일반혈액검사 CBC test - 헤모글로빈 haemoglobin: 빈혈

Haemoglobin 

Too few cells 

1)Reduced production 

• haematinic/nutritonal deficiency 
• alcohol, drugs, toxins 
• liver (TPO), renal (EPO) 
• bone marrow problem 

2)Increased destruction/loss 

• Blood loss - anaemia 
• sepsis, viruses 
• immune-mediated - autoimmune, drug-related 
• hypersplenism 
• fragmentation syndromes 

Microcytic anaemia 

	MCV	Serum iron	serum Ferritin	Transferrin saturation
Iron deficiency anaemia	low	low	VERY LOW	low
anaemia of chronic disease	normal or low	low	normal or high	normal or low
Iron deficiency and chronic disease	low	low	normal or low	low
Thalassaemia	very low or low	normal	normal or high	normal or high

Macrocytic anaemia - causes 

1. B12/Folate deficiency 

2. Liver disease/ alcoholism 

3. Reticulocytosis due to haemolysis or haematinic repletion 

4. Severe hypothyroidism 

5. drugs affecting DNA synthesis e.g. hydroxyurea, methotrexate, azathioprine 

6. Haematological condition: MDS, myeloma, aplastic anaemia 

 

Refer Haem after going through 1-5 

 

Features of haemolysis 

CBE: 

1. Macrocytic anaemia 

2. Reticulocytosis/polychromasia 

3. Fragmented red cells (schistocytes) or spherocytes 

Biochemistry: 

1. high LDH 

2. high bilirubin (unconjugated) 

3. low haptoglobin 

 

Haemolytic anaemia - inherited causes 

Thalassaemia, sickle cell disease, G6PD, hereditary spherocytosis 

• Blood film features 
• family history 
• Previous blood tests

Haemolytic anaemia - acquired causes 

• immune - DAT "Coombs" test positive - mainly spherocytes 
  • idiopathic - frontline-treatment steroids (like ITP) 
  • may be related to lymphoproliferative disease 
• non-immune - mainly schistocytes 
  • fragmentation syndrome - DIC, TTP, preeclampsia/HELLP 
  • severe infections (meningococcus, clostridia, malaria) 
  • severe liver disease (spur cell anaemia) 
  • valve haemolysis 

Normocytic anaemia 

1. bleeding 
2. Causes of microcytic and macrocytic anaemia 
3. Anaemia of renal disease 
4. Anaemia of chronic disease/inflammation 
5. Anaemia of malignancy 
6. bone marrow problem