2 Chapter 2 – Red Blood Cells and Anemia

One of the most common reasons for referral to a hematologist is anemia.  Recall that in approaching anemia it is helpful to ask a couple questions up front:

• Is Hgb the only thing that is decreased or are other lineages also affected?
• The corollary to this is what is the reticulocyte count?  Is the marrow making an effort?
• Finally, what is the MCV of the RBC (normal 82-98 fL)?

With high MCVs, we think of B12/Folate deficiency (for review see: B12 and Folate Deficiency) or MDS.  With low MCVs, we think of situations where the RBC cannot make adequate hemoglobin to fill the cell, including Fe deficiency, Pb or other metal poisoning, chronic inflammation, or one of the thalassemias.  To review hemoglobin chains and thalassemia syndromes, try the following online modules:

Hemoglobin Chain Review

Thalassemias

Thalassemia and Hemoglobin Disorder Cases

Other disorders of hemoglobin, such as sickle cell anemia, are covered here:

Hemoglobinopathies