Hypochromic, microcytic, hyperproductive

Hemolytic - extravascular

target cells, poikilocytosis, anisocytosis, basophilic stippling

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Skeletal deformities

iron overload - low plasma hepcidin (negative iron regulator)

splenomegaly, hepatomegaly, lymphadenopathy

Mentzer <13

Problem in spectrin-ankyrin-4.2-band 3 or spectrin-4.1-GP interaction.

Splenomegaly

Spherocytes - lack of pallor

Reticulocytosis

Lack of Haptoglobin - protein that binds free hemoglobin

Decreased G-6-PD half life -> red cell can't neutralize oxidants -> hb precipitates -> Heinz bodies -> intravascular hemolysis, spleen -> bite cells

Hemolysis triggered by drugs, infxn

G-6-PD on X chromosome -> worse in males

Warm: IgG or IgA, can result from drugs, results in spherocytes

Cold: IgM, affects extremities (Reynaud's phenomenon), Mycoplasma can cause

Schistocytes - pieces of broken cells

from physical trauma or microangiopathic

causes: DIC,HTN, SLE, TTP, HUS, cancer

Microcytic, hypochromic,

low ferritin, high TIBC

Mentzer Index (MCV/RBC Count) > 14

• block hepcidin -> High ferritin, reduced TIBC (ferroportin), increase storage iron in bone marrow
• hypochromic, microcytic

hypersegmented neutrophils, MCV>110, large red cells, bone marrow hypercellular and has increased megaloblasts

pancytopenia

Folate deficiency: GI sx, fatigue, weakness, low serum folate

B12 - neuro defic, folate may exacerbate, low serum b12

1. Iron defic. - anisocytosis, poikilocytosis, hypochromatic, Mentzer >13, high TIBC,
2. Chronic Disease - above, but low TIBC, high Ferritin
3. Beta Thal - basophilic stipling, target cells, mentzer <13, increased F, A₂
4. Alpha Thal - normal F, A₂
5. Lead Poisoning - basophilic stippling

1. Early iron defic, chronic disease
2. Microangiopathic hemolytic - schistocytes
3. H. Spherocytosis - osmotic fragility
4. Immune hemolytic - coombs test
5. Bits cells - G-6-PD
6. Sickle cell - hemoglobin electrophoresis
7. Bleeding

1. B12, folate - hypersegmented polys
2. Drug/alcohol
3. Liver dz - target cells, spur cells?
4. Myelodysplastic syndrome
5. Hypothyroidism
6. Reticulocytosis