01/06/1446

HEMATOLOGY

ANEMIA
Definition, Causes, Classification, and Microcytic Anemia

By
Dr. Abdulfatah al-bakkosh

HEMATOLOGY

Definition of Anemia
General Definition
 Anemia is defined as a condition in which there is a reduction in the
total number of red blood cells (RBCs) or a decrease in the
concentration of hemoglobin in the blood below the normal reference
range for the individual's age, sex, and altitude.
01/06/1446

HEMATOLOGY

Hemoglobin Reference Ranges

Adult Men: Hemoglobin <13.5 g/dL
Adult Women: Hemoglobin <12.0 g/dL
Children and Pregnant Women: Values vary and should be
compared to age-specific reference ranges.

HEMATOLOGY

Causes of Anemia
Anemia can result from various mechanisms affecting red blood
cell production, lifespan, or loss.
1. Decreased Red Blood Cell Production
Nutritional Deficiencies
1. Iron Deficiency: Essential for hemoglobin synthesis.
2. Vitamin B12 Deficiency: Necessary for DNA synthesis.
3. Folate Deficiency: Also required for DNA synthesis.
01/06/1446

HEMATOLOGY

Causes of Anemia
2. Bone Marrow Disorders
 Aplastic Anemia: Failure of bone marrow hematopoietic activity.
 Myelodysplastic Syndromes: Ineffective hematopoiesis leading to dysplastic
cells.
 Bone Marrow Infiltration: By malignancies such as leukemia or lymphoma.
3. Chronic Diseases
 Chronic Kidney Disease: Decreased erythropoietin production.
 Chronic Inflammation: Anemia of chronic disease due to altered iron
metabolism.

HEMATOLOGY

Causes of Anemia
2. Bone Marrow Disorders
 Aplastic Anemia: Failure of bone marrow hematopoietic activity.
 Myelodysplastic Syndromes: Ineffective hematopoiesis leading to dysplastic
cells.
 Bone Marrow Infiltration: By malignancies such as leukemia or lymphoma.
3. Chronic Diseases
 Chronic Kidney Disease: Decreased erythropoietin production.
 Chronic Inflammation: Anemia of chronic disease due to altered iron
metabolism.
01/06/1446

HEMATOLOGY

Causes of Anemia
Increased Red Blood Cell Destruction (Hemolysis)
1. Inherited Hemolytic Anemias
 Sickle Cell Disease: Abnormal hemoglobin S leading to sickling.
 Thalassemias: Reduced synthesis of globin chains.
 Hereditary Spherocytosis: Membrane defects causing spherical RBCs.
2. Acquired Hemolytic Anemias
 Autoimmune Hemolytic Anemia: Antibodies against RBCs.
 Paroxysmal Nocturnal Hemoglobinuria: Complement-mediated lysis.
 Mechanical Destruction: Due to prosthetic heart valves.

HEMATOLOGY

Causes of Anemia
Blood Loss
Acute Blood Loss
Trauma or Surgery: Rapid loss of blood volume.
Chronic Blood Loss
Gastrointestinal Bleeding: Ulcers, malignancies,
hemorrhoids.
Menorrhagia: Heavy menstrual bleeding.
01/06/1446

HEMATOLOGY

Classification of Anemia
Anemia can be classified based on red blood cell size
(mean corpuscular volume, MCV) and hemoglobin content
(mean corpuscular hemoglobin concentration, MCHC).
Morphological Classification
Microcytic Anemia
Definition: MCV <80 femtoliters (fL).
Characteristics: Small-sized red blood cells.

HEMATOLOGY

Classification of Anemia
Normocytic Anemia
 Definition: MCV 80 – 100 fL.
 Characteristics: Normal-sized red blood cells.
Macrocytic Anemia
 Definition: MCV >100 fL.
 Characteristics: Large-sized red blood cells.
01/06/1446

HEMATOLOGY

Classification of Anemia
Etiological Classification
1. Hypoproliferative Anemia
Cause: Decreased RBC production.
Examples: Iron deficiency, anemia of chronic disease.
2. Hemolytic Anemia
Cause: Increased RBC destruction.
Examples: Sickle cell disease, autoimmune hemolytic anemia.
3. Hemorrhagic Anemia
Cause: Blood loss.
Examples: Acute trauma, chronic gastrointestinal bleeding

HEMATOLOGY

Microcytic Anemia

Definition and Overview

 Microcytic Anemia is characterized by red blood cells that are smaller than
normal (MCV <80 fL).
 Hypochromia: Often accompanied by decreased hemoglobin content, leading to
pale cells (low MCHC).
01/06/1446

HEMATOLOGY

Causes of Microcytic Anemia

Iron Deficiency Anemia
 Most Common Cause: Due to inadequate iron for hemoglobin
synthesis.
 Etiology:
o Dietary Insufficiency: Low iron intake.
o Malabsorption: Conditions like celiac disease.
o Increased Demand: Pregnancy, growth spurts.

• Chronic Blood Loss: Gastrointestinal bleeding, menstrual losses.

HEMATOLOGY

Causes of Microcytic Anemia

• Thalassemia Syndromes
 Genetic Disorders: Reduced synthesis of globin chains.
 Types:
o Alpha Thalassemia: Deletion or mutation of alpha-globin genes.
o Beta Thalassemia: Mutation in beta-globin genes.
 Pathophysiology:
o Ineffective Erythropoiesis: Imbalance in globin chain production leads to
premature RBC destruction.
01/06/1446

HEMATOLOGY

Causes of Microcytic Anemia

Anemia of Chronic Disease
 Mechanism:
o Iron Sequestration: Inflammatory cytokines increase hepcidin
levels, reducing iron availability.
 Associated Conditions: Chronic infections, autoimmune
diseases, malignancies.

HEMATOLOGY

Causes of Microcytic Anemia

• Sideroblastic Anemia
 Definition: Impaired incorporation of iron into heme.
 Causes:
o Congenital Forms: Genetic defects in heme synthesis enzymes.
o Acquired Forms: Alcoholism, lead poisoning, certain medications.

• Lead Poisoning
 Mechanism: Inhibits enzymes involved in heme synthesis.
 Clinical Features: Abdominal pain, neurological symptoms.
01/06/1446

HEMATOLOGY

Pathophysiology of Microcytic Anemia

 Impaired Hemoglobin Synthesis:
o Iron Deficiency: Inadequate iron leads to decreased hemoglobin production.
o Globin Chain Disorders: Thalassemias cause imbalance in globin chains.
 Resulting Microcytosis:
o Smaller RBCs: Due to reduced hemoglobin content, cells undergo extra
divisions to maintain hemoglobin concentration, resulting in smaller size.

HEMATOLOGY

Clinical Features
General Symptoms of Anemia:
Fatigue, weakness, dyspnea on exertion.
Pallor of skin and mucous membranes.
Specific Signs:
Iron Deficiency Anemia:
Pica (craving for non-nutritive substances).
Koilonychia (spoon-shaped nails).
Glossitis (inflamed tongue).
01/06/1446

HEMATOLOGY

Clinical Feature
• Thalassemia:
• Facial bone deformities due to marrow expansion.

• Splenomegaly.

• Lead Poisoning:
• Neurological symptoms.

• Abdominal pain.

HEMATOLOGY

Laboratory Diagnosis
Complete Blood Count (CBC)
 Low Hemoglobin and Hematocrit.
 Reduced MCV (<80 fL).
 Low MCH and MCHC: Hypochromia.
Peripheral Blood Smear
 Microcytosis: Small RBCs.
 Anisocytosis: Variation in cell size.
 Poikilocytosis: Variation in cell shape.
 Target Cells: Especially in thalassemia.
01/06/1446

HEMATOLOGY

Laboratory Diagnosis
Iron Studies
• Serum Iron: Decreased in iron deficiency.
• Total Iron-Binding Capacity (TIBC):
• Increased: In iron deficiency anemia.
• Decreased: In anemia of chronic disease.
• Ferritin Levels:
• Decreased: In iron deficiency.
• Normal or Increased: In anemia of chronic disease.
• Transferrin Saturation:
• Decreased: In iron deficiency.