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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
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