Vocabulary, Types of Anemia, Heme Breakdown, and Anemia of Chronic Disease [Biology, MCAT, USMLE] – Moosmosis


In this study guide, we review anemia, types of anemia, important anemia formulas, vocabulary, heme breakdown, and anemia of chronic diseases.

Definitions, Numbers, and Vocabulary of Anemia

Hematocrit = ratio of volume of red cells / total volume of blood

Oxygen transport has 3 independent variables

Oxygen delivery = blood flow x Hb concentration x (Asat-Vsat)

Asat-Vsat = difference in percent oxygenation in Arterial vs Venous blood

Anemia + 2,3-DPG = lower oxygen affinity, oxygen unloads

HIF hypoxia inducible transcription factor = in all cells, detects hypoxia in body

HIF = up-regulates hormone erythropoietin

Reticulocyte count = # of young red blood cells

If have impaired red cell production = LOW reticulocyte count, High EPO levels

Hemolytic anemia or Acute Blood loss = body compensates for the lack of rbc by producing more = HIGH reticulocyte count

Treatment for Blood Loss = Therapeutic iron, not enough sometimes to just give erythropoietin

Types of Anemia

Sideroblastic Anemia = porphyrin synthesis defects = broad distribution of cell sizes

Megaloblastic Anemia = often caused by vitamin B12 or folate deficiency or Chemotherapy agents

Iron-deficiency Anemia = also microcytic but has RBC = low and RDW = high

Thalessemia (Microcytic) = RBC is High = but RDW is Low

Normocytic anemia = maybe like a tumor = have pancytopenia = tear-drop shape blood cells

Anemia due to increased red blood cell destruction (hemolysis):

  1. High Reticulocyte count
  2. High Non-conjugated bilirubin
  3. High LDH
  4. High Hemoglobin
  5. Low Haptoglobin [because binds to free hemoglobin which floats in blood because RBC destroyed –> haptoglobin-hemoglobin removed]

Process of Breaking down heme:

  1. Heme oxygenase catabolizes heme –> biliverdin
  2. BIliverdin –> bilirubin (exits macrophage, binds to albumin in plasma)
  3. Albumin-bound bilirubin –> taken up by liver –> conjugated to glucoronide
  4. Conjugated bilirubin comes out –> bile –> duodenum [Liver disease? High conjugated bilirubin]
  5. Bacteria gut –> conjugated bilirubin converted to urobilinogen –> stercobilin (brown)

Chronic Inflammation Anemia: High iron in macrophages, bone marrow, liver, and spleen –> elevated levels of ferritin in serum but Low levels Serum Iron

  1. Total Transferrin = Low [Low in the blood]
  2. High Ferritin [High storage]
  3. Low Serum Iron

Chronic renal insufficiency = Suppressed Erythropoeisis

  1. Reticulocyte index = Low [Not enough rbc being produced anyways]
  2. Red cell index = Normal

Treatment for Chronic Anemia = rhEPO, especially myelodysplasia effective

Anemia of Chronic Liver disease

  1. Blood smear = target cells
  2. Reticulocyte index = Low
  3. Ring sideroblasts (Alcoholics)

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Natasha M. McKnight

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