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Internal Medicine
2. Red blood cell indices
a. Mean Corpuscular volume ( MCV): Hct/RBC : normal value is 80 – 95 fl
b. Mean corpuscular Hemoglobin( MCH ) : Hgb/RBC : 27 – 32 pg
c. Mean corpuscular Hemoglobin (MCHC): Hgb/Hct 32 – 36%
3. Examination of the peripheral blood smear: examine a cellular morphology, shape,
size, color, abnormality of other cells.
Red cell morphology
Normochromic Normocytic RBCs are aeen in normal individuals and in anemia of
chronic diseases
Anisopoikilocytes: Variation in size and shape may be seen in iron deficiency anemia
Hypochromic microcytic anemia: is seen in iron defeciency anemia , anemia of
chronic diseases , thalassemia and sideroblastic anemia (SBA)
Macrocytic RBCs : Macro – ovalocytes with hyper segmented neutrophils Æ indicate
megaloblastic anemia and myelodysplasia
Schistocytes (fragmented RBC/Helmentcells):- microangiopathies , DIC, vasculitis,
prosthetic heart valve
Classification of anemia
A. Pathophyisiologic Classifications (based on underlying disease)
Anemia associated with impaired RBC Production
a) Aplastic anemia
b) Iron deficiency
c) Myelodysplastic syndrome.
d) Megaloblastic anemia
e) Anemia of CRF
f) Anemia of chronic diseases
g) Drug related
2) Anemia associated with increased RBC loss or destruction
a) Bleeding
b) Hereditary hemolytic anemia
Hemoglobinopathies, sickle cell disease, Thalassemia
ii) Primary disorder of RBCs
iii) RBC erythropathies (G6 PDH, PK deficiency)
c) Acquired hemolytic anemia