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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):
- High Reticulocyte count
- High Non-conjugated bilirubin
- High LDH
- High Hemoglobin
- Low Haptoglobin [because binds to free hemoglobin which floats in blood because RBC destroyed –> haptoglobin-hemoglobin removed]
Process of Breaking down heme:
- Heme oxygenase catabolizes heme –> biliverdin
- BIliverdin –> bilirubin (exits macrophage, binds to albumin in plasma)
- Albumin-bound bilirubin –> taken up by liver –> conjugated to glucoronide
- Conjugated bilirubin comes out –> bile –> duodenum [Liver disease? High conjugated bilirubin]
- 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
- Total Transferrin = Low [Low in the blood]
- High Ferritin [High storage]
- Low Serum Iron
Chronic renal insufficiency = Suppressed Erythropoeisis
- Reticulocyte index = Low [Not enough rbc being produced anyways]
- Red cell index = Normal
Treatment for Chronic Anemia = rhEPO, especially myelodysplasia effective
Anemia of Chronic Liver disease
- Blood smear = target cells
- Reticulocyte index = Low
- Ring sideroblasts (Alcoholics)
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