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CLASSIFICATION OF ANEMIAS

  • Definition – ↓in Hb and Hct
  • Hb – men (140-180g/l), women (120-160g/l)
  • Hct – men (40-52%), women (37-47%)

Macrocytic nonmegaloblastic anemias

Pathophysiologic classification

  • Based on reticulocyte count
  • Hypoproliferative – BM fails to appropriately respond to anaemia, but cells that are produced are normal. RC is low and erythrocyte (Er)morphology is normal
  • Maturation defects – BM is attempting to respond to anaemia, but cells produced are unable to enter the circ and die within BM. RC is low and er morphology is abnormal
    • Cytoplasmic maturation defects – assoc with microcytic er
    • Nuclear maturation defects – assoc with macrocytic er
  • Hyperproliferative (haemolytic) – increased destruction or loss of er. BM attempts to respond to anemia and produces mature er but is unable to fuly compensate for increased RBC loss. RC > 3% and MCV is also normally high.

Reticulocyte count

  • Percentage of young er containing RNA which can be identified as reticulin using methylene blue staining
  • No. of reticulocytes/total no of er
  • RC increases if RBC production by BM increases, therefore, ↑RC is the primary indicator of ↑RBC production
  • Corrected RC – since RC represents a ratio, a decreased in total RBC count may result in an increased RC, even if reticulocyte production by BM has not increased.
    • CRC = reticulocyte x (patient Hct / 45)
    • CRC >3% means a good BM response, effective erythropoeisis
    • CRC<3% means a poor BM response, ineffective erythropoeisis
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