Anemia, Classification,

Pathophysiology, Diagnosis.

Khosrow Mahdavi MD FACP

Classification.

Decreased production of red cells 1-Stem cell failure /Aplastic anemia: a-Idiopathic b-Radiation c-Viruses d-drug induced. e-Myelodysplasia./Myeloproliferative status f-Myeolophethesia g-Cytotoxic therapy

Classification

Erythroid progenitor cell failure a-Pure red cell aplasia (Virus, drug, Thymoma, Antibodies ). b-Endocrinopathies. c-Aquired Sidoblastic anemia (Rx.Copper defficiency,etc).

Classification

Failure due to neutritional factors; a-Vit. B12 defficiency. b-Folate defficiency c-N2O induced,Megaloblastic anemia. d-Rx.Pemetrexate, Methotrexate,Phenytoin etc. e-Iron deficiency f- othere

Classification

Anemia of chronic disease. Anemia of renal failure Anemia assosiated environemental factors

(Lead). Acquired Thallassemia Erythropoietin antibodies. Erythroid

progenitor cell failure

Classification; Hereditary:

Stemcellfailure , Pluripotential; Fanconi’s Shwachman syndrom Dyskeratosis Congenita.

hereditary

Erythroid progenitor Cell Failure; Diamond Blackfan Syndrome Congenital dyserythropoietic Syndromes

Fuctional impairment multiple causes

Selective Malabsorbtion of B12 Congenital Intrinsic Factor Deficiency Transcobalamin II deficiency Impaired Cobalamin Metabolism (MMA) Folate Metabolism Purine and Pyrimidine Atransferrinemia Hereditary Sidrolastic anemia Thalassemias

Increased Rate of RBC distruction Aquired

Aquired: 1-Macroangiopatic : March hemoglobulinuria ,Artificial Valve 2-Microangiopatic : DIC ,TTP, Vasculitis, 3-Parasites and microorganisms : Malaria ,Babesosis, Bartonella

Increased RBC distruction Aquired

Antibody Mediated:

1-Warm Autoimmune Hemolytic anemia 2-Cryopathic ; 3-Transfusion Reaction :early and delied

Increased RBC Distruction aquired

Hypersplenism

Membrane disorders Spur cell, acantocytosis ,stomatocytosis Chemical injery Arsenic, Copper, Chlorate, Spider,Scorpion, Snake venums etc. Physical injery Heat.,radiation oxygen

Hereditary Increased Rate of RBC distruction

Hemoglobinopathies. Sickel Cell , Unstable hemoglobins. Red cell membrane a)Cytoskeletal

(HereditarySphorocytosis,Elyptocytosis ,Pyropokilocytosis ) B)Lipid membrane; Abetalipoproteinemia,hereditary stomatocytosis. c)Abnormal erythrocyte antigen (McLeod,Rh deficiency) d)Abnormal transport (Xerocytosis) Red cell Enzyne disorders (PK,G6PD,Nucleotidase )

Porphyria (congenital erythroporphyria)

Loss and redistribution

Acute Blood Loss.

Splenic Sequestration

Relative anemia

Macroglobulinemia. Pregnancy Athletes Post space flight

Diagnosis/

Reticulocytes.

RDW

MCV

Do not forget Hx,Px, and the rest of the CBC and Chemistry panel

Differential Diagnosis Low Retic count

Microcytic : MVC <80

Iron deficiency Thalassemia, minor Sidroblastic anemia Lead poisoning

D/D Macrocytic Anemia Low Retic

Megaloblastic anemia Folate deficiency Vitamin B 12 deficiency Drug Induced Non megaloblastic Liver disease Hypothyroid

D/D Nc/Nc Low Reic count

Early Fe Deficiency Aplastic Anemia Myelophthisic Endocrine disorder Anemia of chronic disease. Renal failure , Uremia Mixed Nutritional deficiency

Vitamin B 12 Deficiency ,Causes

Impaired absorption: Classic PA Gastrectomy (Partial or total) Pancreatic Deficiency Bacterial overgrowth (Blind Loop) Terminal Ilium conditions Tapeworm infection . Congenital Transcobalamin II deficiency

Nutritional

Causes of Folate deficiency

Relative dietary insuficiency’ Pregnancy Lactation Hemolytic conditions Malignancies Exfoliative dermatitis Malabsorbtion; Short bowel Crohn’s disease Sprue Antifolate Medicines Methotrexate Sulfa components. Etc.

Hemolytic Anemia

Immune mediated. Other extrinsic to RBCs Impaired RBC membrane Erythrocyte enzyme deficiencies Hemoglobinopathies

Hemolytic anemia

Immune hemolytic anemia;

Warm antibodies, Cold antibodies.

Hemolytic anemia

Extrinsic factors ; DIC TTP HELLP (Preeclampsia, Eclampsia) Cardiac Valve Splenomegaly Infection

Hemolytic anemia

Impaired RBC Membrane : Inherited : Spherocytosis. Eliptocytosis. Pyropoikilocytosis Aquired: PNH (Proxysmal Nocturnal Hemoglobinuria) Spur cell (Acantocytes)

Hemolytic anemia

RBC, Enzymopathies; G6PD deficiency Othere Hemoglobinopathies; Sickle Cell anemia. Thalassemia

Autoimmune Drug Induced Hemolytic Anemias

Hapten: Penicilline, Cephalothis . . . Immune complex:Quinine Quinidine

Phenacetine Rifampin INH Tetracycline Chlorpromazine

Anti-RBC antibody: Methyldopa,Levodopa, Procainamide ,Ibuprofen, Interferon-a