Pathophysiologic Classification of Anemias

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Pathophysiologic Classification of Anemias

The pathophysiologic classification system of anemia is divided into two broad categories. These categories are based on the underlying cause of the decrease in RBCs in circulation. The categories are:
  1. Anemia caused by decreased production of RBCs.
  2. Anemia caused by increased destruction or loss of RBCs.
Destruction of RBCs after release from the bone marrow occurs as a result of either an intracorpuscular abnormality or an extracorpuscular abnormality. Intracorpuscular abnormalities are the consequence of an abnormality in the red cell membrane, an enzyme, or globin chain (inherited condition). Extracorpuscular abnormalities are those that are secondary to a clinical condition (acquired condition).
The tables below summarize the pathophysiologic classification of anemia and provide examples in each category.
Table 4: Anemias due to decreased production
CategoryInherited or AcquiredAnemia
Defective stem cell proliferationAcquiredAplastic Anemia
Interruption of DNA synthesisAcquiredMegaloblastic Anemia
Interruption of hemoglobin synthesisAcquired or inherited
Iron deficiency Thalassemia
Interruption of development of precursor cellsAcquired or inheritedAnemia of chronic renal disease, Anemia associated with endocrine diseases
Table 5: Anemias due to increased destruction or loss (intracorpuscular abnormalities)
CategoryInherited or AcquiredAnemia
Membrane defectInheritedHereditary spherocytosis, hereditary elliptocytosis
Enzyme deficiencyInheritedG-6-PD deficiency, Pyruvate kinase deficiency
Globin abnormality - HemoglobinopathyInheritedSickle cell anemia, Hemoglobin C anemia
Complement relatedAcquiredParoxysmal nocturnal hemoglobinuria
Table 6: Anemias due to increased destruction or loss (extracorpuscular abnormalities)
CategoryInherited or AcquiredAnemia
MechanicalAcquiredMicroangiopathic hemolytic anemias
InfectionAcquiredBabesia, Malaria, E. coli spesis
Chemical or physical agentsAcquiredDrugs, toxins, burns
Antibody mediatedAcquiredWarm autoimmune hemolytic anemia