Classification of anemia

1. ANAEMIA
JEESHMA T V
ASST.PROFESSOR
Institute of Paramedical Sciences,
Kannur Medical College

2. ANAEMIA
• Anemia is defined as the reduced Hb con. in
blood below the lower limit of the normal
range for the age and sex of the individual
• Normal Hb values
Males :- 14- 16gm/dl
Females :- 12-14 gm/dl
• New born infants :- 15-17 gm /dl
• In western Males< 13.2 gm /dl
• Females < 11.7 gm /dl taken as anemia

4. • Anemia is not a diseases but it is the
expression of underlying disease and from
the treatment point of view , it is necessary
to identify the cause of anemia

5. WHO criteria
• Adult M <13gm/dl
• Adult F< 12gm/dl
• Infant & children's up to 12 yrs <11gm/dl
• Pregnant women <11gm/dl
• Other parameters
• RBC count, PCV, & absolute values( MCV,
MCH, MCHC) are the other alternative
parameters

7. Classification of anemia
 Morphological classification
 Etiological classification
 Kinetic classification

8. Morphological classification
• Based on the red cell size, Hb content , red
cell indices
• Classified in to 3 types
 Microcytic hypochromic
 Normocytic normochromic
 Macrocytic normochromic

10. Microcytic hypochromic :-
 Many RBCs smaller than normal(MCV<80fL)
TheRBCs are usually hypochromic(MCH<27pg)
Increased zoneof centralpallor
Cells are various in shape &size
MCV,MCH,MCHC are reduced
o Eg:- iron deficiency anemia(IDA)
o And in certain non iron deficicient anaemia
(Sideroblastic anemia),
o Thalassaemia,
o Anaemia of chronic disorder(ACD)

11. Put a
normal
BP
Tryto find
a better
picture of
microcytic
BP
Normal
Microcytic

12. Normocytic normochromic:-
• MCV MCH MCHC are normal
• Theprimary cause- reduction of number ofRBCs.
• Eg:- A/c blood loss,
• Hemolytic anaemia,
• Bone marrow failure,
• Anaemia of chronic disorder

13. ni
Put a
normal
BP
Normal
Normocytic 13JTV/KMC/Patho

14. Normocytic anaemia can be presented with
elevation of reticulocyte count or a reduction of
reticulocyte count.
Elevated
reticulocytecount
• Blood loss
anaemia
• Haemolytic
anaemia
Normal or low
reticulocyte count
• Bone marrow
disorders(Aplasti
c anaemia)
• Chronicdisease
• Kidney disease
14JTV/KMC/Patho

15. Macrocytic normochromic
 Theaveragesizeof RBCsare larger
than normal(>100fL) ie MCV is raised.
 {MCHCis normal or high}
 Eg:- megaloblastic anaemia( vit B12 &
folic acid deficiency)
 2 types of macrocytes
 Oval macrocytes are seen in
megaloblastic anaemia
 Round macrocytes are seen in liver
disease.

16. Normal
Macrocytic
16JTV/KMC/Patho

17. ETIOLOGICAL CLASSIFICATION
• A) ANAEMIA DUE TO BLOOD LOSS
2 TYPES
1. A/C blood loss
Eg :Accidents
Surgery
2. Anaemia of chronic blood loss
Eg: Peptic ulcer
Parasitic infection
GIT bleeding

18. B.ANAEMIA DUE TO IMPAIRED RED
CELL FORMATION
a)Defect in Hematopoietic stem cell
proliferation and differentiation
- Aplastic anaemia
- Pure red cell aplasia
• b)Cytoplasmic metabolic defect
-Deficient haem synthesis(IDA)
-Deficient globin synthesis(Thalassaemia)

19. c)Nuclear maturation defect
-Vit B12 & Folic acid def(megaloblastic)
d)Nutritional deficiency
IDA ,MBA
e)Anaemia of chronic disorders
- Anemia due to inflammation/ infections
- Anaemia in renal disease
- Anaemia in liver disease

20. f). Dyserythropoiesis (BM failure)
--- BM Infiltration,SBA ,Refractory anaemia
--- Leukemia
--- Lymphoma
---- Multiple myeloma
------ Myeloproliferative disorders

21. C) Anaemia due to increased red
destruction/ Haemolytic anaemia
1.Intrinsic red cell abnormalities(Intracorpuscular)
2.Extrinsic red cell abnormalities (Extracorpuscular)
(acquired haemolytic anaemia)
Intrinsic
Hereditary Acquired
PNH
Infections

22. HERDITARY
• 1.ENZYME DEFECIENCY – G6PD deficiency
• 2. MEMBRANE DEFECT
Hereditary Spherocytosis
Hereditary Ovalocytosis
• 3.Hb ABNORMALITIES
 Hemoglobinopathies
 Thalassaemia syndrome
 Sickle cell syndrome
 Hb D,E etc

23. KINETIC CLASSIFICATION
• Based On Reticulocyte Production Index
• RPI = Reticulocyte count x HCT
Reticulocyte maturation time x0.4
Hypocellular RPI < 2
Hypercellular RPI > 3

25. Pathophysiology of anaemia
• Subnormal level of Hb causes lowered O2
carrying of blood
• This initiates compensatory physiologic
adaptations
Increased release of O2 from blood
Increased blood flow to tissue
Maintains of blood volume
• Redistribution of blood flow to maintain
cerebral blood supply.

26. Clinical Features Of Anaemia
1.Speed of onset of anaemia
• Rapidly progressive anaemia cause more
symptoms than that of slow on set anaemia,
less time for physiologic adaptation
2.Severity of anaemia
• No signs & symptoms in some anaemia
Mild 9.1 -10.5 g/dl
Moderate -6-9 g/dl
Severe <6 g/dl of Hb

27. 3.Age of the patient
Young patient due to good cardiovascular
compensation tolerate Anaemia
Elderly people develop cardiac & cerebral
symptoms
4.Spurious anaemia
Red cell concentration decreases due to
hemodilution as in 3rd trimester of pregnancy

28. SYMPTOMS

29. Tiredness
Lack of Concentration
Weakness
Irritability
Palpitation
Fatigue
Dizziness
Dr. SAYID 29JTV/KMC/Patho

30. Other symptoms:
HEADACHE
Dr. SAYID
HAIR LOSS
30JTV/KMC/Patho

31. BRITTLE NAILS
Dr. SAYID
DIFFICULTIES IN CONCENTRATE 31JTV/KMC/Patho

32. Dr. SAYID 32JTV/KMC/Patho

33. SIGNS
• Pallor:- mucus membrane, skin, &
conjunctivae
Lower palpebral conjunctiva Dorsal (upper) surface of tungue Palm & sole
Whole body skin

34. CVS signs
Tachycardia
Cardiomegaly
Murmur
Congestive heart
failure
CNS signs
Faintness
Giddiness
Headache
Tinnitus
Drowsiness
Numbness
GIT
Anorexia
Nausea
Constipation
Weight loss
Ocular
Retinal
hemorrhage
Vascular
disease
Renal
Mild proteinuria
Impaired
concentration
capacity
Reproductive
system:-
Amenorrhea
Menorrhagia

35. EVALUATION OF ANAEMIC PATIENT
Steps required
1.History & Clinical examination
2.Heamtologic investigation
3.Other investigation

36. HISTORY
• Onset of symptoms –A/C or insidious
• History of drug intake,exposure to chemicals
• Family history of similar d/s
• Occupation of pt
• Glossitis,stomatitis
• Haematuria, tarry stools
• No. of pregnancies
• H/o of jaundice
• Pain in legs

37. Clinical examinations
• Pallor
• Nails
• Jaundice
• Lymphadenopathy
• Splenomegaly
• Hepatomegaly
• Cardiac assessment
• Aseesment of renal d/s

38. Hematologic investigations
• Hb ,HCT,RBC count
• Red cell indices –MCV,MCH,MCHC, RDW
• Reticulocyte count
• Periphral smear
• DLC
• ESR
• BM Examination
• BM iron aseesment

39. Biochemical
• S.iron
• S.ferritin
• Transferrin saturation
Urinalysis
• Color ,pH,sp.gravity
• Protein ,sugar, ketone
• Bilirubin, urobilinogen
• Hb in urine
• M/E

40. STOOL
• Occult blood
• Examination of ova & cyst
Other investigations
• Blood urea nitrogen (BUN)
• S.CREATININE
• S.BILIRUBIN
• SGOT,SGPT,LFT
• CT,MRI SCANS

41. 41JTV/KMC/Patho

42. 42JTV/KMC/Patho