Introduction to Anemias & Blood Loss

Question 1

Definition of Anemia

Answer 1

1. decreased/ dysfunctional RBCs
2. decrease in the normal concentration of hemoglobin or RBCs
3. considered present if hemoglobin is under lower limit

more a symptom than a disease

Question 2

total RBC mass (M)

Answer 2

= (# of RBCs produced per day) x ( RBC life span)

Question 3

Development of Anemia

Answer 3

1. RBC loss/ destruction exceeds max capacity of BM RBC production
2. BM RBC production is impaired

Question 4

Screening for Anemia

Answer 4

Relies on the relative Hb and Hct values

Question 5

Hypervolemia

Answer 5

total blood volume increases (IV fluids etc)

Hb & Hct are falsely decreased

Question 6

Hypovolemia

Answer 6

occurs in dehydration

Hb & Hct are falsely elevated

Question 7

Generic Anemia Symptoms

Answer 7

Pallor -pale 1st symptom
fatigue
headaches
faintness
slight fever
all due to diminished delivery of O2

Question 8

Factors that lead to a Diagnosis of Anemia

Answer 8

Patient History
physical examination
symptoms
hematology values!
other lab findings

Question 9

Patient History (in diagnosis)

Answer 9

patient diet, drug ingestion, occupation, family history etc

Question 10

Physical Exam (in diagnosis)

Answer 10

skin - pallor/jaundice
splenomegaly (enlargement of spleen)
hepatomegaly (enlargement of liver)

Question 11

Hematology Values (in diagnosis)

Answer 11

CBC = Hgb, Hct, MCV, MCH, MCHC, Retic Count

RBC morphology

Question 12

2 major classifying schemes for Anemias

Answer 12

Morphological (Wintrobe) - based on RBC indices & retic count
Pathophysiological/ functional - based on lab results

Question 13

Wintrobe classification

Answer 13

morphological classification based on cell size & color
microcytic (100 fL)
hypochromic (36)

Question 14

Pathophysiological Anemia Classification

Answer 14

4 major categories:
blood loss
Impaired production of RBCs
Increased Destruction of RBCs
Defects in Hemoglobin

Question 15

Blood Loss Anemias (2)

Answer 15

Acute

Chronic

Question 16

Acute Blood Loss Anemia

Answer 16

traumatic conditions
associated with hypovalemia
3 major steps of acute blood loss = immediate phase, delayed phase, regenerative phase

Question 17

Immediate Phase of Acute Blood Loss Anemia

Answer 17

initial blood loss creates a fluid shift

Hgb & Hct may not be decreased at the time

Question 18

Delayed Phase of Acute Blood Loss Anemia

Answer 18

IV support
Hgb, RBC, Hct will be decreased
Normochromic, Normocytic anemia

Question 19

Regenerative Phase of Acute Blood Loss Anemia

Answer 19

3-5 days

BM responding to anemia with increased Reticulocytes

Question 20

Summary of Acute Blood Loss Anemia

Answer 20

cause- trauma
blood volume distruption - yes
iron deficiency - no
Hct- initially normal
WBC count- increased
platelets - increased
retics- initially normal then increased

Question 21

Chronic Blood Loss Anemia

Answer 21

associated with GI tract disorders, heavy menstruation, urinary tract abnormalities
slowly developing anemia

Question 22

Adaptions to Anemia

Answer 22

increased in oxygenated blood flow- up cardiac output, up circulation rate
increase in 02 utilization by tissue - increase 2,3 BPG, decrease 02 affinity of Hgb in tissues (bohr effect)

Question 23

Summary of Chronic Blood Loss Anemia

Answer 23

Normochromic, normocytic 
cause- GI tract, menstruation, urinary tract
blood volume distruption - no
iron deficiency - yes
Hct & hgb - decreased
WBC count - normal 
Platelets - normal
Retics - Increased