DR.

DR. SALEEM
SALEEM SHAH
SHAH KHAN
KHAN

(PATHOLOGIST)
(PATHOLOGIST)
 BLOOD

CELL PLASMA

RBC

WBC

PLATELET
 NORMAL VALUES
Haemoglobin Male 12 – 15 gm%
Female 11 – 14 gm%
New Born 15 – 22 gm%
PCV : 36 – 54 %
MCV: 76 – 100 fL
MCH: 27 – 32 pg
MCHC: 31 – 34 %
RBC : 3.9 – 5.6 M/cumm
 ANEMIA….
• DEFINITION:

• Hemoglobin level below the lower limit of

normal range according to age and sex of an
individual.
 CLASSIFICATION
• Microcytic Hypochromic Anemia.

• Nomocytic Nomochromic Anemia

• Macrocytic Anemia.
 HYPOCHROMIC
ANAEMIA

• Iron Deficiency Haemoglobinopathies

 NORMAL VALUES
• Iron 60 – 160 mg %
• TIBC 120 – 350 mg / dl
• Ferritin 15 – 300 Mg / L

• Ferrtin level is a measure of iron store and is last

single test to confirm iron deficiency.
• Total body iron is 4 gm

• Total body requirement 01 mg / day

• It will take approximately 4 years to

develop iron deficiency anemia due to lack
of dietary intake or malabsoption.
 CAUSES OF IRON
DEFICIENCY
• DIET:
» Low in iron
» Vegetarians

• INCREASED PHYSICAL DEMAND:

» Pregnancy
» Breast feeding
» Infants
• BLOOD LOSS:

» Peptic ulcer
» Carcinoma
» Hook worm infection
» Menorrhagia

• MALABSORPTION :

» H.pylori infection
» PPI drugs
» Coeliac disease
 DIFFERENTIAL DIAGNOSIS
OF
HYPOCHROMIC ANEMIA
Iron Deficiency Chronic disease Thalasemia Minor
MCV/MCH or N

Iron N

TIBC or N N

Ferritin or N N
 NORMOCHROMIC
ANEMIA
• Causes
» Acute blood loss.
» Chronic disease tuberculosis, Carcinoma.
» Chronic renal failure.
» Leukaemias & Lymphonas
» Aplastic anaemia.
 MACROCYTIC ANAEMIA
• Deficiency of Vit. B12 & folic acid
• MCU 100 <
• VIT B12:

• Normal values: 200 – 900 pg/ml

• Total body stores are 2 – 3 mg which is sufficient for 3 – 4
years.
• Total body requirement 01 ug/day
• The only source for humans is food of animal origin like
liver, kidney, meat, fish, chicken, egg, cheese, milk.
• Vegetables and fruits are free from Vit. B12
• FOLIC ACID:

• Total body folate is 10 mg.

• Daily requirement is 100 ug/Dday.

• NORMAL VALUES
• Folic Acid 3.0 – 17.0 ng/mll
• Red Cells Folates 175 – 700 ng/ml

• Found in liver, spinach, green vegetables and nuts.

• Stores are sufficient for only 4 months in normal adults so severe
folate deficiency develop rapidly.
 CAUSE OF VIT B12
DEFICIENCY.
• DIET: Nutritional
Vegetarians

• MALABSORPTION
Prenicious Anemia.
Total & Partial gastrectomy
Intestinal Stricture
Crohn’s Disease
Fish Tape Worm
CAUSES FOLATE DEFICIENCY
• DIET
Old Age,
Poverty,
Alcoholism

• MALABSORPTION
Coeliac disease

• EXCESSIVE UTILIZATION :
Physiological
Pregnancy
Lactation
Prematurity
• PATHOLOGICAL:

• CML
• Sickle cell anaemia
• Thalassaemia Major
• Carcinoma
• Leukaemia
• Lymphoma
• Myeloma
• Tuberculosis
• Crohn’s diseae
• Malaria
• Drugs like ATT, Tetracycline
• Barbiturates, Phenytoin Na