anemia background

heme =

porphyrin + iron

globin =

two pairs of polypeptide chains

decreased oxygen carrying capacity of the blood leads to

decreased RBC count & decreased hemoglobin

decreased oxygen carrying of blood leads to

tissue hypoxia

signs & symptoms of anemia are due to _____ ___ and or the compensatory responses of the cardiovascular system to the ____

- tissue hypoxia

- hypoxia

anemia s/sx

fatigue, pallor, dyspnea, dizziness, weakness, headaches, tinnitus, irritability, amenorrhea, palpitations, loss of libido, GI complaints

CBC findings -

RBC counts:

hemoglobin:

- mild:

- moderate:

- severe:

hematocrit:

RBC counts: F 3.5-5.5 M 4.3-5.9

hemoglobin: < 11 g/dL F < 13 g/dL M

- mild: 10-12

- moderate: 6-10

- severe: < 6

hematocrit: 37-47 % F 40-54% M

most important single test in diagnosis of anemia

peripheral blood smear

reticulocyte count:

.5-1.5

MCV

< 80 microcytic (TICS)

80-100 normocytic

> 100 macrocytic (BLAMR)

earliest indicator of anemia

RDW

anemia due to blood loss

- leads to IDA

- acute post hemorrhagic anemia

- chronic post hemorrhagic anemia (subtle findings: GI bleed, cancer, etc.))

anemia due to deficient erythropoiesis

- hypochromic-microcytoic anemia

- normochromic-normocytic anemia

- megaloblastic/macrocytic anemia

anemia due to deficient erythropoiesis

- hypochromic-microcytoic anemia

- IDA (MC)

- iron utilization anemia (siderblastic anemia)

* ACD (iron re-utilization anemia) -> norm/normo possible

* thalassemia (hemolytic too)

anemia due to deficient erythropoiesis

- normochromic-normocytic anemia

- anemia of renal disease (diabetic neuropathy & SLE)

* anemia of endocrine failure (hypothyroidism -> can be hyper/micro or macro)

anemia due to deficient erythropoiesis

- megaloblastic/macrocytic anemia

- B12 def. anemia

- folic acid def. anemia

anemia due to excessive RBC destruction (hemolysis)

- anemia due to intrinsic RBC defects

- anemia due to extrinsic RBC defects

anemia due to intrinsic RBC defects

- anemia due to red cell membrane alterations - broken down @ a faster rate; hereditary sperocytosis (increase fragility, osmotic fragility test)

- anemia due to disorders of red cell metabolism - G6PD deficiency (bite cell)

- anemia due to defective hemoglobin synthesis - structural sickle cell & rate of synthesis - thalassemia

anemia due to extrinsic RBC defects

- traumatic hemolytic anemia

- hemolysis due to infectious agent

- anemia due to immunologic abnormalities (auto/iso immunity)

anemia due to blood loss - acute posthemorrhagic anemia

- etiology

- traumatic/spontaneous rupture of major blood vessels

- erosion of artery by lesion

- failure of hemostasis

anemia due to blood loss - acute posthemorrhagic anemia

- clinical findings:

faintness, dizziness, thirst, sweating, weak/rapid pulse, rapid respiration, orthostatic hypotension

anemia due to blood loss - acute posthemorrhagic anemia

- lab findings:

- treatment:

- during & immediately following hemorrhage - RBC, Hb, Hct are normal

- tissue fluid will enter circulation -> dilution -> drop in RBC count, Hb, Hct (@ this point anemia will be normocytic)

- neutrophilic leukocytosis & thrombocytosis within hours (immune & clotting)

- several days

-- polychromatophilia (production of reticulocytes), slight macrocytosis -> iron deficient

-- occasional normoblasts

-- immature WBCs

treatment: restore iron

anemia due to blood loss - chronic posthemorrhagic anemia

- etiology:

- clinical findings:

etiology:

- prolonged moderate blood loss (IDA)

- GI tract lesion: ulcers, gastritis, GERD, colorectal cancers, chrons

- urologic: cancers of urinary tract

- gynecologic site: heavy menes - hormonal imbalance, uterine fibroids, endometriosis, PCOS, endometrial cancers

clinical findings:

- same for iron deficiency: decrease ferritin (iron stores); produce more RBC

- lab findings: IDA (hypo/micro)