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Medicine

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Hematology

Question
12 out of 16
 

A child has Hb-6.5 gm%, MCV-65, MCH-15 and protoporphyria with increased RDW is most likely to be suffering from: (AIIMS May 2010)



A Thalassemia
B Iron deficiency anaemia

C Porphyria
D Megaloblastic anaemia

Ans. B

Iron deficiency anaemia

1. Red cell distribution width (RDW)

a. RDW is essentially an indication of the degree of anisocytosis (Abnormal variation in size of RBCS).

b. Reference value: 11.5 – 14.5 coefficient of variation (CV) of red cell size.

2. Clinical implications

a. The RDW can be helpful in distinguishing uncomplicated heterozygous thalassemia from iron deficiency anemia.

i. Thalassemia Low MCV, Normal RDW

ii. Iron deficiency anemia Low MCV, High RDW

b. The RDW can be helpful in distinguishing anemia of chronic disease from early iron deficiency anemia.

i. Anemia of chronic disease Low normal MCV, Normal RDW

ii. Early iron deficiency anemia Low normal MCV, elevated RDW

3. Red cell distribution width

Increased

Normal

1.

Iron deficiency

(Anemias with homogenous red cell size)

2.

Vitamin B12 or folate deficiency

Chromic disease

3.

Acute blood loss

Acute blood loss

4.

Aplastic anemia

Aplastic anemia

5.

Immune hemolytic anemia

Hereditary spherocytosis

6.

Marked reticulocytosis

HbE

7.

Fragmentation of RBC

Sickle cell disease.

Extra Edge: There is not known cause for decreased RDW.

Pathogenic classification of Microcytic Anemia

1. Disorders of iron metabolism

a. Iron deficiency anemia

b. Anemia of chronic disorders (Advance stage)

2. Disorders of Globin synthesis

a. Alpha and beta thalassemia

b. Hemoglobin E syndromes.

c. Hemoglobin C syndromes

3. Sideroblastic anemias

Hematology Flashcard List

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