HEMATOLOGY: RBC Disorders

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HEMATOLOGYRBC Disorders

• Dr. VM Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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C.B.C

• Haemoglobin - 152.5, 14 2.5 - g/dl
• PCV - 0.47 0.07, 0.42 0.05 - l/l ()
• Haematocrit, effective RBC volume - better
• RBC count - 5.5 1, 4.8 1 x1012/l
• MCHC - Hb/PCV - 30-36 - g/dl
• Hb synthesis within RBC
• MCH - Hb/RBC - 29.5 2.5 pg/l
• Average Hb in RBC
• MCV - PCV/RBC 85 8 - fl

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Blood Smear - Normal
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Blood Smear - Normal
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Blood Smear - Normal
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RBC disorders (Anemias)

• Anemia is decreased red cell mass affecting
  tissue oxygenation
• Low Hb lt13.5 (males), lt11.5 (females)
• Acquired disorders
• Decreased production
• Increased loss
• Congenital disorders
• Membrane, Hb enzyme disorders.

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Acquired RBC disorders

• Decreased Production
• Aplastic, Hypoplastic anemias
• Deficiency anemias Iron, B12, Folate etc.
• Increased loss/destruction
• Blood loss anemias - parasites, bleeding
• Hemolytic anemias Immune, mechanical, drugs
  toxins.

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Congenital RBC Disorders

• Membrane Disorders
• Spherocytosis
• Hemoglobin Disorders
• Sickle cell disease HbS
• Thalassemias
• Enzyme disorders
• G6PD deficiency

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Anemia with Low MCV(Microcytic Hypochromic)

• Differential diagnosis
• Iron deficiency
• Thalassemia
• Laboratory evaluation
• Iron, iron-binding capacity, and ferritin
• Hb electrophoresis for Thalassemia

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Anemia with High MCV(Macrocytic anemia)

• Differential diagnosis
• Megaloblastic anemia
• Nonmegaloblastic anemia
• Laboratory evaluation
• Serum vitamin B12, RBC folate
• Examination of peripheral smear

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Anemia with Normal MCV(Normocytic anemia)

• Differential diagnosis
• Aplastic anemia
• Bone marrow inflitrations
• Laboratory evaluation
• Blood smear for morphology
• Erythropoietin level
• Bone marrow aspirate and biopsy

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Anemia with high Retics(Hemolytic anemia)

• Acute blood loss, Splenic sequestration
• Hemolysis
• Hemolytic anemia, enzyme deficiency
• Laboratory evaluation
• Blood smear for morphology.
• Coombs test, Cold agglutinin titer
• Hb electrophoresis

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Iron Deficiency Anemia

• Most abundant metal, common deficiency..!
• Limited absorption and no excretory mech.
• Recycling of iron dead cells to new cells
• 1mg/day ? 3-6G body ? 1mg/day
• Increased loss, demand, poor diet.
• Deficiency ? reserves ?exhaustion ?def.synthesis
  ?anemia.
• Angular cheilosis, atrophic glossitis, dysphagia,
  koilonychia, paraesthesia, gastric atrophy.

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Microcytic Anemia (IDA)
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Iron Deficiency Anemia
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IDA on Treatment
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Macrocytic anemia

• Vitamin B12/Folic acid deficiency
• Multi Systemic disorder Macrocytic an.
• All organs with increased cell division
• Delayed DNA synthesis less division
• Nuclear size immature more cytoplasm
• Megaloblasts, destruction, Few Large cells
• Vit B12 also for myelin sheet nerve dis.
• Pernicious anaemia

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Megaloblastic Anemia
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CWM-20353-Meg.An
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CWM-20353-Meg.An
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Iron Metabolism

• 10 of the 10 to 20 mg of dietary iron is
  absorbed each day to balance the 1 to 2 mg daily
  loss.
• Iron is absorbed in Jejunum.
• Stored as Ferritin Hemosiderin.
• Laboratory tests
• Serum iron(1mg/l)
• Serum iron binding capacity (3mg)
• Serum ferritin (gt20ug)

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Iron Deficiency Anemia
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IDA on Treatment
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IDA on Treatment
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Megaloblastic Anemia
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Macrocytic Anemia (Meg.)
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Sickle Cell Disease
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Microcytic Hypochromic RBC
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Thank You...