1. Anemia - Introduction

2. Normal Erythropoiesis
Kidney Bone marrow Multi-potent
stem cell
Epo
mRNA Erythroid
stem cell
Epo
Oxygen
sensor
3-4
days
Blood vessel
Peripheral
blood
RBC survival
100-120 days

7. Anemia
• Understanding anemia
– Disease - to be treated on its own merits
– Condition - a secondary manifestation of
another disease
– Symptoms depend on severity/acuity
• Causes
– Decreased production
– Blood loss
– Hemolysis

8. Laboratory Evaluation of Anemia
• Complete blood count
• Peripheral smear
• Reticulocyte count
– Relative reticulocyte count
♦ Percent of all RBC (normal 0.8%–1.5%)
– Absolute reticulocyte count
♦ Relative reticulocyte count x RBC count
♦ Normal 50,000–75,000/µl
♦ Examples: 6
1.1% x 4.96 x10 = 55,000/l
6
12.2% x 2.05 x10 = 250,000/l

9. Classification of Anemia Based on
RBC Kinetics and Size
MCV
Microcytic Normocytic Macrocytic
Retic Low Common Common Common
count
High Uncommon Common Uncommon

10. Microcytic Hypochromic Anemia:
Diagnosis
• Mild (MCV > 70 fl) • Severe (MCV < 70 )
– Iron deficiency – Iron deficiency
– Thalassemia – Thalassemia
– Lead toxicity
– Sideroblastic anemia
– Anemia of chronic
disease

11. Macrocytic Anemia with Low
Reticulocyte Count
• Megaloblastic anemia
– Vitamin B12 deficiency
– Folate deficiency
• Non-megaloblastic macrocytic anemia
– Liver disease
– Hypothyroidism
– Drug-induced (DNA synthesis block)
– Myelodysplastic syndrome