ANEMIA

Dr.Erwin Taher SpPK

Bagian Patologi Klinik

Fakultas Kedokteran UISU
MEDAN

-Pria : Kadar Hb < 14 gr/dl atau Hct < 42 %

Wanita : Hb < 12 gr/dl atau Hct < 37 %.
-Evaluasi lanjutan anemia, didasari :
(1) indeks retikulosit
(2) penilaian blood film dan indeks
eritrosit
meliputi MCV, MCH dan MCHC
(3) penentuan stadium (akut/kronis
anemi)

*Retikulosit Indeks :
RI =

Retikulosit count
Observered Hct / 2 X normal Hct

RI < 2% inadequate RBC production

RI > 2% Excessive RBC destruction
or
loss

MCV =

MCH =
(Pgr)

MCHC=
)

Hematokrit (vol %)
Eritrosit (juta/mm3)
Hemoglobin (gr/dl)

X 10 ...... (FL)

X 10 ..

Eritrosit (juta/mm3)
Hemoglobin (gr/dl)
Hematokrit (vol%)

X 100 ( %

Classification of Anemia

A.Relative
1. Macrroglobulinemia
2. Pregnancy
3. Athletes
4. Postflight astronauts

B.Absolute
1. Decreased red cell production
a. Stem cell failure
(1) aplastic anemia
(2) anemia of leukemia and of myelodysplastic
synd
b. Progenitor cell failure
(1) pure red cell aplasia
(2) anemia of renal failure

(3) Anemia of chronic disease

(4) Endocrine disorder (e.g.,hypothyroidisme)
c. Precursor cell failure
(1) megaloblatic anemia
(2) iron-deficiency anemia
(3) thalasemia
(4) hemoglobinopathy
(5) hereditary enzymes deficiency
2.Increased Red cell Destruction or loss
a. Hereditary
(1) membrane defects (e.g.,hereditary
spherocytosis)
(2) globin defects (e.g., sickle cell anemia)
(3) enzyme defects (e.g.,PK def or G6PD def)
b. Acquired
(1) Macroangiopathy (traumatic)

(2)microangiopathy

(3)antibody mediated
(4)hyperspleenisme
(5)acute blood loss
(6)paroxysmal nocturnal hemoglobinuria

manual hematology, williams ,p.28, 6 th ed, 2003

Anemia (excessive destruction or loss)

:
trauma ; GI bleeding ; genitourinary
(menorrhagia / gross hematuri) ; internal
atau retroperitoneal bleeding.
Pada perdarahan akut, biasanya didapati
manifestasi :hipovolemia, retikulositosis.
Pada perdarahan kronik, selalu disertai :
defisiensi besi dan gambaran mikrositer
hipokrom.

Anemia ( Hemolisis )
(1)-hiperspleenisme (pansitopenia)
(2)-Autoimmune Hemolitik anemia
Coombs test positive,spherocytes
2 tipe autoantibodi yang
menyebabkan lisis
Warm antibodi (IgG) : Idiopathy,
Limfoma, CLL, SLE, Drugs
(methyldopa, penicilin, quinidine, INH,
Sulfonamid)
Cold antibodi (IgM) : infeksi

(3) Mechanical trauma micro/macroangiopathy

hemolitic, schistocytes :
vasculitis, malignant hipertensi, graft
rejection, HUS, DIC, eclampsi.

(4) Direct toxic effect infection (malaria,

clostridia, toxoplasma )
(5) Kelainan membran sel eritrosit :
spur cells (cirrhosis, anorexia nervosa) ; PNH;
hereditary elliptocytosis
(6) Kelainan intrasellular : G6PD def, PK def, Hb
pathy,

Abnormalitas Laboratorium
-Blood Film :Peningkatan RI,
polikromasi,RBCs
nucleated
-Blood Film : spherocytes, elliptocytes,
target,
sickle cell (tergantung pada gangguan
yang
mendasari)
-Peningkatan billirubin indirect dan LDH
-Peningkatan Hb plasma, penurunan
haptoglobin
-hemoglobinuria,