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What IS anemia?
-reduction below normal Hgb quantity
-reduction in PCV per 100 ml of blood.
Based on Hgb, what is an anemia
Mod = < 10 g/dl
Severe = < 7 g/dl
What are the two most important pieces of info for diagnosing anemia?

Hgb and Hct

Then: RBC indicies, Retic count, iron studies.
What is the effect of anemia?
reduced oxygen delivery to tissues and organs.
What are some clinical symptoms of a significant anemia?
rapid pulse
difficulty breathing
what are two ways to classify anemias, which is used more?
1. Pathophysiologic - cause
2. Morphologic - used more
what are the 2 pathophysiologic classifications of anemia?
1. Relative
2. Absolute
What is a relative anemia?
an anemia that isn't real - something is making it LOOK like anemia, like increased plasma volume in a pregnant woman.
What are the 2 types of Absolute anemias?
1. Anemia due to decr. RBC production

2. Anemia due to incr. RBC destruction
What are 5 things that decrease RBC production, causing an anemia?
1. Defective pluripotent cell
2. Defective unipotent cell
3. Disturbed DNA synthesis
4. Disturbed Hgb synthesis
5. Unknown idiopathic
what are 2 abnormalities that cause Anemia due to incr. destruction?
1. Intrinsic abnormalities - spherocytosis or sickle cells
2. Extrinsic abnormalities - mechanical harm like burn, artificial heart valve, thrombopurpura.
what are the 3 types of morphological classification?
1. Microcytic
2. Normocytic
3. Macrocytic
what are 4 mechanisms for alleviating tissue hypoxia?
1. O2 diss. curve shift
2. Redistribution of blood
3. Increase cardiac output
4. Increase erythropoeisis
what are the 3 types of Micro/Hypo anemias?
1. Fe deficiency
2. Sideroblastic
3. Anemia of chronic disease
what is the most common micro hypo anemia?
iron deficiency
what is the 2nd most common micro hypo anemia?
chronic disease.
what are 4 causes of iron defic. anemia?
-inadequate source of Fe
-increased demand
-excessive loss
what are the clinical features (patient symptoms) of fe defic. anemia?
-pica syndrome
-inability to maintain normal body temp
what is pica syndrome?
the urge to eat all one thing, and that thing is often very strange.
what is koilonychia?
flat fingernails
glossitis = sore tongue
stomatitis = sores/cracks around the mouth.
achlor = lack of stomach acid
What does the b.marrow "QC" do to hemoglobin production in Fe defic. anemia?
decreases Hgb production - b/c abnormal cells due to lack of Fe can't release into circulation.
what are three states of Fe defic. anemia that show different sets of lab findings?
1. Fe depletion state
2. Fe deficient state
3. Fe deficiency anemia
What are the lab findings in Fe depletion state?
Mostly normal - except for Ferritin, which shows the body Fe stores decreasing.
What are the lab findings in Fe Deficient state?
Normal CBC still
Decr serum iron
Decr. %Transferrin saturation
What are the three stages of Fe deficiency anemia?
What are Lab characteristics of Early Fe defic. anemia?
MCV may be normal, RDW only slightly incr., a Few Targets,
Iron studies indicating lack of iron stores. Hgb = 9-12 g/dl
What are Lab characteristics of Intermed. Fe defic. anemia?
Same Fe studies as early;
RBCs: poik, targets, hypo b/c the body's less picky now.
-Hgb about 8 g/dl
-RDW is high and MCV is low
What are Lab characteristics of Severe Fe defic. anemia?
Hgb is very very low.
RBCs tailed, elliptos, burrs, targets, high RDW.
What are the classic indices seen with an Fe defic. anemia?
MCV 53-79
MCH 14-29
MCHC 22-30%
What 3 other factors will contribute to anemia and compound the problems?
-Incr. blood flow, shear stress damages.
-Destruction of cells with MCH less than 20 during release (natural QC)
-Bmarrow detainment of hypochromic cells in case they might develop
what are 3 types of treatment for iron def. anemia
-oral iron
-transfusions for very severe
what are 3 indications of a responseto therapy?
-increased retics
-dual RBC population
-RDW increase
what are 5 causes of iron deficiency?
inadequete Fe intake
inadequate Fe absorption
Increased Fe demand
Excessive blood loss
what are 2 things that cause inadequate Fe absorption?
-achlorhydria - low stomach acid

what may cause
-incr. demand for Fe
Increased demand: pregnancy and growth spurts

Maldist: congenital atransferrinemia
what is the main feature of sideroblastic anemia?
a problem with heme synthesis so there is excess iron - overload
what is the typical Hgb seen in sideroblastic anemia?
3-10 g/dl
SIDEROBLASTIC ANEMIA - what does the peripheral blood look like?
-Very low hemoglobin, HYPOCHROMIC
-Dimorphic population - Macro/micro
-More than 10% Basophilic stippling and Pappenheimer bodies - abnormal heme synth.
-Very high RDW
-normal Platelet/WBC
What is seen in the bone marrow during sideroblastic anemia?
-Erythroid yperplasia
-Over 15% ringed sideroblasts
-may see megaloblastic changes
what are the 3 categories of sideroblastic anemia?
1. Primary
2. Secondary
3. Toxic exposure
what are the three types of primary siderobl. anemia?
1. Sex-linked
2. Autosomal recessive
3. Idiopathic (refractory anemia w/ ringed sideroblasts
what characterizes sex-linked siderobl. anemia?
-usually have enzyme abnormalities like reduced ALA synthetase
what characterizes autosomal recessive siderobl. anemia?
other enzyme deficiencies
what characterizes refractory anemia w/ ringed sideroblasts?
CLONAL abnormality of pluripotent stem cell

-myelodysplastic disease
what are two types of secondary sideroblastic anemias?
1. Due to medication/treatment
2. Due to infections and neoplasms
Name 4 medications/treatments that can cause iatrogenic sideroblastic anemia.
1. Anti-parkinson meds
2. Anti-tubercular meds
3. Chloramphenical
4. Long-term blood transfusions
what are 3 causes of toxic sideroblastic anemia?
1. Excessive vit/mineral intake
2. chronic alcohol abuse
3. lead poisoning
what are 3 important points re: lead poisoning pathology?
-Fe storage
-Heme synth
-abnormal Fe storage in mitochon
-abnormal heme synthesis by interfering with enzymes.
-ineffective erythropoeisis.
what are features of RBCs seen in toxic exposure sidero anemia?
Basoph. stippling, pappenheimers
30% decr. MCV and MCH
decreased lifespan of RBC
dual cell population
how does toxic siderobl. anemia affect:
-Retic index
-Bone marrow
-Fe studies
-Blood lead
Retic index is decr.
Bone marrow: erythroid hyperplasia and ringed sideroblasts
-Fe studies normal-increased
Blood lead: >80ug/dl is BAD
Porph: ALA in urine
What is anemia of chronic disorcer sometimes called?

Describe cell morphology in
- Advanced cases
- Less severe cases
Aka, Anemia of inflammation

Advanced: hypo/micro
Less sev: Normo/normo
what are 6 causes of anemia of chronic disorder?
-chronic inflammatory disease
-regional enteritis
-ulcerative colitis
-liver disease
-chronic infection
What 4 changes occur in anemia of chronic disease?
1. Fe supply gets decreased.
2. Erythropoeitin level doesn't increase though it needs to.
3. Erythropoeisis actually gets SUPPRESSED by cytokines.
4. Cell destruction is increased
what causes the decreased iron supply in anemia of chronic disease, and what results?
Release and reutilization of iron is blocked, resulting in decreased Hgb synthesis.
What suppresses erythropoeisis in chronic disease anemia?
cytokines, produced by macrophages and lymphs - they are doing their inflammation thing.
What are lab findings in anemia of chronic disease?
-Hgb, MCH, MCV, Retic
Hgb is about 7-11 g/dl
MCH is 31, MCV is 80, Retic is normal. Not a hugely hypo/micro disease, can be normo/normo.
what are iron study results in anemia of chronic disease?
Increased ferritin, FEP, BM Fe

Decreased serum Fe, TIBC
How is anemia of chronic disease treated?
Well if it were treatable it wouldn't be chronic would it.

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