Introduction to pathology of RBC disorders. Anemia

1. Any fool can know.
The point is to understand !
-- Albert Einstein
Know Pathology – you know medicine.
Without Pathology, Medicine is quackery…!

2. ….. foundation of clinical medicine
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
Clinical Pathology:
RBC Disorders: Introduction
CPC : Term2 Week1 - Haem 1/2.
System : Haematology - RBC Disorders.
Topic : 1: Anemia Intro 2: IDA & ACD 3: MBA 4: Haemolytic 5: Others.

3. 3
CPC 2.1: Tired woman...
 Increasing lethargy, SOB, dyspnea, ankle swelling…
 Palpitations, chest pain on exertion, relieved on rest.
 Fever some times. Loss of appetite, some loss of weight
 Hypothyroidism- thyroxine, NSAID for osteoarthritis.
 Bruises easily, Pale, mild jaundice.
 Stomatitis, glossitis,
 PNS: 4/5 lower limb, Romberg +ve,
Reflexes , Babinski +ve,  sensation
63y Ayr – Increasing lethargy, dyspnea, edema - 1year
Difficulty walking – weakness & unsteadiness. - 2week
Initially treated with iron tablets.
Differntial Diagnosis:
Megaloblastic anemia
Pernicious anemia
Hypothy. – macro. An.
Malignancy, Aplastic,
Refractory anemia.
GI bleeds,

4. 4
CPC scenarios:
2014: I.H. 16 year old girl from Bamaga; attending boarding school in
Charters Towers Presents to GP: “I’m feeling very short of breath
when I play netball”. Accompanied by boarding house teacher
(female)
2012: Mrs. IS, 68y old pensioner, rural near Ingham. Husband, a
butcher. She is on warfarin for 10y, for atrial fibrillation. HPTN on
Aldomet. She feels tired and is pale yellow and gets angina while going
for a regular evening walk.
What if “The patient” is a …?
• 64y woman (occult GI loss, hypothyroidism, chronic disease)
• 40y woman (mennorhagia)
• 40y man (occult malignancy, haematological malignancy)
• 65y man with Stage 4 renal failure (discuss renal anaemia)
• 74y man with no PMH of note (B12 def., occult GI malignancy)

5. CPC2.1: Tired woman: Lab results:
1. Where is the primary pathology (diagnosis?)
2. What psychiatric symptoms in Vit B12 deficiency?
3. FBC in Haemolytic?, Folate def.?, ACD? Acute / Chronic blood loss?

6. “Success is going from failure to
failure without loss of enthusiasm” !
– Winston Churchill

7. 7
CPC 2.1: RBC disorders
2014 Term 2
CPC 1
Title: Haematopoetic 1/2 Anaemia
System: Haematopoietic system
Aim: To educate students in:
Clinical, pathological & population studies of patients with
anaemia (RBC disorders)
Objectives: 1. Demonstrate competency in history taking & clinical
examination of patients with anaemia and related illnesses.
2. Describe the pathophysiology of the acute anaemic process
and the common causes and important other rare causes of
anaemia, particularly in the tropics and Indigenous populations.
3. Outline the basic sciences relating to bone marrow, red blood
cell production and turnover of iron, routine blood test
parameters, measurement of iron stores, and precursors
important for red cell production.
4. Demonstrate an understanding of the complications of
anaemia and anaemia as a presentation for other pathologies
and as an illness in itself.
MB2:HRM: Week 2&3 RBC

8. Learning Objectives: Diseases of RBC
 Anaemia: Overview, Classification, pathogenesis,
diagnosis, clinical features & complications.
Study TOP 10 ANEMIA
Major (detailed)
1. Iron Deficiency anemia.
2. Megaloblastic anemia.
3. Imm. Hemolytic (Warm/Cold)
4. Anemia of Chronic Disease.
5. Aplastic Anemia
Minor (brief note)
1. Myelodysplastic/Refractory An
2. Sickle Cell Anemia
3. Thalassemia syndromes.
4. G6PD deficiency anemia.
5. Hereditary Spherocytosis.

9. Whatever you think, that you will be.
If you think yourselves weak,
weak you will be.
If you think yourselves strong,
strong you will be!
-- Swami Vivekananda

10. ….. foundation of clinical medicine
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
RBC & Anemia: Pathophysiology

11. Normal RBC
RBC Histogram
8 μ
8 μ
Capillary 5-10 μ
Only healthy elastic
RBC can squeeze
through capillary.
L
8 μ
Band
N
12-14μ
Reticulocyte
(immature)
MCV >100
Retic.
Persisting RNA

12. Definition of Anemia:
“Anemia is decreased red cell mass affecting tissue
oxygenation”
 Diagnosed using Hematocrit or Hb. levels
(Low Hb* or Low HCT)
 Types:
 Decreased production – Deficiency anemia.
 Increased loss/destruction – Hemolytic anemia.
12

13. Pathogenetic Classification of Anemia:
 Decreased Production:
 Nutrient Deficiency.
 Iron def (IDA) / Megaloblastic (MBA)
 Hemopoietic cell defect:
 Anemia of chronic disorders (ACD)
 Aplastic anemia (AA).
 Dysplastic anemia. Myelodysplastic Syndromes
 Increased loss / destruction:
 Blood loss anemia – Acute / Chronic - bleeding.
 Hemolytic anemia – Congenital / Acquired.
 Acquired / External injury.
 Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites
 Congenital / Internal RBC defect
 Defective Membrane (Spherocytic an)
 Defective Hemoglobin (Sickle cell an.)
 Deficient Enzyme (G6PD)
13
2
2
2
•Cell Mem
•Hb.
•Enzymes
Top 6 Anemias:
1. Iron Def. A
2. Megaloblastic
3. Anem. Of Chronic Dis.
4. Aplastic An.
5. Immune Hemolytic – Warm
6. Immune Hemolytic - Cold

14. RBC development:
14
Bone Marrow 
MCV
90
MCV
110

15. Proerythroblast
(Pronormoblast)
Basophilic
Normoblast
Polychromatophilic
Normoblast
Orthochromatophilic
Normoblast
Reticulocyte
Erythrocyte
BLAST Early Intermediate Late  Retic.  RBC
Anemia Pathogenesis:
15
DNA: B12, Folate
Hb: Iron Iron Metabolism: “limited”,10%,
Recycle, Ferritin, Transferrin,
Hepcidin, forms Hb in cytoplasm.
Megaloblastic anemia
Iron Deficiency anemia
Hemolytic anemia
Immune
Mechanical
Infection
Drugs
Defective*
Aplastic anemia
Dysplastic anemia

17. We are here for you….
venkatesh.shashidhar@jcu.edu.au (Shashi)
Daisy.mehra@jcu.edu.au (Daisy)
Need personal help?
Email us for an appointment or call,
Office Tel: 4781 4566 (Shashi)
Office Tel: 4781 5626 (Daisy)

20. When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are….!
-- Christian D. Larson
Fake it until you make it…!
-- Mohd. Ali. Boxer.