It is a branch of medicine that deals with the morphology of blood and blood–forming tissues, and with their physiology and pathology. The Normal Values of Hemoglobin The values of hemoglobin are expressed in grams per deciliter. Normal values are different for males and females mainly because of hormonal difference between the two. The androgens have a more favorable effect on the production of red blood cells.


Hg (g/dl)  Women Men
Salivary Lipase 12–16 13.5–17.7

The percentage of red blood cells that make up blood is called hematocrit. The values are 42–52% for males and 37–48% for females.

Signs and Symptoms of Anemia The clinical manifestations vary with the age, degree and rapidity of onset, presence of other illness and other factors. Mild anemia are often asymptomatic. The main symptoms are, fatigue, shortness of breath on minimal exertion, palpitation, pica (consumption of substances such as ice, starch or clay, frequently found in iron deficiency anemia), syncope (particularly following exercise) and bounding pulse. Dizziness, headache, syncope, tinnitus or vertigo, irritability, difficulty sleeping or concentrating are more frequent in severe chronic anemia.

Common signs are pallor (pale color of skin, palms, oral and conjunctively mucous membrane and nail beds), tachycardia (fast heart rate), heart murmur, swelling of feet. In old people, angina pectoris can be an important clinical manifestation. Females commonly develop abnormal menstruation,

Causes The Common Causes of Anemia Anemia results from the following:

  • Loss of blood through bleeding (hemorrhage).
  • Failure of the body to make enough new or normal red blood cells, The production of red blood cells and hemoglobin requires adequate intake of minerals like iron and vitamins like Vim B12 and Folate. In third world countries nutritional deficiency of these essential ingredients is common especially in children and pregnant women.
  • Hemolysis, the rapid destruction of the red blood cells in the blood.

Anemia is diagnosed by estimating the amount of hemoglobin in the red blood cells. In addition the amount of red blood cells in the blood is estimated. Specific tests are done on the basis of the history and physical examination to diagnose the cause of anemia.

Diagnosis Through RBCs All about Normocytes, Microcytes, Macrocytes. As mentioned earlier the shape and size of the red cells may change in anemia. It provides a diagnostic clue to the underlying cause of anemia. Normcytes are normal sized red blood cells. Normocytic anemia is seen in the following conditions: Chronic disease Secondary anemias (hepatic, renal or endocrine disorders), Primary bone marrow disorders (aplasia, myelodysplasia, myelofibrose), solid tumors, and HIV infection.

Microcytes are red blood cells of size smaller than normal. Microcytic anemia seen in Iron Deficiency Chronic Disease Anemia–Thalassemia. Macrocytes are red blood cells larger than usual. Seen in Megaloblastic anemias (folic acid and cobalamin deficiency and congenital disorders), Alcoholism Drugs, Liver diseases, Primary bone marrow disorder, Hypothyroidism, Splenectomy (after spleen removal).

Peripheral Blood Smear The peripheral blood smear is a very essential investigation in the diagnosis of anemia. A drop of blood is taken on a glass slide and spread evenly to give a thin spread. Certain stains are used to visualize the different components of blood. The size of the red cells, their morphology is studied by examining the slide under a microscope. It gives an idea about the probable cause of anemia.

Reticulocyte Count The reticulocyte count is another very useful test in the diagnosis of anemia. The reticulocyte is an immature red blood cell, usually present in the bone marrow. If increased numbers are present in the blood it indicates that the marrow is functioning well to compensate for the anemia. If low then it indicates an inability of the marrow to compensate as seen in drug or infection induced suppression of the marrow.