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Hb pattern
0
2
4
6
8
10
1214
16
18
20
term 1-3d 2w 1m 6m-2y 2-6y 6-12y 12-18y
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criteria
AGE Hb in g/dL
CHILDREN 6 MONTHS - 6 YEAR
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PCV (Hematocrit)
Volume of RBCs
Volume of whole blood
NORMAL ranges between 36-56
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MCV
Mean volume of an RBC
NORMAL 80-100 Fl
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MCH
Mean amount of Hb in an RBC
NORMAL 27-31 pg
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MCHC
Amount of Hb per unit volume of RBCs
NORMAL 32-36 g/dL
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Reticulocyte count
Differentiate anemia due to increaseddestruction from anemia due to decreasedproduction
Assess response to therapy
NORMAL newborn 2-6%
children 0.5-2%
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Corrected reticulocyte
count
Corrected Retic Count = Retic % X (Patient's
HCT/Normal HCT)
The normal corrected reticulocytepercentage is 1 - 2%.
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TC, DC, platelet count
Other cell lines also affected
Megaloblastic anemia
Aplastic anemia AML, ALL
Myeloproliferative diseases
Metastatic disease
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PERIPHERAL SMEAR
RBC
Size
Color Shape
Inclusion bodies
Immature cells
WBC & PLATELETS
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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
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Macrocytic anemia
Abnormal nucleic acid maturation
cobalamine & Folate deficiency, drugszidovudin, hydroxyurea
Any condition causing reticulocytosishemolytic disease, c/c hemorrhage
Alcohol, hypothyroidism, CLD
Abnormal RBC maturation
MDS, a/c Leukemia, LGL
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NORMOCYTIC NORMOCHROMIC
A/C blood loss
Anemia of c/c diseases
CKD
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others
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iron deficiency parameters
Depletion of stainable iron in bone marrow
Dec serum ferritin levels (14.5) Low serum iron (470MCG/DL)
low transferrin saturation (
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Peripheral smear
hyper segmented neutrophils ¯o ovalocytes
Yes no
likely Megaloblastic likely non Megaloblastic
B i ti t fi M l bl ti i
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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
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If no hyper segmented
neutrophils & macro ovalocytes
reticulocyte count
Decreased increased
Hypothyroidism Hemolysis
Liver disease hemorrhage
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When peripheral smear points towards an
hemolytic etiology
Osmotic fragility testing
Coombs test
Sickling testHb electrophoresis
Serum bilirubin & urine urobilinogen
LDHHaptoglobin
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When nutritonal anemia is suspected
- Iron status
- B12 level
- Folate level
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If other cell lines also affected
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Initial management may depend on the
severity of anemia & general condition of
the patient
Definitive treatment of anemia dependson the etiology , so correct diagnosis of
the cause is important
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Dietary counseling
If nutritional anemia correct Fe , vitB12 & folicacid
Parasitic infestations
Fe deficiency anemia oral iron
preparations, par enteral iron & blood
transfusion in severe cases
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During an acute attack of hemolysis
maintain fluidbalance & renal output
Thalassemia blood transfusion & iron chelation therapy
Hereditary spherocytosis
splenectomy performed after6 yrs of age with pre- surgical immunizations for Hib, strep. Pneumoniae & neisseria meningitidis
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