Comprehensive Guide to Anemia Classifications and Symptoms

1. Alterations of Erythrocyte Function Chapter 26

2. Anemia • Reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin • Impaired erythrocyte production • Acute or chronic blood loss • Increased erythrocyte destruction • Combination of the above

3. Anemia • Classifications • Etiology • Morphology • Based on MCV, MCH, and MCHC values • Size • Identified by terms that end in -cytic • Macrocytic, microcytic, normocytic • Hemoglobin content • Identified by terms that end in -chromic • Normochromic and hypochromic

4. Anemia • Anisocytosis • Red cells are present in various sizes • Poikilocytosis • Red cells are present in various shapes

5. Anemia • Physiologic manifestation • Reduced oxygen carrying capacity • Variable symptoms based on severity and the ability for the body to compensate • Classic anemia symptoms • Fatigue, weakness, dyspnea, and pallor

6. Macrocytic-Normochromic Anemias • Also termed megaloblastic anemias • Characterized by defective DNA synthesis • Due to deficiencies in vitamin B12 or folate • Coenzymes for nuclear maturation and the DNA synthesis pathway • Ribonucleic acid (RNA) processes occur at a normal rate • Results in the unequal growth of the nucleus and cytoplasm

7. Macrocytic-Normochromic Anemias • Pernicious anemia • Caused by a lack of intrinsic factor from the gastric parietal cells • Required for vitamin B12 absorption • Results in vitamin B12 deficiency

8. Macrocytic-Normochromic Anemias • Pernicious anemia • Typical anemia symptoms • Neurologic manifestations • Nerve demyelination • Others • Loss of appetite, abdominal pain, beefy red tongue (atrophic glossitis), icterus, and splenic enlargement • Treatment • Parenteral or high oral doses of vitamin B12

9. Pernicious Anemia

10. Macrocytic-Normochromic Anemias • Folate deficiency anemia • Absorption of folate occurs in the upper small intestine • Not dependent on any other facilitating factor • Similar symptoms to pernicious anemia except neurologic manifestations are generally not seen • Treatment requires daily oral administration of folate

11. Microcytic-Hypochromic Anemias • Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin. • Related to: • Disorders of iron metabolism • Disorders of porphyrin and heme synthesis • Disorders of globin synthesis

12. Microcytic-Hypochromic Anemias • Iron deficiency anemia • Most common type of anemia worldwide • Nutritional iron deficiency • Metabolic or functional deficiency • Progression of iron deficiency causes: • Brittle, thin, coarsely ridged, and spoon-shaped nails • A red, sore, and painful tongue

13. Iron Deficiency Anemia

14. Microcytic-Hypochromic Anemias • Sideroblastic anemia • Group of disorders characterized by anemia • Altered mitochondrial metabolism causing ineffective iron uptake and resulting in dysfunctional hemoglobin synthesis • Ringed sideroblasts within the bone marrow are diagnostic • Sideroblasts are erythroblasts that contain iron granules that have not been synthesized into hemoglobin

15. Microcytic-Hypochromic Anemias • Sideroblastic anemia • Dimorphism • Myelodysplastic syndrome • Erythropoietic hemochromatosis

16. Normocytic-Normochromic Anemias • Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number

17. Normocytic-Normochromic Anemias • Aplastic anemia • Pancytopenia • Pure red cell aplasia • Fanconi anemia • Posthemorrhagic anemia • Acute blood loss from the vascular space

18. Normocytic-Normochromic Anemias • Hemolytic anemia • Accelerated destruction of red blood cells • Autoimmune hemolytic anemias • Immunohemolytic anemia • Warm antibody immunohemolytic anemia • Drug-induced hemolytic anemia • Cold agglutinin immunohemolytic anemia • Cold hemolysin hemolytic anemia

19. Drug-Induced Hemolytic Anemia

20. Normocytic-Normochromic Anemias • Sickle cell anemia • Anemia of chronic inflammation • Mild to moderate anemia seen in: • AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis, renal failure, and malignancies • Pathologic mechanisms • Decreased erythrocyte life span • Ineffective bone marrow response to erythropoietin • Altered iron metabolism

21. Anemia of Chronic Inflammation

22. Myeloproliferative RBC Disorders • Polycythemia • Overproduction of red blood cells • Relative polycythemia • Result of dehydration • Fluid loss results in relative increases of red cell counts and Hgb and Hct values

23. Polycythemia • Absolute polycythemia • Primary absolute • Abnormality of stem cells in the bone marrow • Polycythemia vera (PV) • Secondary absolute • Increase in erythropoietin as a normal response to chronic hypoxia or an inappropriate response to erythropoietin-secreting tumors