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What are the 5 compensatory mechanisms in anemia?
- Increased RBC production
- Increased 2,3 DPG
- Shunting of blood from non-vital areas to vital areas
- Increased cardiac output
- Increased pulmonary fxn
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What are the signs and symptoms of anemia?
- Weakness, malaise, easy fatigability
- Marrow expansion with potential bony abnormalities
- Pallor
- Tachycardia, cardiac ischemia
- Dyspnea on exertion
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What are the 3 components of the functional classification of anemia?
- Blood Loss
- Decreased Production
- Accelerated Destruction
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- Spherocytes:
- hereditary spherocytosis
- autoimmune hemolytic anemia
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- Target cells:
- Liver dz, splenectomy, hemoglobinopathies
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- Elliptocytes (ovalocytes):
- Hereditary elliptocytosis, megaloblastic anemia, iron deficiency, myelofibrosis
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- Teardrop cells:
- Megaloblastic anemia, myelofibrosis, extramedullary hematopoiesis
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- Sickled cells:
- Sickle cell disease
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- Fragments (schistocytes):
- TTP, DIC, malignant hypertension
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- Bite Cells:
- Oxidant hemolysis (G6PD deficiency)
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Anisocytosis: red cell size variability
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Polychromasia (reticulocytes)
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- Howell-Jolly Bodies (nuclear fragments):
- Splenectomy, megaloblastic anemia
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- Pappenheimer bodies (iron granules):
- splenectomy, iron overload
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- Basophilic stippling:
- Thalassemias, myelodysplastic syndrome, lead poisoning
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Hemoglobin C crystals: Hb CC disease, Hb SC disease
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Rouleaux: decreased repulsive forces btwn RBCs (increased serum proteins - Ig, fibrinogen)
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Agglutination: IgM RBC antibodies (cold agglutinins)
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Initially no anemia by CBC parameters despite decreased in blood volume.
Anemia develops as tissue fluid enters vascular space to restore blood volume, producing dilution of cellular elements.
Reticulocyte count increases after 2-3 days and peaks after 7-10 days
Acute anemia of blood loss
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No anemia initially b/c BM is able to compensate.
Slight reticulocytosis.
Eventual development of iron deficiency.
Chronic anemia of blood loss.
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Where are RBCs produced in different stages of life?
Embryo: Yolk Sac
Fetus: Liver
After birth: BM
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What regulates RBC production?
Decreased oxygen delivery induces the production of erythropoietin by kidney.
EPO causes proliferation and differentiation of committed progenitor cells.
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Why do reticulocytes have a blue tinge on blood smears?
They contain residual RNA
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How long do reticulocytes circulate and what percent of peripheral erythrocytes are reticulocytes?
Circulate 1 day before losing residual ribosomes, mitochondria, and other organelles to become mature erythrocytes.
Normally 1 percept of peripheral erythrocytes.
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