This document outlines the definition, signs, symptoms, classification, and laboratory investigation of anemia. Anemia is defined as a low red blood cell or hemoglobin count that varies based on age and sex. Common symptoms include fatigue, weakness, and pale skin. Anemia can be classified as microcytic, normocytic, or macrocytic based on red blood cell size and caused by blood loss, reduced production, or increased destruction. A complete blood count, reticulocyte count, and blood smear examination are important tests to diagnose the underlying cause of anemia.
This document outlines the definition, signs, symptoms, classification, and laboratory investigation of anemia. Anemia is defined as a low red blood cell or hemoglobin count that varies based on age and sex. Common symptoms include fatigue, weakness, and pale skin. Anemia can be classified as microcytic, normocytic, or macrocytic based on red blood cell size and caused by blood loss, reduced production, or increased destruction. A complete blood count, reticulocyte count, and blood smear examination are important tests to diagnose the underlying cause of anemia.
This document outlines the definition, signs, symptoms, classification, and laboratory investigation of anemia. Anemia is defined as a low red blood cell or hemoglobin count that varies based on age and sex. Common symptoms include fatigue, weakness, and pale skin. Anemia can be classified as microcytic, normocytic, or macrocytic based on red blood cell size and caused by blood loss, reduced production, or increased destruction. A complete blood count, reticulocyte count, and blood smear examination are important tests to diagnose the underlying cause of anemia.
This document outlines the definition, signs, symptoms, classification, and laboratory investigation of anemia. Anemia is defined as a low red blood cell or hemoglobin count that varies based on age and sex. Common symptoms include fatigue, weakness, and pale skin. Anemia can be classified as microcytic, normocytic, or macrocytic based on red blood cell size and caused by blood loss, reduced production, or increased destruction. A complete blood count, reticulocyte count, and blood smear examination are important tests to diagnose the underlying cause of anemia.
Anemia Factors affecting definition of Anemia Signs and symptoms of Anemia Classification of Anemia Laboratory investigation of Anemia
Dr. Safia Sabr Ibrahim
10/24/2021 1 Medical Microbiology Department Definition of anemia
• Anemia from the Greek word (ναιμία)(an-haîma) meaning
"without blood“
• Anemia is a condition where the blood has insufficient red
blood cells to carry oxygen from the lungs to the rest of the body or not enough haemoglobin.
• This is normally defined as an Hb concentration in blood of less
than 13.5g/dl in adult males and less than 11.5g/dl in adult females, although some use 14.0g/dl and 12.0g/dl as the adult lower limits of normal.
• Anemia takes several forms and may vary in severity and
duration. It’s often caused by an underlying condition, so it’s important to get prompt diagnosis and treatment. 10/24/2021 2 The definition of anemia is different depending on some factors: 1. Age: ▪ New born infants has high Hb level, 15.0g/dl is taken as the lower limit at birth, from the age of three months to puberty the Hb level will decrease and less than 11.0g/dl indicates anemia. During puberty, an increase in hemoglobin occurs in males due to androgenic steroids. The normal range for hemoglobin in males is therefore higher than for females.
▪ In maturity, the difference between men and women
decreases. In particular, over the two decades after 70 years of age, men’s hemoglobin levels drops by about 1g/dl. Thus the mean hemoglobin concentration of both gender will be close to each other. 10/24/2021 3 ▪ Plasma volume: reduction in plasma volume e.g. dehydration may mask anemia, increase in plasma volume e.g. splenomegally, pregnancy may cause anemia even with normal total red blood cell count and Hb value.
▪ Hb variants: e.g. Hb with low O2 affinity, the patient will
have low Hb, but with normal tissue oxygenation, so that the patient is anemic on blood film examination, but he is physiologically normal.
Note: anemia is not a diagnosis, but it is a laboratory
abnormality that needs explanation and determines the causes of it.
10/24/2021 5 Some parameters for detecting anemia The Complete Blood Count:
1. Hematocrit (Hct) or packed cell volume (PCV):
Volume of packed red blood cells per unit of blood, expressed as a percentage. Example: 44 ml packed red blood cells/ 100 ml of blood = 44%.
2. Hemoglobin = grams of hemoglobin/ dL of blood.
Reduction of Hb is usually accompanied by a fall in red
cell count and packed cell volume (PCV) but these may be normal in some patients with subnormal Hb level.
10/24/2021 6 Symptoms and signs of anemia
• The most common symptom of anemia that patients tend
to report is fatigue. • Decreased exercise tolerance and dyspnea on exertion may be noted by individuals as the extent of the anemia worsens. • Certain types of anemia, such as iron deficiency anemia may be associated with pica, the dietary intake of non-food substances. • When anemia is associated with a microangiopathy, bruising or bleeding may be reported.
10/24/2021 7 Symptoms and signs of anemia
Pale complexion Cracking of the edges of the lips
(angular chelitis)
Spooning of the nails Tachycardia
(koilonychia). 10/24/2021 8 Major broad causes of anemia
• Acute blood loss.
• Inadequate production of red blood cells. • Destruction of red blood cells.
Depending on these factors anemia will be classified into
different categories
10/24/2021 9 Classification of anemia on the bases of aetiology and RBC parameters
Decreased production vs RBC loss (increased
destruction or bleeding).
RBC size : Macrocytic vs. microcytic vs. normocytic.
Hemoglobin Content: Hypochromic vs. normochromic.
Shape: Normal or abnormal.
10/24/2021 10 Decreased production vs RBC loss (increased destruction or bleeding).
1. Blood loss: a- Acute trauma. b- Chronic: lesions of
gastrointestinal tract.
2. Increase rate of destruction (hemolytic anemia):
A. Intrinsic (intra corpuscular) abnormalities of red cells: ❖ Hereditary: 1- Disorders of red cell membrane (Spherocytosis, Elliptocytosis). 2- Red cell enzyme deficiencies: (G6PD, pyruvate & hexokinase deficiency).
1- Antibody mediated: transfusion reaction, drugs and SLE. 2- Mechanical trauma to red cells: microangiopathic and cardiac valves hemolytic anemia. 3- Infections: malaria.
10/24/2021 12 3. Impaired red cell production:
a- Disturbance of proliferation and differentiation of stem
cells (aplastic anemia, anemia of renal failure and endocrine disorders). b- Disturbance of proliferation and maturation of erythroblasts: • Defective DNA synthesis deficiency of B12 and folate (Megaloblastic anemia). • Defective hemoglobin synthesis: – Deficient hem synthesis (iron deficiency anemia). – Deficient globin synthesis (thalassemia). • Unknown or multiple mechanisms (sideroblastic anemia & anemia of chronic infections).
10/24/2021 13 Morphological Classification of Anemia
10/24/2021 14 Classification of anemia based on size of RBC
10/24/2021 15 Laboratory diagnosis of anemia
A systematic approach to the diagnosis of anemia is
essential in order to minimize unnecessary diagnostic testing and to arrive perfectly at the correct diagnosis.
1. complete blood count (CBC)
Despite the availability of sophisticated diagnostic testing, careful consideration of the information provided by the different parameters included in the complete blood count (CBC) and review of a well-prepared peripheral blood smear often provide a great wealth of diagnostic information.
10/24/2021 16 Laboratory diagnosis of anemia
2. Leucocyte and platelet count: Measurement of these
helps to distinguish pure anemia from pancytopenia (a drop in red cells, granulocytes and platelets) which suggests a more general marrow defect, e.g. due to marrow hypoplasia, infiltration or general destruction of cells (e.g. hypersplenism)
In anemia’s due to hemolysis or hemorrhage the neutrophil
and platelet counts are often raised, in infections and leukemia’s the leucocyte count is also often raised and there may be abnormal leucocytes present.
10/24/2021 17 Laboratory diagnosis of anemia 3. Reticulocyte count: The reticulocyte count measures the production and release of newly formed red blood cells. It should be obtained along with the CBC and peripheral blood smear in the evaluation of anemia, as it provides complementary information.
The reticulocyte count is obtained by supravital staining of red
cells with dyes that bind to nucleic acid (e.g., new methylene blue or ethidium bromide) in order to identify the newly released erythrocytes. These cells normally contain residual RNA for about the first day that they are present in the circulation.
10/24/2021 18 Reticulocyte count:
In normal situation the reticulocyte count is about 1%,
which corresponds to an absolute reticulocyte count of 25,000 to 50,000/μL. In the presence of anemia, the absolute reticulocyte count should be at least 100,000/μL. This value corresponds to a reticulocyte index of at least 2%.
10/24/2021 19 Laboratory diagnosis of anemia 4. Blood smear: The wealth of information provided by the CBC and reticulocyte count noted above is greatly complimented by review of the peripheral blood smear.
Sometimes this may be all that is required in order to
reach a diagnosis, and often carefully looking at the peripheral blood smear significantly narrows down the diagnostic entities under consideration.
10/24/2021 20 Morphological features of erythrocytes
Normal erythrocytes Spherocytes
Schistocytes Bite cells
10/24/2021 21 Morphological features of erythrocytes
