic Hypochromic• Low MCV
• Low MCH
• Impaired hemoglobin PRODUCTION
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Microcytic Hypochromic Anemias
• Iron Deficiency
• Chronic Disease, late
• Lead poisoning
• Thallessemias
• Hemoglobinopathies
• Sideroblastic anemia
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Microcytic Hyperchromic• Low MCV
• High MCHC ( MCH/MCV)
• The cells are too small
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Microcytic Hyperchromic Anemias
• Hereditary Spherocytosis
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Normocytic Normochromic• Normal MCV
• Normal MCH
• NOTHING is wrong with the RBCs…
• You do not have enough of them
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Normocytic Normochromic Anemias
• Acute Hemorrhage (less Than 4 days)
• Chronic disease, early
• Renal failure
• Hypothyroidism, early
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Macrocytic Anemia• High MCV
• Impaired nuclear division
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Macrocytic Anemias• B12 Deficiency
• Folate Deficiency
• Hypothyroidism, severe
• Reticulocytosis
• Alcohol
• Chemotherapy drugs
• Anticonvulsants
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Anticonvulsants• Phenytoin
• Ethusuximide
• Valproic Acid
• Carbamezapine
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Organization is the key!