Why increased cardiac output in anemia!

A central concept in answering many "easy questions" in step 1.

Remember that hemoglobin carries oxygen and this O2 together with the dissolved O2
in plasma comprises the total oxygen content of the blood.

In anemia, there's no problem with the dissolved oxygen which determines the PO2
which in turn determines the saturation. All these three are normal in anemia.

What's decreased in anemia is the hemoglobin concentration. So we have a decreased

oxygen content of the blood.

The oxygen delivery to the tissues is a measure of Cardiac Output and Oxygen
content of the blood.

So here's why the cardiac output increases:

* To compensate for the lowered oxygen content, this is done by increasing the
heart rate and the stroke volume (hence the flow murmur in severe anemia).
* On the other hand, RBC concentration is a major determinant of blood
viscosity and so in anemia there's less viscosity and so less resistance to flow
which translates to decreased peripheral vascular resistance.
* The tissue hypoxia itself causes vasodilation