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Anemia:- Part 1 – Anemia Classification, Diagnosis, and Routine Work up

June 13, 2022HematologyLab Tests

Table of Contents

  • Anemia Classification
        • Sample
        • Definition of Anemia
      • Hemoglobin facts:
      • Hemoglobin functions:
    • Anemia classification:
      • Anemia may be classified roughly based on Hb level:
      • Anemia classification based on RBC morphology:
      • Anemia classification based on physiological abnormality:
      • Anemia classification based on etiology:
      • Anemia classification based on the category:
      • Anemia classification based on RBC indices:
      • Laboratory Criteria for the diagnosis of Anemias:
      • Routine workup of the patient with anemia needs:
      • Signs and symptoms of the anemias:
    • Types of Anemias
      • Normochromic, Normocytic Anemia:
    • Microcytic, hypochromic anemia:
    • Macrocytic Anemia:
    •  Hemolytic Anemia:
        • Table showing findings in various anemias:
        • Characteristic findings in various Anemias:
          • Anemia type
          • HB
          • MCV 
          • MCHC
          • Ferritin 
          • Iron binding capacity
          • serum iron
        • Classification of anemia based on RDW:
        • Mean corpuscular volume (MCV) and Red cell distribution (RDW) in relation to various diseases:
        • Abnormalities of RBCs and their etiology:

Anemia Classification

Sample

  1. EDTA blood is needed.
  2. For RBC morphology, a direct smear is preferred.`
  3. Bone marrow is also advised.
  4. Also, a bone biopsy may be needed.

Definition of Anemia

  1. Anemia is defined as a decrease in hemoglobin concentration depending upon the patient’s age and sex.
    1. The diagnostic criteria are low hemoglobin, low hematocrit (Hct), or decreased RBC count.
 Criteria for the anemia

Criteria for the anemia

Criteria for the anemia:

  1. Hemoglobin:
  2. Male = Hb <13.5 g/dL.
  3. Female = Hb 11.5 g/dL.
  4. 2 years to puberty = 11.0 g/dL.
  5. A Newborn = 14.0 g/dL is taken as a lower limit because of the high Hb.
  6. Hematocrit (Hct)
  7. Male = <42%.
  8. Female = <37%.
  9. In a broad sense, anemia is the blood’s inability to supply adequate O2 to the tissue for proper metabolism.
  10. These are the most common hematological disorders.
  11. The diagnosis is essential for the physician to treat the cause of anemia.

Effective erythropoiesis depends upon:

  1. Level of iron and cobalt.
  2. Vitamin B12.
  3. Vitamin B6.
  4. Riboflavin.
  5. Thiamine.
  6. Vitamin C.
  7. Vitamin E.
  8. Hormones like:
    1. Androgens.
    2. Thyroxine.

Hemoglobin facts:

To understand the anemias, it is better to know the hemoglobin types and structure:

Type of hemoglobin Structure of hemoglobin Frequency of the hemoglobin
At birth
Hb F α2 / γ2 60 to 90%
Hb A α2 / β2 10 to 40%
At adult age
Hb A1
α2 / β2 >95%
Hb A2
α2 / δ2 <3.5%
Hb F
α2 / γ2 <1 to 2%

Role of hemoglobin in O2 transport (Hb/O2 dissociation curve):

  1. The RBCs carry O2 from the lung to the tissue and bring CO2 in the venous blood to the lung.
  2. This is dependent upon the 2,3-diphosphoglycerate (2,3-DPG).
  3. When the O2 is unloaded, the β-chain of Hb has pulled apart, permitting the entry of the metabolites 2,3-DPG resulting in a lower affinity of the molecule for O2.
Hemoglobin role for oxygen / CO 2 transport

Hemoglobin’s role in oxygen / CO 2 transport

  1. O2 saturation is an indicator of the % of Hb saturated with O2.
  2. When 92% to 100% of the Hb carries O2, the tissues adequately provide the O2 supply, which means normal O2 dissociation.
  3. Normally O2 exchange takes place:
    1. 95% saturated arterial blood with a mean arterial O2 tension of 95 mmHg.
    2. 70% saturated venous blood with a mean venous O2 tension of 40 mmHg.
    3. So the curve’s normal position depends upon the concentration of 2,3-DPG, H+ ions, and CO2 in the RBCs and the Hb molecule structure.
Hemoglobin-Oxy and Deoxy Hemoglobin

Hemoglobin-Oxy and Deoxy Hemoglobin

Hemoglobin functions:

  1. RBCs in arterial blood carry O2 from the lungs to the tissue and take back CO2 in the venous blood.
RBC (Hemoglobin) role in oxygenation

RBC (Hemoglobin) role in oxygenation

  1. This main function is with the help of hemoglobin (Hb) molecules, as the Hb molecule load and unload the O2.
  2. α1β1 and α2β2 globin stabilize the molecule.

Anemia classification:

Anemia may be classified roughly based on Hb level:

  1. Severe anemia when the Hb is <7 g/dL.
  2. Moderate when the Hb is  7 to 10 g/dL. This group will not produce evident S/S. in most of the cases.

Anemia classification based on RBC morphology:

  1. Normochromic and normocytic anemias are due to:
    1. Anemia of acute hemorrhage.
    2. Hemolytic anemia.
    3. Anemia due to chronic diseases.
  2. Hypochromic and microcytic anemias are due to:
    1. Iron deficiency anemia.
    2. Thalassemia.
  3. Normochromic and macrocytic anemias are due to:
    1. Vit. B12 deficiency.
    2. Folate deficiency.

Anemia classification based on physiological abnormality:

  1. Defective maturation of erythropoiesis.
  2. Hemolytic anemia where is the increased breakdown of the RBCs.
  3. Defect due to an increase in RBC precursors compared to the degree of anemia.

Anemia classification based on etiology:

  1. Increased RBCs destruction due to intra or extra red blood cell defects.
  2. Increased blood loss, which may be acute or chronic.
  3. Defective RBCs formation due to Lake of factors necessary for erythropoiesis.

Anemia classification based on the category:

  1. increased destruction of the RBCs
    1. Hemolytic anemia (nonimmune).
    2. Immune hemolytic anemia.
  2. Anemia due to blood loss in hemorrhage.
  3. Nutritional deficiency like folate or vitamin B12 deficiency.
  4. Toxicity due to drugs.
  5. Infections.
  6. Infiltration of the bone marrow by the cancer cells.
  7. Hereditary or acquired defect in the RBCs.
  8. Hematopoietic stem cell arrest or damage.
  9. Idiopathic or unknown cause.

Anemia classification based on RBC indices:

  1. Normocytic:
    1. MCV is 80 to 100 fl (femtoliter).
    2. MCHC = 32 to 36%
  2. Macrocytic:
    1. MCV = >100 fl.
  3. Microcytic and hypochromic.
    1. MCV = <80 fl.
    2. MCHC = <32%.
      Type of anemia MCV fl MCHC%
      Normocytic and normochromic 80 to 100 32 to 36
      Microcytic and hypochromic <80 <32
      Macrocytic >100

Differentiating points of various anemias:

Characteristics findings Microcytic hypochromic Normocytic normochromic Macrocytic
MCV <80 fl (decreased) 80 to 95 fl (normal) >95 fl (increased)
MCH <27 pg (decreased) ≥27 pg (normal) Increased
MCHC Decreased Normal Normal
Etiological factors
  1. Iron deficiency
  2. Thalassemia
  3. Sideroblastic anemia
  4. Chronic diseases
  5. Lead poisoning
  1. Hemolytic anemias
  2. After acute blood loss
  3. Bone marrow failure by chemotherapy or cancer infiltrates.
  4. Renal diseases
  1. Vitamin B12 deficiency
  2. Folic acid deficiency
  3. Aplastic anemia
  4. Non-megaloblastic anemia due to:
    1. Alcohol use
    2. Liver diseases
    3. Myelodysplasia

Laboratory Criteria for the diagnosis of Anemias:

  1. Hemoglobin when it is less than 12 to 13 G/dL.
  2. Hematocrit when it is less than 36 to 41%.
  3. Reticulocyte count was normal at 0.5 to 1.5%.
  4. MCV is a better choice to classify the anemias and their differentiation. This is useful for the screening of occult alcoholism.
  5. If MCV is high, then advise:
    1. Reticulocytes count.
    2. Vit.B12.
    3. Folate level.
  6. If MCV is low, advised:
    1. Serum Iron.
    2. Iron binding capacity (TIBC).
    3. If the above two tests are low, advise Ferritin and Bone marrow examination.
    4. If normal, then advise electrophoresis.
  7. If MCV is normal, then advise:
    1. Serum Iron.
    2. Iron Binding Capacity. (TIBC).
    3. Comb’s test.
    4. Peripheral blood for RBC morphology.

Routine workup of the patient with anemia needs:

  1. The patient’s detailed clinical history for diagnosis, physical examination, signs, and symptoms with the following lab workup.
  2. Hemoglobin and hematocrit.
  3. Red blood cell count.
  4. Blood indices.
  5. MCH has limited value in the differential diagnosis of anemias. This is instrumental calibration.
  6. MCHC is also instrumental calibration, and changes occur very late in the iron-deficiency anemia when anemia is very severe.
    1. This is better to evaluate hypochromasia than MCH.
  7. Red cell distribution width (RDW) helps to classify the anemia with the help of MCV.
    1. RDW is more sensitive to the differentiation of the microcytic anemia than the macrocytic RBCs cause.
    2. This has no value in patients without anemia.
  8. Serum iron (Normal = 50 to 150 µg/dL).
    1. Serum total iron helps in the diagnosis of anemia.
    2. It differentiates between hemochromatosis and hemosiderosis.
    3. It should be measured along with TIBC for evaluation of iron deficiency.
    4. This also helps to evaluate the acute iron toxicity in children.
  9. Total iron-binding  capacity (TIBC = Normal = 250 to 450 µg/dL).
    1. It helps in the differential diagnosis of anemias.
    2. It should be done along with serum iron to evaluate the % saturation for the diagnosis of iron deficiency anemia.
  10. Transferrin: Serum Transferrin level is needed for the D/D of the anemia.
  11. Percent transferrin saturation (normal % transferrin saturation = 20% to 50%).
    1. Calculation of the % transferrin saturation = Serum iron ÷ TIBC x 100 = Transferrin normally 33% is saturated.
    2. This is used for the D/D of the anemias.
    3. This helps in the screening of hereditary spherocytosis.
  12. Ferritin: Serum ferritin (normal = 20 to 250 ng/dL).
    1. It correlates with the total body iron stores.
    2. It differentiates iron deficiency or excess.
    3. It correlates with total body iron stores.
    4. It will predict and monitor iron deficiency.
    5. It will give an idea about the iron-deficiency anemia treatment effectiveness.
    6. It differentiates iron deficiency from chronic diseases.
    7. It monitors the iron status in patients with chronic kidney diseases with or without dialysis.
    8. It is used to study the population’s iron level and response to iron supplements.
    9. It can detect iron overload and monitor iron accumulation.
    10. It can help to guide the response to iron depletion therapy.
  13. Peripheral blood smear.
    1. This will inform the abnormality of the RBC shape, size, and any kind of inclusions.
    2. There is a dimorphic picture in a mixed deficiency of iron, vitamin B12, or folate; there are microcytes and macrocytes. In this case, blood indices may be normal.
    3. Also, find the abnormal white cells and the assessment of the platelets.
    4. It can find the blast cells like normoblast or granulocytes blast cells.
  14. Reticulocyte count.

    1. The normal range is 0.5 to 2.5%, and the absolute count is 25 to 125 x 109/L.
    2. Reticulocytes are raised in anemia because of the erythropoietin raised level.
    3. After the acute hemorrhage:
      1. Erythropoietin level rises in 6 hours.
      2. Reticulocyte level increases in 2 to 3 days, and the peak level reaches 6 to 10 days.
      3. Reticulocytes will be raised until the Hb becomes normal.
    4. In the case of anemia, if there is no raised reticulocyte count, it means bone marrow abnormality or lack of erythropoietin stimulus.
  15. White blood cells count and platelets count. This will rule out the pancytopenia from the anemia.

    1. In hemolysis or hemorrhage, the neutrophils and the platelets are raised.
    2. In leukemias also, the white cells are raised.
  16. Bone marrow examination.
    1. Bone marrow may be aspirated or can take the biopsy.
    2. This will give the cellularity myeloid: erythroid ratio, presence of abnormal cells like cancer cells infiltrate.
    3. Can do Special stains like iron.
Anemia workup

Anemia workup

Signs and symptoms of the anemias:

Clinically S/S seen are:

  1. The main symptoms are due to cardiovascular system adaptation.
    1. There are increased stroke volume, tachycardia, and the Hb O2 dissociation curve changes.
      1. Hyperdynamic circulation leads to tachycardia, a bounding pulse, systolic murmurs, especially at the apex, and cardiomegaly.
      2. Older adults may find S/S of congestive heart failure.
  2. In some of the patients with anemia, there is no S/S, while mild anemia may have severe S/S.
  3. Acute onset effect: There is an effect on the speed of onset; acute onset has more S/S compared to the slow onset.
  4. The severity of the anemia: In the case of mild anemia, there is no S/S.
    1. When the Hb is <9 to 10 g/dL, it may show S/S.
    2. Even Hb as low as 6 g/dL may not produce severe S/S.
  5. Age: Older people tolerate less as compared to young people.
  6. There is pallor on the face, and better judged from the tongue.
  7. The patient will feel weakness and fatigue.
  8. There are lethargy and malaise.
  9. On exertion, there is dyspnoea and palpitation.
    1. The older patients may have cardiac failure, angina, or intermittent claudication or confusion.
    2. There may cause retinal hemorrhage, and this may complicate anemia of rapid onset.
  10. The patient may like to eat clay, ice, and starch.
  11. The patient may have syncope after the exercise.
  12. They may have dizziness and headaches.
  13. There is tinnitus or vertigo.
  14. Usually, these patients are irritable.
  15. These patients may have gastrointestinal symptoms.
  16. These patients may have difficulty sleeping or concentrating.

Specific Signs are:

  1. K0ilonychia, which is spoon-shaped nails. This is usually seen in:
    1. Iron-deficiency anemia.
    2. Jaundice with hemolytic or megaloblastic anemia.
    3. Leg ulcers in Sickle cell anemia.
    4. Other hemolytic anemias.
      Anemia koilonychia

      Anemia showing  koilonychia

    5. Bone deformities are seen in thalassemia and other severe congenital anemia.
    6. There may be infections and bruising with anemia due to bone marrow failure related to thrombocytopenia and neutropenia.

Normal adult blood indices values:

RBCs values Male Female
Hemoglobin (Hb g/dL) 13.5 to 17.5 g/dL 11.5 to 15.5 g/dL
Hematocrit (Hct % or Packed cell volume = PCV) 40 to 52 % 36 to 48%
RBC count 4.5 to 6.5 x1012 /L 3.6 to 5.6 x 1012/L
Mean cell volume (MCV) 80 to 95 fL
Mean cell hemoglobin (MCH) 27 to 34 pg
Mean cell hemoglobin concentration (MCHC) 30 to 35 g/dL
Reticulocytes count 25 to 125 x 109/L

Types of Anemias

Anemia is divided based on RBCs indices (MCV) into the following broad categories:

  1. Microcytic, MCV <80 fl.
  2. Normocytic, MCV 80 to 100 fl.
  3. Macrocytic, MCV >100 fl.

Normochromic, Normocytic Anemia:

Lab findings:

  1. Low hemoglobin.
  2. Normal MCV 80 to 95 fL.
  3. Normal MCH ≥27 pg.
  4. Normal MCHC.
    1. Mostly these are due to acute blood loss.

The peripheral blood smear shows normal-looking RBCs and normal RBCs indices.

    1. The RBCs produced by the bone marrow are normal, but the number of RBCs in the circulation is reduced in number for so many reasons.
      Peripheral blood smear normochromic and normocytic RBCs

      Peripheral blood smear normochromic and normocytic RBCs

The causes of normochromic and normocytic anemia are:

  1. Iron deficiency in the early stages.
  2. Acute blood loss.
  3. Chronic diseases of the kidneys and the liver.
  4. Infiltration by leukemia and multiple myeloma.
  5. Drugs like chloramphenicol cause aplastic anemia.
  6. Acquired hemolytic anemia may be from the prosthetic surgery of the heart.
  7. Pregnancy due to increased plasma volume.
  8. Overhydration.
Anemia normocytic and differential diagnosis

Anemia normocytic and differential diagnosis

Microcytic, hypochromic anemia:

  1. These are the most common type of anemia, and iron deficiency is the most common cause.

Causes of microcytic hypochromic anemia:

  1. This is due to iron deficiency by decreased iron intake in the diet or impaired absorption.
  2. Iron deficiency anemia.
  3. Lead poisoning.
  4. Thalassemia.
  5. There may be an increased iron loss by chronic bleeding.
  6. There may be an abnormality in iron metabolism.
  7. Increased demand by the body in:
    1. Infancy.
    2. Pregnancy.
    3. Lactation.
  8. Due to cancer.
  9. Hemorrhoids.
  10. Hookworms.
  11. Drugs like salicylates (aspirin).
Anemia microcytic differential diagnosis

Anemia microcytic differential diagnosis

Lab findings of microcytic hypochromic anemia:

  1. Low hemoglobin, male <12 g/dL and females <10 g/dL.
  2. Low MCV <80 fL.
  3. MCH < 27 pg.
  4. Findings in the iron-deficiency anemia:
    1. Serum iron is deficient.
    2. TIBC is very high.
    3. Serum ferritin = <10 ng/dL
    4. Free RBCs protoporphyrin is high.
    5. RDW is high.
    6. RBC survival time is slightly less.
  5. Peripheral blood smears show microcytes and pale, hypochromic RBCs.
    1. There may be leucopenia.
    2. Platelets are high in case of bleeding.
    3. Reticulocytes are low than expected in the degree of anemia.
  6. Bone marrow shows erythroid hyperplasia.
    1. Iron stain shows deficient iron.
Anemia showing microcytic hypochromic RBCs

Anemia showing microcytic hypochromic RBCs

Macrocytic Anemia:

  1. These are basically megaloblastic anemias resulting from the deficiency of vitamin B12, folic acid, or a combination of both two.

Lab findings of macrocytic anemia:

  1. Low hemoglobin.
  2. MCV > 99 fL.
  3. The peripheral blood smear shows macrocytosis and many hypersegmented neutrophils.
  4. Occasionally may see leucopenia and thrombocytopenia.

Causes are of macrocytic anemia:

    1. Vitamin B12 deficiency.
    2. Folic acid deficiency.
      1. Or a combination of both
    3. Chemotherapy side effects.
    4. In the case of hydantoin therapy.
Macrocytic anemia differential diagnosis

Macrocytic anemia differential diagnosis

 Hemolytic Anemia:

Definition of hemolytic anemia:

  1. Hemolytic anemia is a disorder associated with the decreased life span of RBCs.
  2. The shortened life span of RBCs may be an intracorpuscular or extracorpuscular abnormality.
  3. The severity depends on the rate of destruction and the removal of RBCs.
  4. The normal bone marrow can increase its work by 6 to 8 folds, so the anemia may not be apparent until the RBC’s life span reaches only 20 days.

Causes of hemolytic anemia:

  1. Intrinsic defects like:
    1. Hereditary defects like:
      1. An abnormal RBC membrane detects hereditary spherocytosis.
      2. Inherited RBC enzyme disorder like G-6-phosphate dehydrogenase deficiency.
    2. Disorders of abnormal hemoglobin production like sickle cell disease.
    3. Thalassemia syndrome.
    4. Paroxysmal nocturnal hemoglobinuria.
  2. Extrinsic defects like:
    1. Chemical and toxic agents.
    2. Infection causing hemolysis.
    3. Hypersplenism.
    4. Immune hemolytic anemia.

lab findings of hemolytic anemia:

  1. There is a raised bilirubin level.
  2. There are increased reticulocytes.
  3. There is polychromasia.
Hemolytic anemia showing polychromasia

Hemolytic anemia showing polychromasia

Table showing findings in various anemias:

Type of anemia Hb MCV MCH MCHC
Iron deficiency low low low low
Megaloblastic low high high normal
Thalassemia low low low low
Chronic illness low low low low

Characteristic findings in various Anemias:

Anemia type
HB
MCV 
MCH
MCHC
Ferritin 
Iron binding capacity
serum iron
 RDW
Iron deficiency low low <76 fl low low/normal decreased increased decreased increased
Megaloblastic low high >100 fl/cell

increased

>32 pg

low 32 to 36 g/dL  raised/normal increased
Chronic illness low low/normal low low normal/ increased normal / decreased decreased normal
Alpha Thalassemia low or normal low low low  normal /increased  normal

 normal or

increased

increased
Beta Thalassemia low low low low  increased/normal  normal  increased/normal  increased
Aplastic anemia low increased normal  normal normal

Classification of anemia based on RDW:

 Cell size
Normal RDW
 High RDW
  • Microcytosis
  1. Thalassemia minor
  2. Chronic diseases,
  3. Some hemoglobinopathy trait
  1. Iron deficiency
  2. Hb H
  3. Anemia of chronic diseases
  4. some cases of thalassemia.
  •  Normocytic
  1.  Hereditary spherocytosis
  2. Acute bleeding
  3. some chronic diseases
  4. Some Hb traits
  1. Some early or partially treated iron deficiency anemia
  2. Sickle cell anemia
  • Macrocytosis
  1. Aplastic Anemia
  1. Autoimmune hemolytic anemia
  2. vit. B or folate deficiency
  3. Liver disease
  4. thyroid disease
  5. Myelodysplasia
  6. Alcohol use

Mean corpuscular volume (MCV) and Red cell distribution (RDW) in relation to various diseases:

Red cell distribution (RDW) Mean corpuscular volume (MCV) Etiology (causes )
  • Normal
  • Decreased (Low)
  1. Thalassemia
  2. chronic diseases
  • Normal
  • Normal
  1. Hemoglobinopathies
  2. Hereditary spherocytosis
  3. Hemolysis
  4. Hemorrhage (acute bleeding)
  5. Transfusion
  6. Chronic diseases (90%)
  7. Liver diseases (cirrhosis)
  8. Chronic lymphocytic leukemia
  9. Uremia
  • Normal
  • Raised (High)
  1. Aplastic anemia
  2. Preleukemia
  3. Alcoholism
  4. Myelodysplastic syndrome
  • Raised (High)
  • Decreased (Low)
  1. Thalassemia
  2. S-thalassemia
  3. Iron deficiency anemia (RBCs fragmentation)
  4. Artificial valves
  5. Hb H
  6. RBC fragmentation
  • Raised (High)
  • Normal
  1. Abnormal hemoglobin
  2. Myelofibrosis
  3. Early iron or folate deficiency
  4. Sideroblastic anemia
  5. SS disease (HbS is present in both genes)
  6. SC disease (one gene Hb S is combined with Hb C)
  • Raised (High)
  • Raised (High)
  1. Folate or B12 deficiency
  2. Cold agglutinin disease (Mycoplasma infection)
  3. Autoimmune hemolytic anemia
  4. Newborn

Abnormalities of RBCs and their etiology:

Type of RBCs abnormality Etiology for the abnormality

Microcytic RBCs

Anemia Microcytic hypochromic

Sickle cell Hb structure

  1. Iron-deficiency anemia
  2. Thalassemia
  3. Sideroblastic anemia
  4. Lead poisoning
MacrocyticAnemia macrocytic megaloblastic
  1. Megaloblastic anemia
  2. Liver diseases
  3. Myelodysplastic syndrome
  4. Increased reticulocyte count
SpherocytesRBC spherocyte
  1. Hereditary spherocytosis
  2. Hemolytic anemia
  3. Post transfusion
Target cellsRBC target cell
  1. Thalassemia
  2. Liver diseases
  3. Sideroblastic anemia
  4. Hemoglobinopathies
Teardrop cells   RBC tear drop poikilocyte
  1. Severe anemia
  2. Pernicious anemia
  3. Myeloproliferative anemia
Elliptocytes     RBC elliptocyte
  1. Hereditary elliptocytosis
  2. Thalassemia
  3. Iron-deficiency anemia
Sickle cellsSickle cell RBCs
  1. Sickle cell anemia
  2. Sickle-thalassemia
Stomatocytes  RBC Elliptocyte
  1. Malignant tumors
  2. Acute alcoholism
Burr cells         RBC burr cells
  1. Renal diseases
  2. Liver diseases
  3. Bleeding gastric ulcer
  4. Severe burns
Acanthocytes  RBC acanthocyte
  1. Alcohol intoxication
  2. Postsplenectomy
  3. Vitamin E deficiency
  4. Congenital abetalipoproteinemia
Helmet cells    RBC Helmet cell
  1. G-6-PD deficiency
  2. Pulmonary emboli
Schistocytes   RBC Schistocyte cell
  1. Hemolytic uremic syndrome
  2. Thrombotic idiopathic thrombocytopenia (ITP)
  3. Disseminated intravascular coagulopathy (DIC)

Summary of lab findings in various anemias:

Lab test Iron-deficiency anemia Pernicious anemia Folic acid deficiency Aplastic anemia Thalassemia Sideroblastic anemia Hemolytic anemia Post hemorrhagic anemia Anemia of chronic diseases
Hemoglobin Low Low Low Low or normal Low Low Low Normal or low Low
Hematocrit Low Low Low Low or normal Low Low Low Normal or low Low
MCV Low High High A normal or mild increase Low Low Normal or high Slightly low Low or normal
Reticulocytes count A normal or mild increase Low Low Low Increased A normal or mild increase High Increased Normal
Plasma Iron Low Increased Increased Increased Increased or normal Increased Normal or high Normal Low
TIBC Increased Normal Normal Normal Normal Normal Normal Normal Low
Ferritin level Low Increased Increased Normal Increased or normal Increased Normal Normal Normal
Folate level Normal Normal Low Normal Normal Normal Normal Normal Normal
Serum B12 level Normal Low Normal Normal Normal Normal Normal Normal Normal
Transferrin Low Mild increase Mild increase Normal Increased Normal Normal Mildly low
Bilirubin level Normal Mild increase Mild increase Normal Increased Increased Increased Normal Normal
Various forms of red blood cells

Various forms of red blood cells

Panic values are:

  1. Hb = <5 g/dL or >20 g/dL
  2. Hct = <20 % ( leads to heart failure)  or > 60% (leads to spontaneous clotting).

Questions and answers:

Q 1: Does red cell distribution (RDW) differentiate between Thalassemia, anemia of chronic diseases, and iron deficiency anemia.

Q2: What will happen to the following laboratory parameters in hemolytic anemia:

  1. Reticulocytes      2.  RDW     3. Indirect bilirubin    4. Haptoglobin

Answers:  Q1 = RDW is usually normal in Thalassemia and anemia of chronic diseases, while raised in iron deficiency anemia.

Q2 = Indirect bilirubin, reticulocytes, and RDW are increased, while haptoglobin is decreased.


Possible References Used
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Comments

ismaeel ali Reply
April 17, 2020

Thanks

Dr. Riaz Reply
April 17, 2020

Thanks for the appreciation.

Trenton Skarupa Reply
July 16, 2020

Dead written content, Really enjoyed reading through.

Dr. Riaz Reply
July 16, 2020

Thanks

Christine Reply
October 17, 2020

Thank you so much for this. We have a discussion about Anemia in class and this has helped me a lot.

Dr. Riaz Reply
October 17, 2020

Thanks.

HOR Setha Reply
May 5, 2021

Many thank.

Dr. Riaz Reply
May 5, 2021

You are welcome.

sharon Reply
August 21, 2021

really great write up. very informative .thanks

Dr. Riaz Reply
August 21, 2021

Thanks.

Alinaitwe Mugabe Reply
September 9, 2021

Wow, good work

Dr. Riaz Reply
September 10, 2021

Thanks.

Rhonda Reply
January 11, 2022

Dr. Riaz,
This was AWESOME! How in the world did you put this all together? I want to share this with my classmates. My name is Rhonda and I am a NP student graduating in August 2022. I so happy that this popped up into my feed. Thank you so much for the time and effort you put into this presentation on anemia. I will print this and use this in my practice years to come. Have you written anything else?

Dr. Riaz Reply
January 11, 2022

Thanks for the remarks. You can see other topics on labpedia.net.

Ateeq ullah Reply
February 2, 2022

Helpful for ME thank you 😊

Dr. Riaz Reply
February 2, 2022

Thanks.

Rx Reply
April 4, 2022

thanks!

Harnek Lal Powar Reply
April 15, 2022

Awesome

Dr. Riaz Reply
April 16, 2022

Thanks.

Kyomugisa Reply
April 17, 2022

I really appreciate this

Dr. Riaz Reply
April 17, 2022

Thanks.

Yuri M Reply
June 23, 2022

Amazing content! Much appreciated

Dr. Riaz Reply
June 23, 2022

Thanks.

Omer Alkhateem Reply
August 28, 2022

Thank you for all this information, I really appreciate it.

Dr. Riaz Reply
August 28, 2022

Thanks.

Ali T Reply
January 21, 2023

Hi, this really was helpful for me , especially the charts! Thanks Dr. Riaz!

Dr. Riaz Reply
January 21, 2023

Thanks.

Abigail D Reply
February 6, 2023

Thanks ,is really helpful

Dr. Riaz Reply
February 6, 2023

Thanks.

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