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Deficiencies of Vitamin B 12 or folate produce a macrocytic anemia (large cell anemia) in which the RDW is elevated in roughly two-thirds of all cases. However, a varied size distribution of red blood cells is a hallmark of iron deficiency anemia, and as such shows an increased RDW in virtually all cases.
General signs and symptoms include fatigue, pallor, shortness of breath, and tachycardia. [2] In small children, failure to thrive may occur in any form of anemia. [6] [7] In addition, symptoms related to hemolysis may be present such as chills, jaundice, dark urine, and an enlarged spleen. [2]
Main symptoms that may appear in anemia [20] The hand of a person with severe anemia (on the left, with ring) compared to one without (on the right). A person with anemia may not have any symptoms, depending on the underlying cause, and no symptoms may be noticed, as the anemia is initially mild, and then the symptoms become worse as the anemia worsens.
Signs of hemolysis that are present in AIHA include low hemoglobin (blood count), alterations in levels of cell markers of hemolysis; including elevated lactate dehydrogenase (LDH), decreased haptoglobin and elevated unconjugated bilirubin. [4] Reticulocytosis, or an increase in circulating immature red blood cells, may be seen. [4]
The mean cell volume is commonly decreased (i.e., a microcytic anemia), but it may also be normal or even high. The RDW is increased with the red blood cell histogram shifted to the left. Leukocytes and platelets are normal.
Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size. This is commonly found in anemia and other blood conditions. False diagnostic flagging may be triggered on a complete blood count by an elevated WBC count, agglutinated RBCs, RBC fragments, giant platelets or platelet clumps due to anisocytosis.
Pyruvate kinase deficiency is an inherited metabolic disorder of the enzyme pyruvate kinase which affects the survival of red blood cells. [4] [5] Both autosomal dominant and recessive inheritance have been observed with the disorder; classically, and more commonly, the inheritance is autosomal recessive.
These include fatigue and pallor, as well as signs of jaundice, splenomegaly and gallstone formation from prolonged hemolysis. [1] [3] Certain cases of hereditary stomatocytosis associated with genetic syndromes have additional symptoms that are unrelated to the hemolytic anemia. [1]