Diagnosing Anemia Diagnosing Anemia Dr Robert Liwski MD PhD FRCPC Dr . Robert Liwski, MD, PhD, FRCPC Medical Director, HLA Typing Laboratory Division of Hematopathology Department of Pathology and Laboratory Medicine Dalhousie University [email protected]
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6. Diagnosing Anemia - Capital Health Nova Scotia · Anemia • Decrease in the number of circulating red blood cells, resulting in decreased oxygen carrying capacity • Most common
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Diagnosing AnemiaDiagnosing Anemia
Dr Robert Liwski MD PhD FRCPCDr. Robert Liwski, MD, PhD, FRCPCMedical Director, HLA Typing LaboratoryDivision of HematopathologyDepartment of Pathology and Laboratory Medicinep f gy yDalhousie [email protected]
AnemiaAnemia• Decrease in the number of circulating redg
blood cells, resulting in decreased oxygen carrying capacity
• Most common hematologic disorder
• Most cases due to a secondary disorder
• Critical for physicians to know how to determine the causethe cause
Red cell functionRed cell function
• Function:Function:– Oxygen delivery to tissues
Removal of CO from tissues– Removal of CO2 from tissues– Mediated by hemoglobin within the red
cellscells.
Hemoglobin structureHemoglobin structure
Hemoglobin cannot be made without iron !
Normal red cell morphologyNormal red cell morphology
Central pallorNormally less than ½ diameter
Cellular blood components• Red cells • Platelets • White cells
N t hil– Neutrophils– Monocytes– LymphocytesLymphocytes– Eosinophils– Basophils
• All formed in the bone marrow through a process called hematopoiesisprocess called hematopoiesis
Erythropoiesis
Kidney
Bone MarrowBone Marrow
http://yewbiotech.com/blog/erythropoiesis/
Bone marrow examination
Bone marrow aspirate smear preparation
Drop of marrow
Slide 1Slide 2
Slide 2
On contact, slide 2 extends the drop along its 1” side
Slide 2
Pushing angled slide 2 g galong #1 smears the line of blood across slide 1
Smear
Lift away slide 2; dry #1 ; stain; coverslip
2. Basophilic erythroblastErythropoiesis
1. Proerythroblast3. Polychromatic erythroblasts
4. Orthochromatic erythroblastserythroblasts
Aspirate 100x
Erythropoiesis
5. Nuclear expulsion
4 O th h ti4. Orthochromatic erythroblasts
Aspirate 100x
PB 50x
Causes of anemiaCauses of anemia
• Blood lossBlood loss
D d d ti f d bl d ll• Decreased production of red blood cells– Nutritional deficiencies– toxic exposures– Renal failure (↓erythropoietin)– bone marrow failure/disorders
H l bi l t h i• Hemoglobin electrophoresis• Osmotic fragility• PNH testing• Endoscopy• Bone marrow examination• HepcidinHepcidin• Soluble transferrin receptor • HLA typing (DR15)
Targeted approachTargeted approach• History (acute vs chronic, kinetics, ethnic