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Anemia can be broadly categorized into three major classifications according to the size or mean corpuscular volume (MCV) of the erythrocytes (RBCs).

A) Microcytosis (decreased MCV)

  • Iron deficiency anemia

  • Alpha or beta thalassemia

  • Anemia of chronic diseases, chronic inflammation or infection

  • Sideroblastic anemia

B) Normocytosis (normal MCV)

  • Normal variant.

  • Anemia of chronic disease.

  • Acute haemorrhage (bleeding).

  • Endocrinopathies

    • myxedema (decrease in thyroid function),

    • Addison's disease (deficient secretion of adrenocortical hormones)                                                             

  • HIV-related anemia.

  • Dilutional anemia

  • Mixed anemia: the presence of two or more causes. 

  • Myelophthisic anemia: replacement of the normal marrow cells by leukemic, myeloma, or metastatic cancer cells or by myelofibrosis.

  • Liver disease like:

  • Uremia: history of renal dysfunction;

  • Hemoglobinopathies

C) Macrocytosis (increased MCV)

  • Pure red cell aplasia

    • Drug-induced 

    • Underlying malignancies (thymoma, lymphoma),

    • Viruses (parvovirus B19).

  • Alcohol addiction

  • Aplastic anemia

    • bone marrow failure resulting from 

      • Drugs 

      • Radiation

      • Viral infections

      • Hereditary (Fanconi's anemia).

  • Paroxysmal nocturnal hemoglobinuria (PNH).

  • Myelodysplastic syndromes

  • Megaloblastic anemias: B12 or folate deficiency.

  • Hemolytic anemia's: Characterized by an excessive destruction of Red Blood Corpuscles.

They are:

a. Extrinsic

  • Antibody-mediated: immunohemolytic anemia 

  • Microangiopathic hemolytic anemias:

    • Thrombotic thrombocytopenic purpura (TTP)

    • Disseminated intravascular coagulation (DIC)

    • Hemolytic-uremia syndrome (HUS)

  • Toxins, malaria

b. Intrinsic

  • RBC membrance defects

    • Hereditary spherocytosis.

    • Hereditary elliptocytosis.

  • PNH

  • Hemoglobinopathies

    • sickle cell disease

    • thalassemia

  • Enzymopthies: G6PD deficiency, pyruvate kinase deficiency

Symptoms of Anemia

The symptoms of anemia are

If the anemia develops slowly, the patient maybe asymptomatic.

Signs of Anemia

The Signs are

  • On physical examination: Orthostatic hypotension,

  • Tachycardia

  • Tachypnea

  • Jaundice and hepatosplenomegaly 

  • Neurologic manifestations, such as loss of vibratory or positional sensation

Evidence of underlying disease as cause for the anemia.


Laboratory tests conducted are

  • Serum iron

  • Total iron-binding capacity (TIBC), and

  • Serum ferritin

  • Transferring saturation

  • Hemoglobin electrophoresis 

  • Free erythrocyte protoporphyrin (FEP).

  • Check feces for occult blood.

  • Serum B12.

  • Folate levels.

  • Thyroid function tests.

  • Complete blood count (CBC) with differential and platelet count.

  • Reticulocyte count.

  • Peripheral smear.

  • Bone marrow biopsy and/or aspirate, if required.

Investigations specific for underlying disease, if any.



 Anemia > 1 > 2  >

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