Anemia

Evaluation of anemia

male: Hb<13

famale, children: Hb<11

new born: Hb<15

Morphology 

macrocytic anemia: MCV>100, Vit. B12 or folic acid insufficiency, aplastic anemia, reticulocytosis, alcoholism, hypothyroidism, drug, other hematologic disease

normocytic anemia: MCV=80-100, uremia, endocrine disorder, leukemia, liver abscess

microcytic anemia: MCV<80, anemia of chronic disease, iron insufficiency, thalassemia

Reticulocyte productive index, RPI

RPI=Ret (%) X Hct / (45X maturation index)

Microcytic anemia

anemia of chronic disease

malignancy, chronic infection, chronic inflammation cause massive cytokine and hepcidin production and EPO production reduced

<Lab>

    serum ferritin: ─/↑

    serum iron: ↓

    TIBC: ↓

    transferrin saturation: ↓

Iron deficiency disease

most common, female predominal

<Lab>

    serum ferritin: ↓

    serum iron: ↓

    TIBC: ↑

    transferrin saturation: ↓

thalassemia

autosominal recessive, target cell or basophilic stippling in blood smear

alpha-thalassemia

1 alpha abnormal: carrier, no symptom

2 alpha abnormal: alpha thalassemia-minor, may disdiagnosised as iron deficiency anemia

3 alpha abnormal: alpha thalassemia-intermdiate=Hb H disease, jaundice, splenomegaly, hemochromatosis 

4 alpha abnormal: alpha thalassemia-major=hydrops fetalis=Hb Bart's disease: unable to born

beta-thalassemia

1 beta abnormal: beta thalassemia-minor, no symptom or mild anemia 

2 beta abnormal: beta thalassemia-major=Cooley's disease: Hb F>2% or Hb A2>3.5%, need transfusion to survive, and bone marrow transplant soon after birth

Macrocytic anemia

megaloblastic anemia

Vit. B12 or folic acid insufficiency, MCV>115, pancytopenia, reticulocyte↓, megaloblastic hyperplasia

* PANCYTO for pancytopenia: PNH, Aplastic anemia, Neoplasm, Cirrhosis,Y(Vit. B12 or folic acid), Toxin, Overwhelming sepsis

Aplastic anemia

Hb<10, neutrophil<1500, platelet<50K, autoimmune disease
* neutropenia: ANC(=WBC*(Seg%+band%)<1500/uL