A.

Anemia and its types

Anemia is characterized as the reduction of hemoglobin (Hb) or hematocrit (HCT) or
RBC count. Anemia is not a diagnosis, but rather a symptom of an ailment. It is a very
frequent condition that affects up to one-third of the world's population. (Turner et.al, 2023)
Anemia is dependent on the blood loss rate with symptoms such as tiredness, weakness,
lethargic feeling, restless legs, chest pain decreased exercise tolerance (severe anemia), pica,
and mild anemia that is asymptomatic.
Main mechanisms involved in anemia are an increase in RBC destruction and
deficient or defective erythropoiesis.
1. Increased RBC Destruction
● Blood Loss
○ Acute- hemorrhage, surgery, trauma, menorrhagia
○ Chronic- heavy menstrual bleeding, chronic gastrointestinal blood losses (in
the setting of hookworm infestation, ulcers, etc.), urinary losses (BPH, renal
carcinoma, schistosomiasis)
● Hemolytic anemia
○ Acquired- immune-mediated, infection, microangiopathic, blood
transfusion-related, and secondary to hypersplenism
○ Hereditary- enzymopathies, disorders of hemoglobin (sickle cell), defects in
red blood cell metabolism (G6PD deficiency, pyruvate kinase deficiency),
defects in red blood cell membrane production (hereditary spherocytosis and
elliptocytosis)
2. Deficient/defective erythropoiesis
● Microcytic
● Normocytic, normochromic
● Macrocytic

RBC are produced in the bone marrow and then circulated. Every day, around 1% of
RBC are eliminated from circulation. Anemia is caused by an imbalance in RBC production
to elimination or destruction. The cause of anemia is determined by whether the anemia is
hypoproliferative (i.e., corrected reticulocyte count less than 2%) or hyperproliferative (i.e.,
corrected reticulocyte count greater than 2%). Three types of hypoproliferative anemia
include Microcytic anemia (MCV<80fl), normocytic anemia (MCV 80-100 fl), and
macrocytic anemia (MCV>100fl).

1. Hypoproliferative Microcytic Anemia (MCV<80 fl)

● Iron deficiency anemia
● Anemia of chronic disease (AOCD)
● Sideroblastic anemia (may be associated with an elevated MCV as well, resulting in a
dimorphic cell population)
● Thalassemia
● Lead poisoning
2. Hypoproliferative Normocytic Anemia (MCV 80-100 fL)
● Anemia of chronic disease (AOCD)
● Renal failure
● Aplastic anemia
● Pure red cell aplasia
● Myelofibrosis or myelophthisic processes
 ● Multiple myeloma
3. Hypoproliferative Macrocytic Anemia (MCV>100 fL)
● Alcohol
● Liver disease
● Hypothyroidism
● Folate and Vitamin B12 deficiency
● Myelodysplastic syndrome (MDS)
○ Refractory anemia (RA)
○ Refractory anemia with ringed sideroblasts (RA-RS)
○ Refractory anemia with excess blasts (RA-EB)
○ Refractory anemia with excess blasts in transformation
○ Chronic myelomonocytic leukemia (CMML)
● Drug-induced
○ Diuretics
○ Chemotherapeutic agents
○ Hypoglycemic agents
○ Antiretroviral agents
○ Antimicrobials
○ Anticonvulsants