Lecture notes

microcytic and macrocytic anaemia

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Module
Clinical sciences

Institution
Aston University, Birmingham (Aston)

● We will focus on the general characteristics of anaemia and then I will go into detail on microcytic anaemia. ● Although anaemia is a primary pathological condition of the red blood cells there is a surprising lack of consensus on how it should be defined and the values that you find will ...

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Uploaded on August 27, 2024
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3. Microcytic and Macrocytic Anaemia

1

● We will focus on the general characteristics of anaemia and then I will go into detail on
microcytic anaemia.

● Although anaemia is a primary pathological condition of the red blood cells there is a
surprising lack of consensus on how it should be defined and the values that you find will
actually vary from textbook to textbook.
● Globally if we have a look at the epidemiology anaemia affects 1.62 billion people (1/4 of the
worlds population).
● It is caused by either a decrease in production or increase in destruction of red blood cells or
it can be caused by blood loss.
● Here we've got the normal reference ranges for males and females, it is slightly lower in
females.
● Anaemia is a problem caused by too few RBCS or a problem with their function and that
leads to the symptoms in the patients.
● Polycythaemia and erythrocytosis is actually the opposite of low red cell count and it can be
viewed as a situation where too many red blood cells are present therefore in the
haematocrit the haemoglobin levels are actually going to look higher.

● Milder degrees of anaemia have slight and vague symptoms so probably fatigue or lack of
energy however as the condition progresses, we see the more severe symptoms, so these
include shortness of breath, pounding at the heart, rapid pulse and these are actually caused
by the inability of the anaemic blood to supply the body tissues with the required oxygen
that they need.
● More severe cases will see heart palpitations chest pain, heart attacks, angina and also
respiratory disorders, pallor particularly in the palms of the hand, the fingernails and
conjunctivitis of the eyes (yellowing in the lining of the eyelids and that's due to the
breakdown of the red blood cells) and we also see tachycardia (pulse rate over 100 beats per
minute), in very advanced cases we will get the swelling of the ankles and heart failure as
well so it can actually lead to really severe health complications.

● Haemoglobin is measured in grams per litre, and we've given you the values in the previous
slide.
● If we go down, we’ve got the mean cell volume, mean cell haemoglobin, reticulocyte count,
normal white cell count in an exam setting I will give you a reference values for most of
these but I expect you to know the basics so you should know what a healthy mean cell
volume, mean cell haemoglobin and a normal red cell count.

● Leukocyte and platelet counts help us find out the difference between a real anaemia
pancytopenia.

, 3. Microcytic and Macrocytic Anaemia

● A pancytopenia is a general defect of the marrow meaning it is not because of the ability of
red blood cells carry oxygen.
● A high reticulocyte count is often seen on the full blood count and that's indicative of an
anaemia so in response to the low levels of oxygen, the bone marrow releases red blood
cells earlier to compensate for that so you can see immature cells trying to meet the needs
of the tissues and the bone marrow is chugging out these immature red blood cells.
● In a healthy individual we wouldn't expect to see more than 0.5%-1.5% of reticulocytes
however in an anaemia we would see above 2.5%.
● Anaemias can be defined morphologically or by cause and they can be either microcytic
normocytic or macrocytic and this is all depending on the mean cell volume and the mean
cell haemoglobin.
● For microcytic anaemia, anything about lead poising counts as extra reading.

● For normocytic anaemia, chronic anaemia and renal disease class as extra reading.

● How do we classify anaemias in the laboratory and what do we normally see? Your blood
film is really important in diagnosing anaemia and then these are the sorts of terms your
haematologist will be using to describe them.
● If our blood cells RBCs are abnormally sized, we call that anisocytosis.

● RBCs that are not round but different shapes are called poikilocytes.

● In iron deficiency anaemia the indicative cell that we would see our pencil cells so due to the
size and shape of these cells they can't carry the oxygen, we also get target cells in iron
deficiency anaemia and another cell type that we would see are basket cells and then we see
them in G6PD (we will cover that in a few lectures time). In some conditions like your
haemolytic anaemias, we also get spherocytes, so the RBCs become too round and then they
cause vessel blockage.
● In the figure on the right, we can see different types of our cells, so we’ve got a normoblast
which is a nucleated red blood cell. Basophilic stippling is the presence of lots of little
basophilic granules and they are distributed throughout the cell, and you can see them in
blue, but they don’t give a positive pearls reaction when ionised, this is indicative of
disturbed rather than increased erythropoiesis and it occurs in many blood diseases such as
thalassaemia, megaloblastic anaemia, infections and liver diseases as well.
● Looking down the microscope and actually looking at the types of cells that are present is
really important.
● Heinz bodies are like little blisters of cells, so they are little chunks that are cut out the red
cells.

● Reading form table.

● The body’s iron store is indicative by ferritin so in iron deficiency it will be low.

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