ANEMIA DEFINITION & CLASSIFICATION

1. ANEMIADEFINITION & CLASSIFICATION Maj Gen (R) Masood Anwar Professor of Haematology

2. DEFINITION • Functions of blood • Transport of nutrients • Transport of gases • Haemostasis • Defence • Composition of blood • Cells (RBC, WBC, Platelets) • Plasma (Colloids, Crystalloids, Water)

3. DEFINITION • PYSIOLOGICAL DEFINITION • Decrease in oxygen carrying capacity of blood. • ANALYTICAL (PATHOLOGICAL) DEFINITION • Reduction in total circulating red cell mass • Reduction in Haemoglobin concentration and/or Haematocrit

4. RED BLOOD CELLS These are blood cells produced in the bone marrow from a pleuripotenthaemopoieticstem cell by processes of division, differentiation and maturation and released in the circulation to function mainly to transport oxygen from lungs to other tissues of the body.

5. RED BLOOD CELL

6. MEASUREMENT OF RED BLOOD CELL MASS AND INDICES • Haemoglobin (Hb) • Haematocrit (Hct) • [Packed Cell Volume (PCV)] • Total Red Blood Cell Count (TRBC) • Mean Cell Volume (MCV) • Mean Cell Haemoglobin (MCH) • Mean Cell Haemoglobin Concentration (MCHC) • Red Cell Distribution Width (RDW)

7. NORMAL VALUES

8. CLASSIFICATION • MORPHOLOGICAL CLASSIFICATION Based on appearance of RBC under the microscope OR red blood cell indices • PATHOLOGICAL CLASSIFICATION Based on abnormality of anatomical, biochemical or physiological abnormality • ETIOLOGICAL CLASSIFICATION Based on specific causative process/agent

9. MORPHOLOGICAL CLASSIFICATION Normocyticnormochromicanaemia

10. MORPHOLOGICAL CLASSIFICATION HypochromicMicrocyticAnaemia

11. HYPOCHROMIC MICROCYTIC ANAEMIA • Iron deficiency anaemia • Thalassaemia minor • Sideroblasticanaemia • Anaemia of chronic disorders

12. MORPHOLOGICAL CLASSIFICATION Macrocyticanaemia

13. MACROCYTIC ANAEMIA • Megaloblasticanaemia • Aplasticanaemia • Myxoedema • Chronic Obstructive Pulmonary Disease • Liver Disease • Myelodysplastic syndromes

14. PATHOLOGICAL CLASSIFICATION • Blood loss • Acute • Chronic • Decreased production • Disturbance of proliferation and differentiation • Of stem cells • Of erythroblasts • Defective Hb synthesis • Increased destruction • Intracarpuscular (Intrinsic) defects • Extracarpuscular (Extrinsic) defects

15. ETIOLOGICAL CLASSIFICATION • Hereditary • Blood loss – Hereditary Intestinal telengiectasia • Decreased production – Pure Red Cell aplasia • Increased destruction – Membrane, Enzyme and Hb defects • Congenital • Defective production – Congenital dyserythropoieticanaemia,Congenitalsideroblasticanaemia • Increased destruction – Cardiac defects, vascular defects • Acquired

16. ACQUIRED ANAEMIAS • Blood loss • Acute • Chronic • Ulcerative lesions of GIT • Female reproductive system • Parasites – Ankylostomaduodenale, Schistosomahaematobium

17. ACQUIRED ANAEMIAS • Increased destruction of RBC • Membrane defect (PNH) • Mechanical trauma (Microangiopathies) • Antibody mediated (Immune haemolyticanaemia) • Parasites (malaria, Aroya fever)

18. ACQUIRED ANAEMIAS • Decreased production • Deficiency anaemias • Iron deficiency • Vitamin B12 and Folate deficiency • Bone marrow disease/infiltration • Miscellaneous • Pyridoxin responsive anaemia • Sideroblasticanaemia