Alterations of Erythrocyte Alterations of Erythrocyte Function Function Chapter 26 Chapter 26 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Elsevier Inc.
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Alterations of Erythrocyte FunctionAlterations of Erythrocyte Function
Chapter 26Chapter 26
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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Alterations in ErythrocytesAlterations in Erythrocytes Too many cellsToo many cells
PolycythemiasPolycythemias Too few cellsToo few cells
AnemiasAnemias Normal number of cells with altered Normal number of cells with altered
componentscomponents
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AnemiaAnemia Reduction in the total number of erythrocytes Reduction in the total number of erythrocytes
in the circulating blood or in the quality or in the circulating blood or in the quality or quantity of hemoglobinquantity of hemoglobin Impaired erythrocyte productionImpaired erythrocyte production Acute or chronic blood lossAcute or chronic blood loss Increased erythrocyte destructionIncreased erythrocyte destruction Combination of the aboveCombination of the above
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AnemiaAnemia ClassificationsClassifications
EtiologyEtiology MorphologyMorphology
• Based on MCV, MCH, and MCHC valuesBased on MCV, MCH, and MCHC values• Size Size
Identified by terms that end in “-cytic”Identified by terms that end in “-cytic” Macrocytic, microcytic, normocyticMacrocytic, microcytic, normocytic
• Hemoglobin content Hemoglobin content Identified by terms that end in “-chromic”Identified by terms that end in “-chromic” Normochromic and hypochromicNormochromic and hypochromic
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AnemiaAnemia AnisocytosisAnisocytosis
Red cells are present in various sizesRed cells are present in various sizes PoikilocytosisPoikilocytosis
Red cells are present in various shapesRed cells are present in various shapes
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AnemiaAnemia
Physiologic manifestationPhysiologic manifestation Reduced oxygen carrying capacityReduced oxygen carrying capacity
Variable symptoms based on severity and the Variable symptoms based on severity and the ability of the body to compensateability of the body to compensate
Classic anemia symptomsClassic anemia symptoms Fatigue, weakness, dyspnea, and pallorFatigue, weakness, dyspnea, and pallor
OtherOther Due to hypoxemia and tissue hypoxiaDue to hypoxemia and tissue hypoxia
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AnemiaAnemia Cardiovascular function Cardiovascular function
Increased preload, heart rate, and stroke volume; Increased preload, heart rate, and stroke volume; reduced afterloadreduced afterload
Respiratory functionRespiratory function DyspneaDyspnea
Nervous system functionNervous system function Myelin degenerationMyelin degeneration
Gastrointestinal functionGastrointestinal function Pain, nausea, vomiting, anorexiaPain, nausea, vomiting, anorexia
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Normochromic-Macrocytic Normochromic-Macrocytic AnemiasAnemias
Also termed megaloblastic anemiasAlso termed megaloblastic anemias Defective DNA synthesisDefective DNA synthesis
Due to deficiencies in vitamin BDue to deficiencies in vitamin B1212 or folate or folate• Coenzymes for nuclear maturation and the DNA Coenzymes for nuclear maturation and the DNA
synthesis pathwaysynthesis pathway
Ribonucleic acid (RNA) processes occur at a Ribonucleic acid (RNA) processes occur at a normal ratenormal rate Results in unequal growth of the nucleus and Results in unequal growth of the nucleus and
cytoplasmcytoplasm
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Normochromic-Macrocytic Normochromic-Macrocytic AnemiasAnemias
Pernicious anemiaPernicious anemia Caused by a lack of intrinsic factor from the gastric Caused by a lack of intrinsic factor from the gastric
parietal cellsparietal cells Required for vitamin BRequired for vitamin B1212 absorption absorption
Results in vitamin BResults in vitamin B1212 deficiency deficiency
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Normochromic-Macrocytic AnemiasNormochromic-Macrocytic Anemias Pernicious anemiaPernicious anemia
Typical anemia symptomsTypical anemia symptoms Neurologic manifestationsNeurologic manifestations
• Nerve demyelinationNerve demyelination Loss of appetite, abdominal pain, beefy red tongue Loss of appetite, abdominal pain, beefy red tongue
(atrophic glossitis), icterus, splenic enlargement(atrophic glossitis), icterus, splenic enlargement TreatmentTreatment
• Parenteral or high oral doses of vitamin BParenteral or high oral doses of vitamin B1212
Often unrecognized in older adults due to subtle, slow Often unrecognized in older adults due to subtle, slow onset and presentationonset and presentation
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Pernicious AnemiaPernicious Anemia
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Normochromic-Macrocytic Normochromic-Macrocytic AnemiasAnemias
Folate deficiency anemiaFolate deficiency anemia Absorption of folate occurs in the upper small Absorption of folate occurs in the upper small
intestineintestine Not dependent on any other facilitating factorNot dependent on any other facilitating factor Similar to pernicious anemia except neurologic Similar to pernicious anemia except neurologic
manifestations generally not seenmanifestations generally not seen Treatment requires daily oral administration of folateTreatment requires daily oral administration of folate
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Hypochromic-Microcytic AnemiasHypochromic-Microcytic Anemias Characterized by red cells that are Characterized by red cells that are
abnormally small and contain reduced abnormally small and contain reduced amounts of hemoglobin amounts of hemoglobin
Related to:Related to: Disorders of iron metabolismDisorders of iron metabolism Disorders of porphyrin and heme synthesisDisorders of porphyrin and heme synthesis Disorders of globin synthesisDisorders of globin synthesis
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Hypochromic-Microcytic AnemiasHypochromic-Microcytic Anemias Iron deficiency anemiaIron deficiency anemia
Most common type of anemia worldwideMost common type of anemia worldwide Nutritional iron deficiencyNutritional iron deficiency Metabolic or functional deficiencyMetabolic or functional deficiency Progression of iron deficiency causes:Progression of iron deficiency causes:
• Brittle, thin, coarsely ridged, spoon-shaped nailsBrittle, thin, coarsely ridged, spoon-shaped nails
• A red, sore, painful tongueA red, sore, painful tongue
Symptomtic Hgb 7-8 g/dlSymptomtic Hgb 7-8 g/dl
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Hypochromic-Microcytic AnemiasHypochromic-Microcytic Anemias
Sideroblastic anemiaSideroblastic anemia Group of disorders characterized by anemiaGroup of disorders characterized by anemia Altered mitochondrial metabolism causing Altered mitochondrial metabolism causing
ineffective iron uptake and resulting in ineffective iron uptake and resulting in dysfunctional hemoglobin synthesisdysfunctional hemoglobin synthesis
Ringed sideroblasts within the bone marrow are Ringed sideroblasts within the bone marrow are diagnosticdiagnostic• Sideroblasts are erythroblasts that contain iron granules Sideroblasts are erythroblasts that contain iron granules
that have not been synthesized into hemoglobinthat have not been synthesized into hemoglobin
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Hypochromic-Microcytic AnemiasHypochromic-Microcytic Anemias Sideroblastic anemiaSideroblastic anemia
DimorphismDimorphism Myelodysplastic syndromeMyelodysplastic syndrome Erythropoietic hemochromatosisErythropoietic hemochromatosis
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Normochromic-Normocytic Normochromic-Normocytic AnemiasAnemias
Characterized by red cells that are relatively Characterized by red cells that are relatively normal in size and hemoglobin content but normal in size and hemoglobin content but insufficient in numberinsufficient in number
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Normochromic-Normocytic Normochromic-Normocytic AnemiasAnemias
Aplastic anemiaAplastic anemia PancytopeniaPancytopenia Pure red cell aplasiaPure red cell aplasia Fanconi anemiaFanconi anemia
Posthemorrhagic anemiaPosthemorrhagic anemia Acute blood loss from the vascular spaceAcute blood loss from the vascular space
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Normochromic-Normocytic Normochromic-Normocytic AnemiasAnemias
Hemolytic anemiaHemolytic anemia Accelerated destruction of red blood cellsAccelerated destruction of red blood cells Autoimmune hemolytic anemiasAutoimmune hemolytic anemias Immunohemolytic anemiaImmunohemolytic anemia Warm antibody immunohemolytic anemiaWarm antibody immunohemolytic anemia Drug-induced hemolytic anemiaDrug-induced hemolytic anemia Cold agglutinin immunohemolytic anemiaCold agglutinin immunohemolytic anemia Cold hemolysin hemolytic anemiaCold hemolysin hemolytic anemia
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Drug-Induced Hemolytic AnemiaDrug-Induced Hemolytic Anemia
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Normochromic-Normocytic Normochromic-Normocytic AnemiasAnemias
Sickle cell anemiaSickle cell anemia Anemia of chronic inflammationAnemia of chronic inflammation
Mild to moderate anemia seen in:Mild to moderate anemia seen in:• AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis, AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis,
renal failure, and malignanciesrenal failure, and malignancies Pathologic mechanismsPathologic mechanisms
• Decreased erythrocyte life spanDecreased erythrocyte life span• Ineffective bone marrow response to erythropoietinIneffective bone marrow response to erythropoietin• Altered iron metabolismAltered iron metabolism
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Anemia of Chronic InflammationAnemia of Chronic Inflammation
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Myeloproliferative RBC DisordersMyeloproliferative RBC Disorders PolycythemiaPolycythemia
Overproduction of RBCsOverproduction of RBCs Relative polycythemiaRelative polycythemia
Result of dehydrationResult of dehydration Fluid loss results in relative increases of red cell Fluid loss results in relative increases of red cell
counts and Hb and Hct valuescounts and Hb and Hct values
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PolycythemiaPolycythemia Absolute polycythemiaAbsolute polycythemia
Primary absolutePrimary absolute• Abnormality of stem cells in the bone marrow Abnormality of stem cells in the bone marrow
• Polycythemia vera (PV)Polycythemia vera (PV)
Secondary absoluteSecondary absolute• Increase in erythropoietin as a normal response to Increase in erythropoietin as a normal response to
chronic hypoxia or an inappropriate response to chronic hypoxia or an inappropriate response to erythropoietin-secreting tumorserythropoietin-secreting tumors
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