View source for Red Blood Cell Conditions

There are a variety of conditions that contribute to abnormal RBC function or counts.
{| class="wikitable"
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!Condition
!Physiology
!RBC
!HGB
!HCT
!MCV
!MCH
!MCHC
!RDW
!Morphology
!Followup Tests
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|Blood loss/hemorrhage 
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|N/↓
|N
|N
|N
|N
|N
|N
|Normal
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|Iron Deficiency Anemia
|Insufficient erythropoiesis

* Inadequate iron intake
* Chronic blood loss
|N/↓
|N/↓
|↓
|↓
|↓
|↓
|↑
|Hypo/micro

* Ovals, pencils
* Tears, targets (occasional)
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|Anemia of Chronic Inflammation
|Insufficient erythropoiesis
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|Normal or Hypo/micro
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| rowspan="2" |Sideroblastic Anemia
|Ineffective erythropoiesis

* Deficient protoporphyrin synthesis
* RBCs made but iron doesn't bind to ring
|↓
|↓
|↓
|N/↓
|N/↓
|N/↓
|↑
|Dual population

# Normochromic/normocytic
# Hypo/micro

Pappenheimers
|Ringed sideroblasts in BM
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|Lead poisoning (secondary)

* Certain drugs and heavy metals
|↓
|↓
|↓
|N/↓
|N/↓
|N/'''↓'''
|N
|Normal OR hypo/micro

* Stomatocytes
* Coarse basophilic stippling
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|Iron Overload
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* Inherited conditions (hereditary hemochromatosis)
* Excess iron accumulation from treatment (e.g., blood transfusion)
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|Thalassemia
|Ineffective erythropoiesis
|N/↑
|N/↓
|N/↓
|↓↓
|↓
|N/↓
|N
|Hypo/micro

* Targets
* Tears
* Increased polychromasia
* Basophilic stipping
* NRBCs
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| rowspan="2" |Megaloblastic Anemia
|Ineffective erythropoiesis

* Vitamin B12 deficiency
* Folic acid deficiency
* Certain cancers or drugs
Causes nuclear-cytoplasmic asynchrony
|↓
|↓
|↓
|↑↑
|↑
|N
|↑
|Macrocytic/normochromic

* Pancytopenia
* Oval macrocytes
* Hypersegmented neutrophils
* Tears, schistocytes, microspherocytes, targets
* HJ bodies, basophilic stippling
* NRBCs
|Cell fragmentation/lysis

* ↑ Serum bilirubin
* ↑ LDH
* Vitamin testing
* Antibody assays
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|Pernicious anemia

* Autoimmune cause (destruction of parietal cells)
|↓
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| rowspan="5" |Macrocytic non-megaloblastic anemia
|Liver disease
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|↑
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|N
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|Macrocytic/normochromic

* Round macrocytes
* Targets
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* Liver panel
* Bilirubin
* Coagulation testing
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|Chronic alcoholism
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|Macrocytic

* Round macrocytes
* Spur cells
* Stomatocytes?
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|Normal newborn
|↑
|↑
|↑
|↑
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|Macrocytic/normochromic

* Macrocytes

* Burrs
* Fragments
* Spherocytes
* Increased poly
* NRBCs
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|Reticulocytosis
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|Bone marrow failure
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|Aplastic Anemia
|Insufficient erythropoiesis

* Hypocellularity due to autoimmune destruction
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|↑
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Insufficient Erythropoiesis

* Iron deficiency anemia
* Erythropoietin deficiency (renal disease)
* Loss of erythroid precursors
** Aplastic anemia (autoimmune)
** Infection
** Destruction/suppression of erythroid precursors (cancers, granulomas, fibrosis)
Anemias

* Ineffective erythropoiesis
** Defective precursors made that are destroyed or function poorly
* Insufficient erythropoiesis
* Blood loss (acute or chronic)
* Increased RBC destruction (hemolytic anemia)
** Shortened cell survival
** Intrinsic RBC defects
** Extrinsic RBC defects
Hemoglobin & Size

* Normocytic and normochromic
** Hemoglobinopathies
*** Sickle cell
*** Other abnormal hemoglobins
** Infections (including malaria and sepsis)
** Hemolytic anemias
*** HUS, DIC, TTP
** Membrane disorders (hereditary sph
** Enzyme disorders (PK and G6PD deficiencies)
** Poisons, toxins, drugs
** Aplastic anemia
** Burns
** Hemorrhage
* Hypochromic and microcytic
** IDA
** Sideroblastic anemia
** Thalassemia (globin chain deficiency)
** Anemia of chronic inflammation (severe)
* Macrocytic and normochromic
** Megaloblastic anemia (B12 or folate deficiency)
** Liver disease