HAEMATOPOIESIS AND CLASSIFICATION OF ANAEMIA

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HAEMATOPOIESIS AND CLASSIFICATION OF ANAEMIA

• BY
• DR. KAMAL E. HIGGY
• CONSULTANT HAEMATOLOGIST

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HAEMATOPOIESISNEUTROPHILS
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Neutrophilia Causes ----------------------------
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• Acute infections
• Bacterial, viral, fungal, mycobacterial
  and rickettsial
• Physical stimuli
• Trauma, electric shock, anoxia,
  pregnancy
• Drugs and chemicals
• Corticosteroids, aetiocholanolone,
  adrenaline, lead, mercury poisoning,
  lithium
• Hematological causes
• Acute haemorrhage, acute haemolysis,
  transfusion reactions, post-
• splenectomy, leukaemia and
  myeloproliferative disorders.
• Malignant disease
• Carcinoma, especially of
  gastro-intestinal tract, liver or bone marrow
• Miscellaneous conditions
• Certain dermatoses, hepatic necrosis,
  chronic idiopathic leucocytosis

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Lymphocytosis Non-Malignant causes
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• Virus infections
• Infectious mononucleosis
• Infectious lymphocytosis
• Cytomegalovirus infection
• Occasionally mumps, varicella, hepatitis,
  rubella, influenza
• Bacterial Infections
• Pertussis
• Occasionally cat-scratch fever, tuberculosis,
  syphilis, brucellosis
• Protozoal infections
• Toxoplasmosis
• occasionally malaria
• Other rare causes
• Hyperthyroidism, congenital adrenal hyperplasia

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Monocytosis Causes------------------------------
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• Chronic bacterial infections
• Tuberculosis, subacute bacterial endocarditis,
  brucellosis
• Other Specific Infections
• Malaria, Kala-azar, trypanosomiasis, typhus,
  Rocky
• Mountain spotted fever
• Malignant diseases
• Hodgkins disease, carcinoma
• Leukaemia
• Acute myeloid leukaemia, chronic monocytic
  leukaemia
• Neutropenias
• Familial benign and severe neutropenia
• Cyclical neutropenia
• Drug-induced Agranulocytosis
• Miscellaneous
• Cirrhosis, systemic lupus erythematosus,
  rheumatoid arthritis

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Eosinophilia Causes

• Allergic reactions
• Asthma, hay fever, urticaria, angioneurotic
  oedema
• Parasitic Infestation
• Tissue parasites trichinosis, filariasis,
  visceral larva migrans, etc..
• Intestinal parasites Ascaris, Taenia, etc.
  (less regularly)
• Skin disorders
• Pemphigus, pemphigoid, eczema, psoriasis,
  (dermatitis herpetiformis)
• Drug hypersensitivity reactions
• Especially iodides, penicillin, allopurinol,
  gold salts, tartrazine
• Lofflers pulmonary syndrome and Lofflers
  endomyocarditis
• Tropical eosinophilia (probably filarial)

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Eosinophilia Causes (Cont)

• Malignant diseases
• Especially Hodgkins disease,
  carcinoma of ovary, lung stomach,
• angioimmunoblastic lymphadenopathy.
• Following irradiation or splenectomy
• Hypereosinophilic syndromes
• Eosinophilic leukaemia
• Miscellaneous Conditions
• Polyarteritis nodosa, ulcerative
  colitis, sardoidosis, scarlet fever,
• pernicious anaemia, chronic active
  hepatitis, eosinophilic granuloma,
• familial eosinophilia

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Leukaemoid Reactions or LeucoerythroblasticAnaemia
Causes

• Severe infections, especially in children
• a. Pneumonia, septicaemia,
  meningococcal meningitis
• b. Infectious mononucleosis, pertussis
• Intoxications
• Eclampsia, severe burns,
  mercury poisoning
• Neoplasia
• Especially with bone-marrow
  infiltration
• Severe haemorrhage or haemolysis

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NeutropeniaCauses

• Drugs
• Selective neutropenia
• Agranulocytosis (Aplastic anaemia)
• Infections
• Viral including hepatitis, influenza,
  rubella
• Bacterial typhoid fever, brucellosis,
  miliary tuberculosis
• Rickettsial and protozoal infections
  (Sometimes)
• Megaloblastic anaemia
• Vitamin B12 or folate deficiency
• Chronic neutropenia
• Chronic idiopathic neutropenia
• Immune neutropenia
• Congenital neutropenias
• Cyclical neutropenia
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NeutropeniaCauses (cont)

• Hypersplenism
• Primary
• In association with cirrhosis, Feltys
  syndrome, etc.
• Ionizing radiation and cytotoxic drugs
• Radiotherapy
• Alkylating agents, antimetabolites,
  others
• Malignant disease
• Acute leukaemia
• Leuco-erythroblastic anaemia due to
  metastatic carcinoma, multiple myeloma
  or lymphoma
• Micscellaneous conditions
• Systemic lupus erythematosus, myxoedema,
  hypopituitrism, iron deficiency, anaphylactic
  shock

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LymphopeniaSecondary Causes

• Loss
• Mostly from gut as in intestinal
  lymphangiectasia, Whipples disease and rarely
  Crohns disease
• Thoracic-duct fistula
• Maturation
• Primary, or secondary to gut disease
• Vit B12 or folate deficiency
• Zinc deficiency
• Pharmacological agents
• Antilymphocyte globulin
• Corticosteroids
• Cytotoxic drugs

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LymphopeniaSecondary Causes (Cont)

• Infections
• Severe septicaemias
• Influenza, occasionally other virus infections
• Colorado tick fever
• Miliary tuberculosis
• Other miscellaneous conditions
• Collagen vascular diseases, especially SLE
• Malignant disease
• Other conditions with lymhocytotoxins
• Radiotherapy
• Graft-versus-host disease

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Hypochromic and/or Microcytic Anaemia
Serum Fe
Serum Fe Increased Hyperferraemia
Serum Fe Reduced Hypoferraemia
Serum Fe Normal
Bone marrow Sideroblast Fe Increased
Hemoglobin Electrophoresis, etc
Bone Marrow Macrophage Iron
Serum Ferritin
OR
Low
Absent
THLASSEMIA
IRON DEFICIENCY
SIDEROBLASTIC ANAEMIA
Normal or Increased
ANAEMIA OF CHRONIC DISORDERS
Increased
CONGENITAL
HEMOGLOBINOPATHIES (S,C,D,E)
ACQUIRED
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MACROCYTIC ANAEMIA

BLOOD AND MARROW MORPHOLOGY
NON-MEGALOBLASTIC
MEGALOBLASTIC
Clinical data serum vitamins
B12 DEFICIENCY
NO DEFICIENCY
FOLATE DEFICIENCY
Congenital diseases
Drugs
RETICULOCYTES
Schilling Test with intrinsic factor
DIET
Poor
Normal or decreased
corrected
Not corrected
Good
increased
Small bowel bacteria
Drug-induced malabsorption
Dietary Deficiency
Hepatic Disease
Hemolytic Anemia
Pernicious anaemia
Myxaedema
Fish tapeworm
Gastric resection
Pregnancy
Jejunal resection
Hemorrhage
Hypoplastic anemia
Familial B12 malabsorption
Ingestion of corrosives
infancy
Acq. Sideroblastic Anaemia
Drug-induced malabsorption
Certain Blood Diseases
Tropical sprue, gluten sensitivity
Inertintrinsic factor
Myelophthisic Anemia
Ileal Disease
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NORMOCYTIC, NORMOCHROMIC ANEMIA
RETICULOCYTES
Normal or Decreased Erythrocyte Production
Increased Erythrocyte Production
History, Course, Blood Smear, Bile Pigments
Bone Marrow Aspirate and Biopsy
Post hemorr-hagic Anemia
Abnormal Marrow
Normal Marrow
Hemolytic Anaemia
Serum Iron
Test Liver Function
Test Renal Function
Test Endocrine Function
Dyserythropoie-tic Anaemia
Hypoplastic Anaemia
Infiltration
Leukemia
Myxaedema
Anaemia of renal failure
Anemia of liver disease
Anemia of chronic disorders
Myeloma
Addisons
Myelofibrosis
eunuchoidism
Early Fe deficiency
Metastases
Panhypopituitarism
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Hypochromic and/or Microcytic Anaemia
Serum Fe
Serum Fe Increased Hyperferraemia
Serum Fe Reduced Hypoferraemia
Serum Fe Normal
Bone marrow Sideroblast Fe Increased
Hemoglobin Electrophoresis, etc
Bone Marrow Macrophage Iron
Serum Ferritin
OR
Low
Absent
THLASSEMIA
IRON DEFICIENCY
SIDEROBLASTIC ANAEMIA
Normal or Increased
ANAEMIA OF CHRONIC DISORDERS
Increased
CONGENITAL
HEMOGLOBINOPATHIES (S,C,D,E)
ACQUIRED
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MACROCYTIC ANAEMIA

BLOOD AND MARROW MORPHOLOGY
NON-MEGALOBLASTIC
MEGALOBLASTIC
Clinical data serum vitamins
B12 DEFICIENCY
NO DEFICIENCY
FOLATE DEFICIENCY
Congenital diseases
Drugs
RETICULOCYTES
Schilling Test with intrinsic factor
DIET
Poor
Normal or decreased
corrected
Not corrected
Good
increased
Small bowel bacteria
Drug-induced malabsorption
Dietary Deficiency
Hepatic Disease
Hemolytic Anemia
Pernicious anaemia
Myxaedema
Fish tapeworm
Gastric resection
Pregnancy
Jejunal resection
Hemorrhage
Hypoplastic anemia
Familial B12 malabsorption
Ingestion of corrosives
infancy
Acq. Sideroblastic Anaemia
Drug-induced malabsorption
Certain Blood Diseases
Tropical sprue, gluten sensitivity
Inertintrinsic factor
Myelophthisic Anemia
Ileal Disease
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NORMOCYTIC, NORMOCHROMIC ANEMIA
RETICULOCYTES
Normal or Decreased Erythrocyte Production
Increased Erythrocyte Production
History, Course, Blood Smear, Bile Pigments
Bone Marrow Aspirate and Biopsy
Post hemorr-hagic Anemia
Abnormal Marrow
Normal Marrow
Hemolytic Anaemia
Serum Iron
Test Liver Function
Test Renal Function
Test Endocrine Function
Dyserythropoie-tic Anaemia
Hypoplastic Anaemia
Infiltration
Leukemia
Myxaedema
Anaemia of renal failure
Anemia of liver disease
Anemia of chronic disorders
Myeloma
Addisons
Myelofibrosis
eunuchoidism
Early Fe deficiency
Metastases
Panhypopituitarism