Anemia classification for undergraduate medical school students

1. Classification of anemia
• Functional classification:
Hypoproliferative destruction (infective
hematopoiesis).
• Clinical classification:
Causes of anemia (blood loss, IDA, hemolysis).
• Quantitative classification:
• Hematocrit
• Hemoglobin
• Blood cell indices (MCV, MCH, MCHC).
• Reticulocytes count.

2. Red cell indices
MCV (mean corpuscular volume)
 The average volume of RBC
Hct
=  10 (fl)
RBC count (m/µL)
e.g. Hct= 40%
RBC=5.0 (m /µL)
MCV= 40/5.0  10 = 80 fl
NR= 80-96 fl

3. MCH (mean corpuscular hemoglobin)
 The average content of Hb in average RBC.
 It is directly proportional to the amount of Hb
and RBC size.
Hb
RBC count (m/µL)
 10 (pg)
MCH =
e.g. Hb = 14 g/dl
RBC = 4 (m/µL)
MCH= 14/4  10
= 35 pg
NR= 27-32 pg

4. MCHC (mean corpuscular hemoglobin
concentration)
 Express the average concentration of
hemoglobin per unit volume of RBC.
 It defined as the ratio of the weight of
hemoglobin to volume of RBC.
Hb (g/dl)
Hct (%)
 100 (%)
MCHC=
e.g. Hb = 14 g/dl
Hct = 45 %
MCHC 14/45  100 = 31%
NR= 32-36%

5. Symptoms of Anemia
Hemoglobin/Hematocrit
Normal or High
Check other
Causes of symptoms
e.g. Cardiac
Pulmonary
Low
RBC indices
MCV < 80
MCHC < 32
Serum iron and Total
Iron binding capacity
of Ferritin
Low Iron
IDA, chronic
diseases, Renal
diseases
Normal
Hb
electrophoresis
for Thala.
High Iron
BM exam
For
Sideroblastic
anemia
MCV=80-96
History of acute blood loss
Auto immune Hemolytic anemia
Anemia of chronic Diseases
Anemia of infection
MCV > 98
B12 and folate
levels
Low B12
PA, GI
problems
Severe
malnutrition.
Low folate
Folate
malnutrition
GI problems
Liver disease
High or Normal
MPD
Liver Disease

6. Normal red cell morphology

7. Hypochromic Hyperchromic
Macrocytic Microcytic

8. IDA
Target cells
Sickle cells
Poikiolocytosis
Stomatocytes
Acanthocytes
Ovalocyte
Spherocytes
Nucleated RBC