Hematology: Anemia & Sickle Cell Disease

Anemia Overview

• Definition: Anemia is a condition characterized by low levels of red blood cells (RBCs) and/or hemoglobin in the blood.

• Function of Hemoglobin: Hemoglobin is crucial as it binds oxygen for transport by RBCs to body tissues.

• Impact on Oxygenation: Low RBCs or hemoglobin levels lead to compromised oxygen delivery, resulting in symptoms and health issues.

Types of Anemia

Iron Deficiency Anemia

• Significance of Iron: Iron is vital for hemoglobin formation; insufficient iron leads to reduced oxygen binding.

• Risk Factors:

  • Heavy menstrual bleeding

  • Pregnancy (increased demand for iron)

  • Stomach diseases (such as peptic ulcers or post-surgery conditions that affect absorption)

Hemolytic Anemia

• Definition: A condition where RBCs are destroyed prematurely before their lifecycle completion.

• Causes:

  • Genetic disorders affecting enzyme function

  • Chronic conditions leading to RBC destruction

• Consequence: Increased destruction leads to anemia when the body cannot replace RBCs quickly enough.

Signs and Symptoms of Anemia

• Common Symptoms:

  • Fatigue, lethargy, malaise (general tiredness)

  • Headaches

  • Possible internal or external bleeding

  • Fever

• Progression: Symptoms worsen with severity, including:

  • Breathing difficulties

  • Chest pain

EMS Approach to Anemia

• Assessment Steps:

  • Full patient assessment including vital signs (blood pressure, pulse oximetry)

  • Blood sugar check

  • EKG consideration for sudden changes in patient condition

• Supportive Care: Providing oxygen and symptomatic relief are key focus areas in emergency settings.

• Severe Cases: May require hospital interventions including blood transfusions if hemoglobin/hematocrit levels are critically low.

Sickle Cell Disease

• Characteristics: Sickle cell disease involves abnormally-shaped RBCs that impairs oxygen carrying capacity.

• Inheritance: A hereditary condition affecting red blood cell morphology.

• Risks: Can lead to blood clots due to abnormal RBC shapes, causing significant health crises (sickle cell crisis).

Sickle Cell Crisis

• Symptoms of Crisis:

  • Severe (10/10) pain localized to areas of the body affected by clots.

  • Symptoms may include:

    • Chest pain

    • Back pain

    • Extremity and joint pain

    • Shortness of breath

    • Fatigue

    • Jaundice (liver involvement)

• Acute Chest Syndrome: A severe condition linked with respiratory infection in sickle cell patients.

Risk Factors for Crisis

• Precipitating Factors:

  • Dehydration

  • Temperature extremes

  • Recent infections

  • Physical stress or trauma

Management in Emergency Settings

• Treatments:

  • IV fluids for dehydration (careful not to overhydrate)

  • Pain management with narcotics due to severe discomfort.

  • Maintain oxygen saturation levels (targeting >94-95%).

• Considerations: Always balance hydration, avoid excessive fluid administration unless critically needed.