Anemia can contribute to: – ANS coronary ischemia
Composition of blood – ANS 5.5L total. 50-55% = plasma; 90% water
Erythropoesis is stimulated by… – ANS erythropoetin
Hemoglobin A – ANS the majority of adult hemoglobin. 97% of circulating
hemoglobin. 2 alpha and 2 beta chains.
HbA2 – ANS minor adult hemoglobin. 2-3% of circulating hemoglobin. 2 alpha
and 2 delta chains.
Hemoglobin F – ANS Fetal hemoglobin. 2 alpha and 2 gamma chains. Has a
greater affinity for and more regularly binds O2.
Anemia – ANS a decrease in circulating red blood cells in the body, as reflected
by a reduction in hemoglobin, hematocrit, and/or RBCs. Less than 14 in men and
less than 12 in women.
Normal RBC – ANS 4.5-6
1 / 3
Normal Hemoglobin – ANS >13 in men, >12 in women.
Normal HCT – ANS 40-50in men; 35-45 in women. usually 3x the hemoglobin
count.
Reticulocyte count – ANS Low (<0.5%) High (>2%) if high, bone marrow is trying
to compensate for loss in hgb or red cells. problem exists outside of the bome
marrow
MCV (mean corpuscular volume) – ANS description of the volume of an RBC.
NOT DIAGNOSTIC
RDW (red cell distribution width) – ANS 11.5-15 %; index of variation in RBC size
and shape. Indicates evolving macro/microcytic anemia.
MCH (mean corpuscular hemoglobin) – ANS commonly used: 27 – 31 pg/ cell
Amount of hemoglobin per RBC
Microcytic anemia – ANS Iron deficiency, thalassemia, inflammation. low MCV
<80. Low reticulocyte count. Underproduction. 2 / 3 macrocytic anemia – ANS Underproduction. B12 deficiency, Folic Acid Deficiency, Antimetabolite drugs. MCV > 100; low reticulocyte count
Normocytic Anemia – ANS MCV 80-100; low reticulocyte count; ex:
dilutional/iatrogenic secondary to phlebotomy.
Folate Deficiency Anemia – ANS Macrocytic anemia; poor intake; low retic,
elevate MCV/MCH, thrombocytopenia ad neutropenia, elevated homocysteine;
low RBC folate. Eat orange fruits! Never treat folate deficiency without testing for
B12 deficiency – can worsen neurological symptoms specific to B12 deficiency
Vitamin B12 Deficiency – ANS Macrocytic; malabsorption; occurs when B12 is
not released from food proteins due to impaired digestion; Elevated
MCV/Macrocytic;
Pernicious Anemia – ANS lack of mature erythrocytes caused by inability to
absorb vitamin B12 into the bloodstream
Destruction (Hemolytic anemia) – ANS anemia with elevated reticulocytes;
intrinsic and extrinsic
intrinsic hemolytic anemia (hereditary) – ANS – Abnormal hemoglobin
- Enzyme deficiencies (pyruvate kinase, G6PD)