HOLY NAME UNIVERSITY – COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF MEDICAL TECHNOLOGY

ERYTHROCYTES AND ABNORMALITIES
MT 114 LEC
________________________________________________________________________________
HOMEOSTASIS FOUR CATEGORIES OF ANEMIA:

- Under normal circumstances, red cell production and A. HYPOPROLIFERATIVE

circulating RCM (red cell mass) remain at a constant B. MATURATION DISORDERS
level regulated by the erythropoietic mechanism, C. HEMOLYTIC DISORDERS
which functions to maintain the body’s oxygen D. BLOODLOSS
requirement.
CLASSIFICATION OF ANEMIA
- If the RCM is excessively either decreased or
increased, significant clinical problems occur
1. Etiologic
ANEMIA 2. Morphologic
3. Physiologic
- Is the term used to denote conditions associated with
decrease red cells ANEMIA of BONE MARROW FAILURE:

- Best defined in reference to a decreased hemoglobin 1. Aplastic anemia

level, as the physiologic consequences and 2. Fanconi’s anemia
symptoms are the direct result of the decreased 3. Acquired Pure Red Cell Aplasia
oxygen-carrying capacity of the blood. 4. Diamond—Blackfan anemia
5. Myelopthisic anemia
ERYTHROCYTOSIS/POLYCYTHEMIA
ANEMIA of SYSTEMIC DISORDERS:
- Designate conditions involving the presence of too
many red cells in the circulation. • Anemia of chronic renal disease
• Anemia of endocrine disorders
- Best defined in relation to hematocrit level above the • Anemia of Pregnancy
established reference range.
APLASTIC ANEMIA
ABSOLUTE ANEMIA OR RELATIVE ANEMIA
- A condition in which there is a peripheral blood
Absolute anemia - there is true decrease in the RCM. pancytopenia, which is decreased in all cellular
constituents: leukocytes, erythrocytes, and
Relative anemia - this is secondary to the change in the platelets.
plasma volume, such that there is a shift of the
extravascular volume to the intravascular compartment, - The bone marrow is severely hypoplastic or aplastic.
expanding the plasma volume and diluting the RCM (e.g.
Pregnancy, hyperproteinemia) - There are no immature myeloid cells in the peripheral
blood.
ABSOLUTE/RELATIVE ERYTHROCYTOSIS
- There is absence of splenomegaly.

Absolute erythrocytosis - there is a true increase in the DIAGNOSTIC CRITERIA FOR SEVERE APLASTIC
RCM ANEMIA:

Relative erythrocytosis - there is decrease in the Bone marrow cellularity = < 25% of normal or <50% of
plasma volume, the RCM is normal (e.g. Dehydration) normal cellularity with <30% hematopoietic cells

LIBASORA, CHESKA THERESE 1

HOLY NAME UNIVERSITY – COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF MEDICAL TECHNOLOGY
ERYTHROCYTES AND ABNORMALITIES
MT 114 LEC
________________________________________________________________________________
INHERITED PURE RED CELL ANEMIA
PLUS any two of the following:
Peripheral blood: Diamond Black-fan anemia (congenital hypoplastic
Granulocytes: <0.5 x 109/L anemia or PRCA)- a rare congenital disorder diagnosed
Platelets: <20 x 109/L during infancy or early childhood. -normocytic,
Anemia with < 1% reticulocytes normochromic anemia with normal leukocyte and platelet
counts and a marked decrease in marrow erythroblasts –
Primary Aplastic Anemia etiology
a. Congenital or Hereditary Fanconi’s anemia
b. Idiopathic Aplastic Anemia ACQUIRED PURE RED CELL
Secondary Aplastic Anemia
PRIMARY:
FANCONI’S ANEMIA - Idiopathic
- Immune mechanism
- A rare, inherited form of aplastic anemia, first seen in - Immunoglobulin Inhibitor to RBC precursors
3 brothers by Fanconi. - Erythropoietin inhibitor

- Autosomal recessive inheritance characterized as SECONDARY:

pancytopenia with hypoplastic to aplastic bone - Benign Thymomas
marrow. - Drugs
- Chemicals
Clinical presentation: microcephaly, brown skin - Infections
pigmentation, short stature, malformations of the - Hemolytic anemia-aplastic crises
thumbs, malformations of the kidney, genital

hypoplasia, internal strabismus and mental DIAMOND-BLACKFAN ANEMIA

retardation. CONGENITAL PURE RED CELL APLASIA
- A rare congenital disorder first described in 1938
HEMATOLOGIC PICTURE: manifests 5-10 years after
birth - A normochromic, normocytic anemia, normal
leukocyte count and platelet count, Marked decrease
- Anemia, neutropenia and thrombocytopenia in marrow erythroblasts

- Anisocytosis and poikilocytosis are seen - Diagnosed during infancy or early childhood
- Marked increase in hgb f, with resultant decrease in
Hgb A Etiology: unknown
- Osmotic fragility and esr are increased
- Pallor may be evident at birth and is almost always
Bone marrow- hypoplastic which eventually evident by 1 year of age
becomes aplastic
- Retarded growth, bone age retardation and failure of
TREATMENT: androgens to stimulate erythropoiesis and secondary sexual maturation, some have
corticosteroids : bone marrow transplantation osteoporosis

PURE RED CELL APLASIA - Characteristically, they do not demonstrate renal

Abnormalities
• Inherited
• Acquired LABORATORY FINDINGS:
- Primary Hb values as low as 1.7 g/dL to 9.4 g/dL normocytic,
- Secondary normochromic with normal red cell morphology, there is
poor response to erythropoietin, elevated Hgb

LIBASORA, CHESKA THERESE 2

HOLY NAME UNIVERSITY – COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF MEDICAL TECHNOLOGY
ERYTHROCYTES AND ABNORMALITIES
MT 114 LEC
________________________________________________________________________________
• Treatment and prognosis will depend on the
PRINCIPAL CLINICAL AND LABORATORY underlying cause of the anemia
FACTORS
ANEMIA OF CHRONIC RENAL DISEASE

A hypoproliferative anemia that can be severe and almost

invariably occurs in patients with chronic renal failure; and
have elevated BUN levels.

The principal cause is the inadequate marrow response

to anemia because of decrease production of
erythropoietin; some studies have evidence that the bone
marrow may not respond to any form of erythropoietin
MANAGEMENT/TREATMENT:
- Patients have signs and symptoms of anemia,
depending on its severity.
- Red cell transfusions are the mainstays of therapy
every 3-6 weeks to prevent the symptoms of anemia
- Uremia or accumulation of waste products in the body
- after months to years of treatment, patients may
is associated with shortened red cell survival and
resultant mild hemolytic anemia
undergo remissions which may or may not be
maintained
- Normocytic, normochromic anemia (with normal
indices)
- 40-50% responds to steroid therapy
- bone marrow transplantation is also a potential
- Because of the resultant kidney disease, plasma
curative therapy
volume is increased, resulting in an artificially
decreased hematocrit.
MYELOPHTHISIC ANEMIA
• A common finding among 94% of cancer patients. - Although erythrocyte morphology is usually normal,
• Classified as hypoproliferative anemia, also the uremic condition occasionally produces abnormal
under anemia of chronic inflammation or chronic cells such as the BURR CELLS and some HELMET
disease. CELLS.
• In some PATIENTS, the degree of anemia
- There is a rough correlation between the degree of
correlates with the degree of tumor load. In
renal insufficiency (as measured by the serum
others, there is no correlation between the degree creatinine) and the hematocrit.
of anemia and the degree of tumor load.
• Results when the bone marrow is invaded by - The higher the serum creatinine, the lower the
abnormal cells or replacement by metastatic hematocrit and the more severe the anemia.
carcinoma, however there are cases where the
invasion is not due to metastatic cancer cells but - The degree of shortening of the red cell survival is
directly proportional to the creatinine level.
by other cells such as those with miliary
tuberculosis and granulomas.
o Dialysis therapy
• Not synonymous with o Successful kidney transplant
leucoerythroblastic reaction. o Recombinant human erythropoietin
• Leukoerythroblastic reaction - is the presence
of circulating nucleated RBC and immature
leukocytes in the peripheral blood.
• Diagnosis – thru bone marrow biopsy

LIBASORA, CHESKA THERESE 3

HOLY NAME UNIVERSITY – COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF MEDICAL TECHNOLOGY
ERYTHROCYTES AND ABNORMALITIES
MT 114 LEC
________________________________________________________________________________

ANEMIA OF ENDOCRINE DISORDERS HEREDITARY ANEMIA OF INCREASED

DESTRUCTION
Anemia may develop secondary to interference with the
normal action of hormones on red cell production. • Hereditary Spherocytosis
• Hereditary Elliptocytosis
Red cells are normochromic, normocytic with the marrow • Hereditary Pyropoikilocytosis
showing only decreased erythroid production with normal • Hereditary Stomatocytosis/Hydrocytosis
myeloid and megakaryocyte production. • Pyruvate Kinase Deficiency Anemia
• Glucose-6-Phosphate Dehydrogenase Deficiency
o Hypothyroidism
Anemia
o Hypoadrenalism (Addison’s Disease)
• Abetalipoproteinemia
o Hypogonadism (testosterone-stimulates
renal erythropoietin production)
NON-IMMUNE HEMOLYTIC ANEMIA
ANEMIA OF PREGNANCY
- Microangiopathic Hemolytic anemia
- Thrombotic Thrombocytopenic purpura
There is expansion of the total blood volume which may
- Hemolytic Uremic Syndrome
be a physiologic protective mechanism against the effects
of excessive blood loss at the time of delivery. - Disseminated intravascular coagulation

ANEMIA OF MATURATION DISORDERS OTHERS:

- Hemolytic anemia associated with cardiovascular

MACROCYTIC DISORDERS prosthesis, aortic atenosis
1. Pernicious anemia - Hemolytic anemias associated with
2. Folate Deficiency anemia
3. Tropical Sprue/Non-Tropical Sprue parasites – malaria, toxoplamosis
4. Congenital Dyserythropoietic anemia bacteria – Clostridium, Staphylococcus,Streptococcus
- Animal bites
B. MICROCYTIC ANEMIA
1. Iron Deficiency anemia IMMUNE HEMOLYTIC ANEMIA
2. Anemia of Chronic Infectious, Non-Infectious and
Malignant Diseases
3. Sideroblastic anemia - Paroxysmal nocturna hemoglobinuria
4. Hereditary Hemochromatosis - Autoimmune hemolytic anemia-cold and warm types
- Paroxysmal cold hemoglobinuria
- Drug induced hemolytic anemia
E.g.
- Hemolytic disease of the newborn
• Alpha Thalassemia - Hemolytic transfusion reactions
• Beta Thalassemia
• Hereditary Persistence of Fetal Hemoglobin
• Hb-S Beta Thalassemia
• Sickle Cell anemia

LIBASORA, CHESKA THERESE 4