ANEMIASANEMIASAHMAD MAGABLEH.MDAHMAD MAGABLEH.MDANEMIAANEMIA AnemiaAnemia: Is defned as a reduction in one : Is defned as a reduction in one or more of major RBC measurements.or more of major RBC measurements.HGB.HGB.HTC.HTC.RBCcount .RBCcount .AnemiaAnemia is not a disease by itsef but is one is not a disease by itsef but is one of t!e major si"ns of disease.of t!e major si"ns of disease.May be t!e frst manifestation of a May be t!e frst manifestation of a systemic disease#aon" $it! ot!er systemic disease#aon" $it! ot!er nons%ecifc com%aints suc! as nons%ecifc com%aints suc! as fe&er#$ei"!t oss#anore'ia.fe&er#$ei"!t oss#anore'ia.HGB Concentration:HGB Concentration:measures t!e measures t!e major o'y"en(carryin" %i"ment in major o'y"en(carryin" %i"ment in $!oe bood.$!oe bood.)aues are e'%ressedas "rams of )aues are e'%ressedas "rams of HGB %er d* of $!oe bood+",d*-.HGB %er d* of $!oe bood+",d*-.Norma ran"e: M ./(.0#1 ",d*Norma ran"e: M ./(.0#1 ",d*

2.3(.1#1 ",d* 2.3(.1#1 ",d* HematocritHematocrit +HTC-:Is t!e %ercent of a +HTC-:Is t!e %ercent of a &oume of $!oe bood occu%ied by &oume of $!oe bood occu%ied by intact RBCs.intact RBCs.)aues are e'%ressed as a %ercenta"e.)aues are e'%ressed as a %ercenta"e.Norma ran"e: M4.(1.5.Norma ran"e: M4.(1.5.

2/6(465.2/6(465.RBC Count:RBC Count: Is t!e number of RBCs Is t!e number of RBCs contained in a unit of $!oe bood.contained in a unit of $!oe bood.)aues are e'%ressed as miions of )aues are e'%ressed as miions of ces %er u* of $!oe bood.ces %er u* of $!oe bood. Norma ran"e:M4#1(0#1Norma ran"e:M4#1(0#1

2 /#7(1#7 2 /#7(1#7 )8*9ME :TAT9:)8*9ME :TAT9:T!e t!ree measurements are a T!e t!ree measurements are a concentrations.concentrations.As suc! t!ey are de%endent u%on bot! t!e As suc! t!ey are de%endent u%on bot! t!e RBC mass and t!e %asma &oume.RBC mass and t!e %asma &oume.1.1.In acute beedin" anemia de&eo%s ony In acute beedin" anemia de&eo%s ony after /0(47 !ours.after /0(47 !ours.2.2.;re"nancy:RBC mass is increased by ;re"nancy:RBC mass is increased by 315 and %asma is increased by 315 and %asma is increased by 1e!ydration.>e!ydration.:;ECIA* ;8;9*ATI8N::;ECIA* ;8;9*ATI8N: 1.1.*i&in" at !i"! atutute.*i&in" at !i"! atutute.2.2.:mo?in" and air %oution.:mo?in" and air %oution.3.3.African(Americans@o$er &aues.African(Americans@o$er &aues.4.4.;o%uations $it! a !i"! incidence of ;o%uations $it! a !i"! incidence of c!.diseases.c!.diseases.5.5.At!etes.At!etes.6.6.T!e edery:s!oud not !a&e a o$er T!e edery:s!oud not !a&e a o$er norma ran"e for fear of missin" a norma ran"e for fear of missin" a serious underyin" disorder. serious underyin" disorder. ERATHR8;8E:I: (.ERATHR8;8E:I: (.Eryt!ro%oesis ta?es %ace in aduts $it!in Eryt!ro%oesis ta?es %ace in aduts $it!in t!e BM under t!e inBuence of t!e stroma t!e BM under t!e inBuence of t!e stroma frame$or?#a number of cyto?ines#and t!e frame$or?#a number of cyto?ines#and t!e eryr!roid s%ecifc "ro$t! eryr!roid s%ecifc "ro$t! factor#eryt!ro%oietin+E;8-.factor#eryt!ro%oietin+E;8-.E;8 is a true endocrine !ormone %roduced E;8 is a true endocrine !ormone %roduced in t!e ?idney.in t!e ?idney.E;8 en!ances t!e "ro$t! and E;8 en!ances t!e "ro$t! and di=erentiation of t!e 3 eryt!roid di=erentiation of t!e 3 eryt!roid %ro"enitors.%ro"enitors.1.1.Burst 2ormin" 9nits(eryt!roid,B29(E,.Burst 2ormin" 9nits(eryt!roid,B29(E,.2.2.Coony 2ormin" 9nits(eryt!roid,C29(E,. Coony 2ormin" 9nits(eryt!roid,C29(E,. ERATHR8;8E:I:(3ERATHR8;8E:I:(3T!e rate of RBC %roduction eCuas t!e T!e rate of RBC %roduction eCuas t!e rate of RBC destruction.rate of RBC destruction.A%%ro'imatey .5 of RBCs is remo&ed A%%ro'imatey .5 of RBCs is remo&ed from t!e circuation daiy.from t!e circuation daiy.T!e rate of RBC %roduction can T!e rate of RBC %roduction can increase mar?edy under t!e increase mar?edy under t!e inBuence of !i"! e&es of E;8.1(6 inBuence of !i"! e&es of E;8.1(6 fods.fods. C*INICA* C8N:ED9ENCE: C*INICA* C8N:ED9ENCE: 82 ANEMIA82 ANEMIAT!e si"ns and sym%toms induced by T!e si"ns and sym%toms induced by anemia are de%endent u%on t!e anemia are de%endent u%on t!e de"ree of anemia as $e as t!e rate de"ree of anemia as $e as t!e rate at $!ic! t!e anemia !as e&o&ed.at $!ic! t!e anemia !as e&o&ed.:ym%toms of anemia can resut from :ym%toms of anemia can resut from t$o factors:t$o factors:..>ecreased 83 dei&ery to tissues...>ecreased 83 dei&ery to tissues.3.Hy%o&oemia,acute b.oss,.3.Hy%o&oemia,acute b.oss,. C8M;EN:AT8RA C8M;EN:AT8RA MECHANI:M:MECHANI:M::i"ns and sym%toms de%end aso on t!e :i"ns and sym%toms de%end aso on t!e com%ensatory mec!anisms.com%ensatory mec!anisms.1.1.E'traction of 83 by t!e tissues can increase E'traction of 83 by t!e tissues can increase from 315 to 0 :IGN: SymptomSymptom:is a sensation or c!an"e in :is a sensation or c!an"e in !eat! function e'%erienced by t!e !eat! function e'%erienced by t!e %atient.It is a subjecti&e re%ort.%atient.It is a subjecti&e re%ort.

2ati"ue,tiredness2ati"ue,tiredness

;ain.;ain.

Nausea.Nausea.

>iEEiness.>iEEiness.:i"n:is an objecti&e e&idence of t!e :i"n:is an objecti&e e&idence of t!e %resence of a disease or disorder %resence of a disease or disorder .:i"ns are disco&ered and re%orted.:i"ns are disco&ered and re%orted by by t!e %!ysician#not by t!e %atient.t!e %!ysician#not by t!e %atient.

Ee&ated B;.Ee&ated B;.

:?in ras!.:?in ras!.

Tac!y%nea.Tac!y%nea.:AM;T8M: AN> :IGN: 82 :AM;T8M: AN> :IGN: 82 ANEMIA ANEMIA >ys%nea,:.8.B.:on e'ersion,at rest. >ys%nea,:.8.B.:on e'ersion,at rest.2ati"ue,tiredness. 2ati"ue,tiredness.:i"ns and sym%toms of !y%er?inetic state: :i"ns and sym%toms of !y%er?inetic state:1 1.boundin" %uses. .boundin" %uses.2. 2.%a%itations. %a%itations.3. 3.roarin" in ears. roarin" in ears.In more se&ereIn more se&ere anemia:*et!ar"y#confusion#CH2#an"ina#MI. anemia:*et!ar"y#confusion#CH2#an"ina#MI.;aor. ;aor.Headac!e. Headac!e.Com%ications of e'traceuar &oume de%etion,inCom%ications of e'traceuar &oume de%etion,in acute beedin",acute beedin", CA9:E: 82 ANEMIA CA9:E: 82 ANEMIA T!ere are 3 interreated a%%roac!es T!ere are 3 interreated a%%roac!es one can use to !e% identify t!e one can use to !e% identify t!e cause of anemia.cause of anemia...Finetic a%%roac!...Finetic a%%roac!.3.Mor%!oo"ic a%%roac!.3.Mor%!oo"ic a%%roac!.FINETIC A;;R8ACH FINETIC A;;R8ACH Anemia can be caused by one or more Anemia can be caused by one or more of / inde%endent mec!anisms.of / inde%endent mec!anisms...>ecreased RBC %roduction...>ecreased RBC %roduction.3.Increased RBC destruction.3.Increased RBC destruction./.RBC oss./.RBC oss.M8R;H8*8GIC M8R;H8*8GIC A;;R8ACH A;;R8ACH Accordin" to RBC siEe.Accordin" to RBC siEe.Mean Cor%uscuar )oume ,MC),.Mean Cor%uscuar )oume ,MC),.RBC siEe,MC), is 7ING T8 THE RBC :IHE THE RBC :IHE 1.1.Microcytic anemia.Microcytic anemia.2.2.Macrocytic anemia.Macrocytic anemia.3.3.Normocytic anemia.Normocytic anemia.MICR8CATICANEMIA: MICR8CATICANEMIA: Are associated $it! an MC) beo$ 7< Are associated $it! an MC) beo$ 7< f*.f*.

I>AI>A

AC>AC>

T!aassemias.T!aassemias.MACR8CATIC ANEMIA: MACR8CATIC ANEMIA: Are c!aracteriEed by an MC) abo&e Are c!aracteriEed by an MC) abo&e .:.

Hy%ot!yroidismHy%ot!yroidismN8RM8CATIC ANEMIA:N8RM8CATIC ANEMIA: By defnition t!e MC) is norma.By defnition t!e MC) is norma.

AC>.AC>.

M>:.M>:.E)A*9ATI8N 82 THE E)A*9ATI8N 82 THE ;ATIENT IITH ANEMIA(.;ATIENT IITH ANEMIA(. Anemia is one of t!e major si"ns of Anemia is one of t!e major si"ns of disease.disease.It is ne&er norma and itJs cause s!oud be It is ne&er norma and itJs cause s!oud be a$ays be sou"!t.a$ays be sou"!t.History.History.;!ysica e'amination.;!ysica e'amination.:im%e ab.tests.:im%e ab.tests.Are a usefu in e&auatin" t!e anemic Are a usefu in e&auatin" t!e anemic %atient.%atient.E)A*9ATI8N 82 THE E)A*9ATI8N 82 THE ANEMIC ;ATIENT(3ANEMIC ;ATIENT(3The workup hou!" #e "$re%te" tow&r" The workup hou!" #e "$re%te" tow&r" &'wer$'( the )o!!ow$'( *uet$o'+&'wer$'( the )o!!ow$'( *uet$o'+..Is t!e %atient beedin"+no$ or in t!e ..Is t!e %atient beedin"+no$ or in t!e %ast- K.%ast- K.3.Is t!ere e&idence of increased RBC 3.Is t!ere e&idence of increased RBC destructionKdestructionK/.Is t!e BM su%%ressedK./.Is t!e BM su%%ressedK.4.Is t!e %atient iron defcientKif so#$!yK.4.Is t!e %atient iron defcientKif so#$!yK.HIST,-.HIST,-.:ym%toms reated to anemia:ym%toms reated to anemia+meena#CR2#RA-.+meena#CR2#RA-.>uration of anemia +Recent ori"in#or >uration of anemia +Recent ori"in#or

ife(on"-.ife(on"-.>ru" !istory +N:AI>s-.>ru" !istory +N:AI>s-.2amiy !istory.2amiy !istory./H.SI0AL /H.SI0AL E1AMINATI,NE1AMINATI,N;aor.;aor.Laundice.Laundice.Tac!ycardia.Tac!ycardia.*ym%!adeno%at!y.*ym%!adeno%at!y.He%atos%enome"ay.He%atos%enome"ay.Bone tenderness.Bone tenderness.

LAB,-AT,-. LAB,-AT,-. E2AL3ATI,N41E2AL3ATI,N41Com%ete bood count +CBC-: Com%ete bood count +CBC-: HBG#HCT#HBG#HCT#

RBC count#RBC indices#andRBC count#RBC indices#and

IBC count.IBC count.IBC di=erentia#;*T count#andIBC di=erentia#;*T count#and

reticuocyte count.reticuocyte count.Bood fm +Bood smear-.Bood fm +Bood smear-.Red ce distribution $idt!.Red ce distribution $idt!.LAB,-AT,-. LAB,-AT,-. E2AL3ATI,N42E2AL3ATI,N42Red ce indices:Red ce indices:

.(Mean cor%uscuar &oume..(Mean cor%uscuar &oume.MC)MC) 7