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LABORATORY DIAGNOSIS OF MACROCYTIC ANAEMIA

LABORATORY TESTINTERPRETATION Macrocytic anaemia 

Megaloblasticchanges  No megaloblastic

changes

Low LowHigh

Possible liverdisease

(evaluate liverfunction tests)

Probablehaemolytic

anaemia(continueworkup)

Responds tofolic acid

Respondsto vit B12

Peripheral smear

Bone marrowexamination

Reticulocytecount

Therapeuticresponse

Diagnosis  Vit B12deficiency(determineif dietary or

abnormalabsorption

Folic aciddeficiency

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1. BLOOD SMEAR 

 A. RBC : Megaloblastic

• Great variationin size & shape

• Howell Jolly bodies

• Circulating

megaloblast cells

Liver diseases

• Less macrocyticuniform in size

& shape

Haemolytic

• PolychromatophiliaRBC

B. WBC

• Hypersegmented

PMN ( 6 lobes)

or > 5% PMN

have 5 lobes

C. Platelet

• Thrombocytopenia

DIAGNOSIS

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Macrocytic Microcytic hypochromic

Normocytic normochromic

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Hypersegmentation Macro ovalocyte with cabotring inclusion

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LABORATORY TEST INTERPRETATION Hypochromic & microcyticanaemia 

 Absent  Increased

Ringed sideroblasts

Normal AbnormalNormal

Peripheralsmear

Iron

(Bone marrow)

Haemoglobinelectrophoresis

DiagnosisIron

deficiencyanaemia

Thalassaemiahaemoglobino

-pathies

LABORATORY DIAGNOSIS OF HYPOCHROMICMICROCYTIC ANAEMIA

Sideroblasticanaemia

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LABORATORY DIAGNOSIS OF NORMOCYTIC ANAEMIA

OTHER HAEMOLYTIC ANAEMIAS

Parasites

Hypersplenism

Microangiopathic

haemolysisHereditary

spherocytosis

Paroxysmal noctural

haemoglobinuria

Enzyme deficiencies

Drug or toxin

Haemoglobinopathies

 AUTO IMMUNOHAEMOLYTIC ANAEMIA

Erythroblastosis

foetalis

Transfusion

reaction

Collagen

vascular

disease

OTHER 

Renal disease

Infection

Malnutrition

 Aplastic

anaemia

Radiation

MYELOPHTHISIC

Tumor

Myelofibrosis

Infection

Leukaemia

BLOODLOSS ANAEMIA

REPLACEMENT OFNORMAL MARROW

ELEMENTS

DECREASEDCELLULARITY 

HYPERCELLULAR ERYTHROID

HYPERPLASIA

HYPERCELLULAR ERYTHROID

HYPERPLASIA

POSITIVE

POSITIVE

NEGATIVE NEGATIVE

NEGATIVE

INCREASED REDUCED

NORMOCYTIC ANAEMIA

INTERPRETATIONLABORATORY TEST

PERIPHERAL SMEAR 

RETICULOCYTE COUNT

BLOOD IN STOOL OR OTHER SOURCE OFBLEEDING IDENTIFIED

 ANTIHUMAN GLOBULIN(COOMBS’TEST) 

BONE MARROW ANDBONE MARROW BIOPSY 

DIAGNOSIS

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