Based on different clinical characteristics, there are different classifications of anemia. For example, according to the progression speed of anemia, it is divided into acute and chronic anemia; according to red blood cell morphology, it is divided into macrocytic anemia, normal cell anemia and small cell hypochromic anemia; according to hemoglobin concentration, it is divided into mild, moderate, severe and very severe anemia; Bone marrow erythroid hyperplasia is divided into proliferative anemia (such as hemolytic anemia, iron deficiency anemia, megaloblastic anemia, etc.) and hypoplastic anemia (such as aplastic anemia). Clinically, it is often classified from the mechanism and etiology of anemia:
Anemia with reduced red blood cell production
Abnormalities in hematopoietic cells, bone marrow hematopoietic microenvironment, and hematopoietic materials affect erythropoiesis, which can lead to reduced erythropoiesis anemia.
Anemia caused by abnormal hematopoietic stem and progenitor cells
1. Aplastic anemia (AA) AA is a type of bone marrow hematopoietic failure, which is related to primary and secondary hematopoietic stem and progenitor cell damage. Part of the pathogenesis of pancytopenia is related to the production of autoantibodies against bone marrow cells by B cells, which in turn destroys or inhibits bone marrow hematopoietic cells.
2. Pure red blood cell aplastic anemia (PRCA) PRCA refers to the damage to the erythroid hematopoietic stem and progenitor cells of the bone marrow, which causes anemia. According to the cause, the disease can be divided into two types: congenital and acquired. Congenital PRCA is Diamond-Blackfan syndrome, which is caused by heredity; acquired PRCA includes primary and secondary types. Some scholars have found that some patients with primary PRCA have their own EPO or young red blood cell antibodies in the serum. Secondary PRCA mainly includes drug-related types, infection-related types (bacteria and viruses, such as parvovirus B19, hepatitis virus, etc.), autoimmune disease-related types, and lymphocytic proliferative disease-related types (such as thymoma, lymphoma, plasma cell disease and lymphocytic leukemia, etc.) and acute aplastic crisis, etc.
3. Congenital erythropoiesis anemia (CDA) CDA is a type of refractory anemia characterized by ineffective erythropoiesis and morphological abnormalities caused by benign clonal abnormalities of hereditary erythroid stem progenitor cells. According to the mode of inheritance, the disease can be divided into the autosomal recessive genetic type and dominant genetic type.
4. Malignant clonal diseases of the hematopoietic system These diseases have qualitative abnormalities in hematopoietic stem and progenitor cells, including myelodysplastic syndrome and various types of hematopoietic tumor diseases such as leukemia. The former has hemolysis in situ due to pathological hematopoiesis, high proliferation of blood cells, and high apoptosis; in the latter, neoplastic hyperplasia, low apoptosis, and poor differentiation, hematopoietic regulation is also affected, so that normal mature red blood cells are reduced and anemia occurs.
Anemia caused by abnormal hematopoietic microenvironment
The hematopoietic microenvironment includes bone marrow stromal cells, stromal cells, and cytokines.
1) Anemia caused by damage to bone marrow stromal and stromal cells, bone marrow necrosis, bone marrow fibrosis, bone marrow sclerosis, marble disease, bone marrow metastasis of various extramedullary tumors, and various infectious or non-infectious osteomyelitis can all be caused by damage to the bone marrow Stromal and stromal cells, the hematopoietic microenvironment is abnormal and affects blood cell production.
2) Anemia caused by abnormal levels of hematopoietic regulatory factors stem cell factor (SCF), interleukin (IL), granulocyte-monolinear colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), thrombopoietin (TPO), platelet growth factor (TGF), tumor necrosis factor (TNF) and interferon (IFN) all have positive and negative regulation of hematopoiesis. Insufficiency of EPO occurs when renal insufficiency, liver disease, pituitary or thyroid function is low; tumorous diseases or certain viral infections can induce the body to produce more negative hematopoietic regulators such as TNF, IFN, inflammatory factors, etc., which can lead to chronic disease Anemia (ACD).
3) Hyperfunction of lymphocytes AA, autoimmune diseases, autoimmune hemolytic anemia.
4) Hyperapoptosis of hematopoietic cells Myelodysplastic syndrome (MDS), AA.
Anemia caused by insufficient hematopoietic materials or utilization obstacles.
Hematopoietic materials refer to substances necessary for the proliferation, differentiation and metabolism of hematopoietic cells, such as proteins, lipids, vitamins (folic acid, vitamin B12, etc.), trace elements (iron, copper, etc.) Zinc, etc.) and so on. Any lack of hematopoietic materials or impaired utilization may lead to reduced red blood cell production.
1. Anemia caused by folic acid or vitamin B12 deficiency or utilization disorder. Megaloblastic anemia can be caused by the body's absolute or relative deficiency or utilization disorder of folic acid or vitamin B12 due to various physiological or pathological factors.
2. Iron deficiency and iron utilization disorder anemia This is the most common clinical anemia. Iron deficiency and iron utilization disorders affect heme synthesis, and this type of anemia is called abnormal heme synthesis anemia. In this type of anemia, the red blood cell morphology becomes smaller and the central light-stained area expands. It belongs to small cell hypochromic anemia.
(Iron deficiency anemia blood film ,picture from wikimedia)
Red blood cell destruction excessive anemia
(1) Abnormalities of red blood cells:
abnormal membranes, abnormal enzymes, abnormal globin, and abnormal hemoglobin.
(2) Abnormal surrounding environment of red blood cells.
Immune, vascular, and hemolytic anemia (HA).
Hemorrhagic anemia
Acute and chronic according to the rate of blood loss, chronic hemorrhagic anemia is often combined with iron deficiency anemia. Can be divided into blood clotting diseases (such as idiopathic thrombocytopenic purpura, hemophilia and severe liver disease, etc.) and non-blood clotting diseases (such as trauma, tumor, tuberculosis, bronchiectasis, peptic ulcer, hemorrhoids and Gynecological diseases, etc.) caused by two types.
(article content from baike.baidu, translate and by medasia.store,pictures from wikipedia)