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Anemia

Background of anemia

Type	Clinical features
Definitions	*Anemia* Decreased number of circulating red blood cells (RBCs) measured as either hemoglobin concentration, hematocrit (HCT), or RBC count *Hemoglobin concentration* Concentration of hemoglobin in whole blood Can range from 13-14.2 g/dL (men) and 11.6-12.3 g/dL (women) Value can vary in athletes, people living at high altitude, smokers, older adults *Hematocrit (HCT)* *Mean corpuscular volume (MCV)* Percentage of RBCs in spun blood HCT= (RBC times MCV)/10 Usually equals Hgb times 3 *RBC count* Number of RBCs in whole volume of blood (millions of cells/microliter) *RBC indices* Mean corpuscular volume (MCV) Average size of a patient’s RBCs Reported as femtoliters (fL) MCV= 10 (HCT)/RBC Defined as microcytic, normocytic, or macrocytic Mean corpuscular hemoglobin (MCH) Average hemoglobin content in a RBC Reported as picograms (pg) per cell MCH= Hgb (10)/RBC Defined as hypochromic, normochromic, or hyperchromic Mean corpuscular hemoglobin concentration (MCHC) Average Hgb concentration per RBC Reported as g/dL MCHC= Hgb (10)/HCT Red cell distribution width (RDW) Measures variation in RBC size (anisocytosis) RDW= (standard deviation of RBC size/MCV) (100)
Erythropoiesis	Erythropoietin (EPO) made in kidney and released based on adequate tissue oxygenation EPO stimulates bone marrow to make erythroid progenitors burst forming units-erythroid (BFU-E) and colony forming units-erythroid (CFU-E) BFU-E and CFU-E mature into orthochromatic erythroblast Erythoblast differnetiates into reticulocyte Reticulocyte survives in circulation for 1 day and becomes mature RBC, which lives for 110-120 days Reticulocytosis refers to increased concentration of immature RBCs
Mechanisms of anemia	*Decreased bone marrow production of red blood cells* Decreased production of effective RBCs Ineffective erythropoeisis with bone marrow hyperplasia but decreased reticulocytes Increased RBC destruction (hemolysis) Blood loss

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