58. Anaemias. Erythrocytes regenerative and degenerative forms. Cells of pathological regeneration.

Anaemia – is haematological syndrome or separate disease characterized by erythrocytes number reducing or (and) haemoglobine level in blood volume unit as well as erythrocytes qualitative changings.

Quantitative signs:

1. erythrocytes content decreasing in blood volume unit (lower than 4x10¹² in men and lower than 3,5x10¹² in women in 1 l of blood);

2. haemoglobine level decreasing (lower than 130 g/l in men and lower than 120 g/l in women);

3. haematocrit level reducing (lower than 43% in men and lower than 40% in women);

4. colour index reducing (lower than 0,85).

Qualitative features:

1. erythrocytes regeneratory forms;

2. degenerative changings in erythroid cells;

3. cells of pathological regeneration.

Anaemias total clinical manifestations:

1. hypoxy – syndrome occurring at any anaemia type;

2. syndromes determined by separate anaemia type distinguishing features (for instance, neurological disorders and alimentary tract dysfunction at B₁₂-B₉-deficiency; jaundice at haemolytic anaemia).

Anaemias classification:

1. Pathogenetically:

1. posthaemorrhagic (anaemia after acute blood loss);

2. haemolytic (sircle-celled);

3. dyseryhtropoietic (iron-deficient).

2. Aethiologically:

   1. hereditary (thalassemia);

   2. acquired (chronic posthaemorrhagical).

3. By red bone marrow regenerative ability:

   1. regeneratory (acute posthaemorhagic);

   2. hyperregeneratory (acquired haemolytic anaemia);

   3. hyporegeneratory (iron-deficient anaemia);

   4. aregeneratory (apalastic anaemia).

4) By colour index (CI):

1. normochromic (CI=0,85-1,0; for instance, acute posthaemorrhagic anaemia during first several days after blood loss);

2. hypochromic (CI <0,85; for example, iron-deficient anaemia);

3. hyperchromic (CI >1,0; for instance, B₁₂-B₉-deficient anaemia).

5) By haemopoiesis type:

1. anaemias with haemopoiesis erythroblastic type (iron-deficient anaemia);

2. anaemias with megaloblastic haemopoiesis (B₁₂-B₉-deficient anaemia).

6) Clinically:

1. acute (anaemia after haemotransfusional shock);

2. chronic (hypoplastic anaemia).

Regeneratory anaemias features:

1. in perypheral blood – reticulocytes and polychromatophils amount increasing and normoblasts appearance (erythrocytes regeneratory forms);

2. in red bone marrow – leuco-erythroid correlation from 3:1 up to 1:1 and even to 1:2 and 1:3.

Cells of pathological regeneration:

1. megaloblasts;

2. megalocytes.

Erythrocytes degeneratory changings:

1. anisocytosis (size diminishing);

2. poikylocytosis (shape changing);

3. colour changings (aisochromy);

4. pathological inclusions:

   1. Zholly’s bodies (nuclear substance derivates);

   2. Kebot’s rings (nuclear membrane residues ring-or 8-shaped);

   3. Basophilic granulation – cytoplasm basophilic substance residues testifying red bone marrow toxic injury.

54. Anisocytosis, poikylocytosis, price-jonce’ curve movements on the right and on the left.

Anisocytosis – presence in blood stains erythrocytes different by their size: with low-sized Er dominance – microcytosis or microanisocytosis (for instance, at iron-deficient anaemia); with large-sized Er dominance - macrocytosis or macroanisocytosis (for instance, at B12-B9-deficient anaemia).

Anisocytosis is present at iron-deficient anaemia both in its initial period and as a result of performed therapy with iron. Er saturated with Hb appeared after therapy are alternated with small Er which were formed before treatment. Anisocytosis is present at diseases characterized by parallel existence of normal and pathologic erythropoiesis; hypoplastic anaemia, paroxysmal night haemoglobinuria, myeloproliferative diseases, thalassemia.

Movement of Price-Jones curve to the left – microcytosis (d<6,5 mcm), to the right – macrocytosis (d>8,0 mcm).

Poykilocytosis – can be observed practically at any anaemia independently on its origin. Doctor should remember that 10-15% of all normal Er can have shape different from discoid. Scientists mention 20-40 different possible Er shapes. Examples: echinocytes (hedgehog), acantocytes (with needles like echinocytes but they are larger and Er can not return to usual shape), stomatocytes or hydrocytes (like boat if to look from the side) drepanocytes (circle-shaped), dacryocytes (like tear), pear-shaphed, spherocytes, elliptocytes and so on.

Only several Er types are specific for separate anaemias. Hereditary spherocytosis – disease of Minkovsky-Shoffar is characterized by microspherocytes, circle-celled anaemia –by drepanocytes. Doctor must differentiate here reversible shapes which can be returned to the normal state (echinocytes, stomatocytes) and irreversibly changed cells (acantocytes, codocytes or target-cells, spherocytes, irreversibly changed stomatocytes).