How can Anemia be classified?
RBC size and morphology
Severity
Others
Define mild anemia.
Hb level: below normal range based on age and sex, but > 10–11 g/dL
How do patient with mild anemia typically present?
Presentation: usually asymptomatic; clinical features of anemia may be present
Define moderate anemia.
Hb level: ∼ 7–10.9 g/dL
How do patient with moderate anemia typically present?
clinical features of anemia may or may not be present.
Define severe anemia.
Hb level: ∼ 7–8 g/dL
How do patient with severe anemia typically present?
clinical features of anemia typically present; hemodynamic compromise may be present.
List other classifications of anemia.
Time course: acute vs. chronic
Inheritance: inherited vs. acquired
Etiology: primary vs. secondary
RBC proliferation: hypoproliferative (decreased RBC production) vs. hyperproliferative (increased RBC destruction or blood loss)
What is the most widely used classification for anemia?
According to RBC size and morphology.
Define the Mean Corpuscular volume (MCV) of a microcytic anemia.
< 80 fL
Describe the mechanism behind microcytic anemia.
Insufficient hemoglobin production
Describe the etiology behind microcytic anemia.
Defective heme synthesis: e.g., IDA, lead poisoning
Defective globin chain (↓ Globin → ↓ hemoglobin → ↓ MCV): e.g., thalassemia
Define the MCV for normocytic anemia.
80 - 100 fL
Describe the mechanism behind normocytic anemia.
Decreased blood volume and/or decreased erythropoiesis
List etiologies for normocytic anemia.
Hemolytic anemia
Intrinsic defects: e.g., hemoglobinopathies, enzyme deficiencies
Extrinsic defects: e.g., AIHA, MAHA,
Nonhemolytic anemia: e.g., blood loss, aplastic anemia, anemia of chronic disease
Define the MCV for macrocytic anemia.
> 100
Describe the mechanim behind macrocytic anemia.
Insufficient nucleus maturation relative to cytoplasm expansion due to
Defective DNA synthesis
Defective DNA repair
List two etiologies for macrocytic anemia.
Megaloblastic anemia: impaired DNA synthesis and/or repair with hypersegmented neutrophils (e.g., Vitamin B12 or folate deficiency)
Nonmegaloblastic anemia: normal DNA synthesis without hypersegmented neutrophils (e.g., liver disease)
How can both iron deficiency anemia and anemia of chronic disease manifest?
Both can manifest with normocytic anemia in the initial phase and microcytic anemia later on.
How can bone marrow failure (e.g., due to myeloproliferative malignancy, myelodysplastic syndrome) manifest?
It can manifest with microcytic, normocytic, or macrocytic anemia.
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