Hb pattern

20
18
16
14
12
10
8
6
4
2
0
term 1-3d 2w 1m 6m-2y 2-6y 6-12y 12-18y
criteria

AGE Hb in g/dL

CHILDREN 6 MONTHS - 6 YEAR <11

CHILDREN 6 YEARS TO 14 YEARS <12

ADULT MALES <13

ADULT NON PREG FEMALES <12

ADULT FEMALES <11

PCV (Hematocrit)

Volume of RBCs

Volume of whole blood

NORMAL ranges between 36-56

MCV

 Mean volume of an RBC

 NORMAL 80-100 Fl
MCH

 Mean amount of Hb in an RBC

 NORMAL 27-31 pg
MCHC

 Amount of Hb per unit volume of RBCs

 NORMAL 32-36 g/dL

RDW

 Spectrum of variation in the size of RBCs

 Anisocytosis

 NORMAL 11.5-14
Reticulocyte count

 Differentiate anemia due to increased

destruction from anemia due to decreased
production

 Assess response to therapy

 NORMAL newborn 2-6%

children 0.5-2%
 Corrected reticulocyte
count

 Corrected Retic Count = Retic % X (Patient's

HCT/Normal HCT)

The normal corrected reticulocyte

percentage is 1 - 2%.
TC, DC, platelet count

Other cell lines also affected

 Megaloblastic anemia
 Aplastic anemia
 AML, ALL
 Myeloproliferative diseases
 Metastatic disease
PERIPHERAL SMEAR

RBC
 Size
 Color
 Shape
 Inclusion bodies
 Immature cells

WBC & PLATELETS

Microcytic hypochromic

 Reduced iron availability/ utilization

Iron deficiency, anemia of c/c diseases

 Reduced heme synthesis

lead poisoning, sideroblastic anemia

 Reduced globin synthesis

thalassemia & other hemoglobinopathies
Macrocytic anemia
 Abnormal nucleic acid maturation
cobalamine & Folate deficiency, drugs
zidovudin, hydroxyurea

 Any condition causing reticulocytosis

hemolytic disease, c/c hemorrhage

 Alcohol, hypothyroidism, CLD

 Abnormal RBC maturation

MDS, a/c Leukemia, LGL
NORMOCYTIC NORMOCHROMIC

 A/C blood loss

 Anemia of c/c diseases

 CKD
others
 iron deficiency parameters

 Depletion of stainable iron in bone marrow

 Dec serum ferritin levels (<15mcg/ml)
 Inc RDW (>14.5)
 Low serum iron (<75mcg/dl)
 Inc TIBC (>470MCG/DL)
 low transferrin saturation (<14%)
 inc red cell protoporphyrin
 Peripheral smear

hyper segmented neutrophils &

macro ovalocytes

Yes no

likely Megaloblastic likely non Megaloblastic

Bone marrow examination to confirm Megaloblastic anemia
Response to vit B12 / folic acid therapy

Megaloblastic marrow &

Anemia improves

Continue vit B12 / Folate

non Megaloblastic marrow or

no improvement

investigate for : intrinsic factor

drug induced
 If no hyper segmented
neutrophils & macro ovalocytes

reticulocyte count

Decreased increased

Hypothyroidism Hemolysis
Liver disease hemorrhage
When peripheral smear points towards an
hemolytic etiology –

•Osmotic fragility testing

•Coombs test
•Sickling test
•Hb electrophoresis
•Serum bilirubin & urine urobilinogen
•LDH
•Haptoglobin
When nutritonal anemia is suspected

- Iron status
- B12 level
- Folate level
 If other cell lines also affected
Initial management may depend on the
severity of anemia & general condition of
the patient

Definitive treatment of anemia depends

on the etiology , so correct diagnosis of
the cause is important
 Dietary counseling

 If nutritional anemia – correct Fe , vitB12 & folic

acid

 Parasitic infestations

 Fe deficiency anemia – oral iron

preparations, par enteral iron & blood
transfusion in severe cases
During an acute attack of hemolysis – maintain fluid
balance & renal output

Thalassemia – blood transfusion & iron chelation therapy

Hereditary spherocytosis – splenectomy performed after

6 yrs of age with pre- surgical immunizations for Hib
, strep. Pneumoniae & neisseria meningitidis