I used this lecture guide to study anemia and to summarize the important details on it found in the Rodak Book of Hematology. I used this to pass my course and prepare for our annual assessment. This briefly tackles anemia and its characteristics.
Primary function: Transport and delivery of oxygen to the different
tissues of the body; what enables RBC to function as such is because of
hemoglobin.
→ Hemoglobin
✓ Protein that allows RBC to bind with and release oxygen to the
peripheral tissues; responsible for binding and releasing oxygen
to peripheral tissues.
✓ Enables RBC to carry oxygen; w/o hemoglobin, RBCs will not be
able to carry oxygen
✓ Responsible for the red pigment of RBCs; RBCs are red in color b/c they are rich in
hemoglobin
Cytoplasm is rich in hemoglobin – rich in hemoglobin that is responsible for the oxygen-carrying
capacity of RBCs
Mature RBCs are flexible biconcave disks that lacks a nucleus
→ Biconcavity shape is an important property of RBCs b/c it enables RBCs to easily load and unload
oxygen; easy for RBCs to pick up and unload b/c of its shape;
→ Additionally, mature RBCs are anucleated meaning they lack nucleus; in the maturation series, the
last nucleated stage is the metarubricyte.
✓ After the metarubricyte, the nucleus will be extruded and the cell will become reticulocyte.
From reticulocyte to mature erythrocyte, these cells are no longer nucleated.
✓ It is important to extrude nucleus so that what will fill the cytoplasm of the RBCs will be the
hemoglobin; so that cytoplasm will be abundant in hemoglobin
24 million new RBCs are produced per second
RBCs are produced and developed in the bone marrow particularly in the red marrow where
hematopoiesis occurs; on the other hand, yellow marrow is primarily made up of fat
RBCs circulate for about 90-120 days before they are culled/ sequestered in the spleen and their
components recycled
→ Spleen serve as the graveyard of RBCs;
→ In the spleen, RBCs will be destroyed by the action of splenic macrophages;
→ After destruction, the RBCs will release the contents of its cytoplasm; these contents,
particularly hemoglobin will be recycled
Any abnormality in the property of RBCs will result to an abnormality or impairment in its function
Remember that an RBC must have a flexible, biconcave disks; if the RBCs loses these properties, it
will be very difficult for RBC to perform its function.
For example, if RBCs have distorted shape, it will be very difficult for it to go to the small capillaries
of the body; its oxygen delivery will also be impaired which may lead to the ultimate consequence—
death of the person.
Before that happens, RBCs have to be evaluated for physicians to know if there are abnormalities in
the RBCs.
An abnormality related to RBCs is called as Anemia.
, Reduction in the total number of RBCs
Reduction in the amount of circulating hemoglobin and RBC mass
→ In the clinical setting, these definitions do not exactly apply because
doctors generally do not know the baseline values of the patient —
values of patients when they are normal or they are well—because
most of the patient only visit the doctors when they are already sick; does not really apply because
doctors do not have a point of reference if a certain result is a normal result or a sickly result
Decrease in the oxygen-carrying capacity of the blood due to varied reasons – generic definition b/c
it does not merely pertain/ does not entirely pertain to the number, hemoglobin of the RBC.
→ There are instances that even though the RBC count, hematocrit of the patient is normal but
anemia is still existing
Decrease in RBC, hemoglobin and hematocrit below the reference range for healthy individuals
→ There is a point of reference for doctors to evaluate; so doctors may use lab results to evaluate
anemia
→ The problem in diagnosing anemia based on reference range is that there are actually individuals
with either high or low hemoglobin concentration; they are considered normal even though they
have high or low hemoglobin b/c there is no evident anemia present
→ Remember that the variation in hemoglobin is also multifactorial; diseases are not the only cause
why hemoglobin may increase or decrease.
✓ Hemoglobin > reference range - Instances when hemoglobin is above the reference range may
be due to:
o Heavy smoking - as compensatory mechanism; most individuals who are smokers have high
hemoglobin concentration
o Living at high altitude - as compensatory mechanism because of low oxygen pressure
o Chronic hypoxemic lung disease (e.g. COPD) - diseases of the lungs may lead to
hemoglobin that is increased; as compensatory mechanism b/c of low oxygen tension; the
body will produce more RBCs in so that there will be more hemoglobin in order to facilitate
the rapid delivery of oxygen
✓ Hemoglobin < reference range - Instances that will result to a low hemoglobin than the
reference range:
o African descent
o Pregnancy
o Endurance athletes - because they have higher plasma volume so there is a relative
decrease in the RBC parameters including hemoglobin
o Elderly - due to old age or due to an underlying condition
→ Hemoglobin really varies that is why when it comes to diagnosing anemia, the doctors look at
different angles.
Anemia in itself is not a disease; rather, it is a manifestation of an underlying disease just like fever, it
is a sign that something is wrong going on in the body which affects RBCs and the function of RBCs
It is important that the cause of the anemia must be identified first in order to successfully resolve the
anemic episode of the patient
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