Types of anemia (classified by MCH and MCV)
Hypochromic anemia (microcytic anemia; MCH ↓ → hypochromic; MCV↓ → microcytic).
- Iron deficiency anemia [ferritin ↓↓; serum iron ↓↓; transferrin ↑↑]
- Other hypochromic anemias: [ferritin: normal to ↑]
- Iron utilization disorders
- Inflammatory anemia/infectious anemia/tumor anemia [ferritin ↑; serum iron ↓↓; transferrin ↓]
- Hemoglobinopathies (diseases caused by disorders of hemoglobin).
- Myelodysplastic syndrome [ferritin ↑↑; serum iron ↑↑; transferrin ↓↓]
- Sideroblastic anemias (increased sideroblasts are present in the bone marrow smear; this is the sign of impaired iron utilization, resulting in ineffective erythropoiesis (formation and development of erythrocytes/red blood cells)).
- Thalassemia [beta-thalassemia: ferritin normal to ↑; serum iron normal to ↑; transferrin normal to ↓).
Normochromic anemia (normocytic anemia; MCH normal → normochromic; MCV normal → normocytic).
- Normochromic, normocytic anemia + reticulocyte count ↑
- Acute hemorrhage (hemorrhage anemia).
- Hemolytic anemia
- Normochromic, normocytic anemia + reticulocyte count normal to ↓
- Endocrinological causes:
- Eunuchoidism
- Hypo- and hyperthyroidism (hypo- or hyperthyroidism, respectively).
- Liver disease
- M. Addison’s disease (adrenocortical insufficiency)
- Renal insufficiency (renal dysfunction; renal anemia).
- Panhypopituitarism (deficiency or an absence of all hormones produced in the anterior pituitary gland).
- Normochromic, normocytic anemia + reticulocyte count normal to ↓ + serum iron normal to ↑
- Aplastic anemia (bone marrow insufficiency with pancytopenia/deficiency in all three cell series (tricytopenia) of hematopoiesis, i.e., a leukocytopenia (abnormal decrease in leukocytes/white blood cells), anemia, and thrombocytopenia (abnormal decrease in platelets/platelets).
- Leukemia, metastases (daughter tumors), myelofibrosis, plasmocytoma (multiple myeloma).
- Normochromic, normocytic anemia + reticulocyte count normal to ↓ + serum iron ↓
- Early iron deficiency anemia
- Endocrinological causes:
Hyperchromic anemia (macrocytic anemia; MCH ↑ → hyperchromic; MCV ↑ → macrocytic) / megaloblastic anemia.
- Serum folic acid or B12 concentrations ↓
- Folic acid deficiency anemia
- Pernicious anemia (absorption disorder for B12; B12 deficiency anemia).
- Folic acid or B12 concentrations in serum normal.
- Chronic liver disease
- Chronic kidney disease
- Chronic inflammatory diseases
- Intoxications (poisonings)
Hemolytic anemia
Hemolytic anemia (MCH normal → normochromic; MCV ↑ → macrocytic; elevated are: Urinary urobilin (dark urine), indirect bilirubin, LDH, HBDH, iron, free hemoglobin, reticulocytes, and ESR (erythrocyte sedimentation rate); decreased: haptoglobin).