ANEMIA:

INTRODUCTION:

Anemia is defined as a low number of red blood cells. In a routine blood test, anemia is
reported as a low hemoglobin or hematocrit. Hemoglobin is the main protein in your red blood cells.
It carries oxygen, and delivers it throughout your body. If you have anemia, your hemoglobin level
will be low too. If it is low enough, your tissues or organs may not get enough oxygen. Symptoms of
anemia -like fatigue or pain -- happen because your organs aren't getting what they need to work the
way they should.

ANEMIA
Anemia, per se, is not a specific disease state but a sign of an underlying
disorder. It is by far the most common hematologic condition.
Anemia, a condition in which the hemoglobin concentration
is lower than normal, reflects the presence of fewer than normal
RBCs within the circulation. As a result, the amount of oxygen
delivered to body tissues is also diminished.
There are many different kinds of anemia (Table 33-3), but
all can be classified into three broad etiologic categories:

• Loss of RBCs—occurs with bleeding, potentially from any

major source, such as the gastrointestinal tract, the uterus,
the nose, or a wound
• Decreased production of RBCs—can be caused by a deficiency
in cofactors (including folic acid, vitamin B12, and
iron) required for erythropoiesis; RBC production may
also be reduced if the bone marrow is suppressed (eg, by
tumor, medications, toxins) or is inadequately stimulated
because of a lack of erythropoietin (as occurs in chronic
renal disease).
• Increased destruction of RBCs—may occur because of an
overactive RES (including hypersplenism) or because the
bone marrow produces abnormal RBCs that are then destroyed
by the RES (eg, sickle cell anemia).
A conclusion as to whether the anemia is caused by destruction
or by inadequate production of RBCs usually can be reached
on the basis of the following factors:
• The marrow’s ability to respond to the decreased RBCs (as
evidenced by an increased reticulocyte count in the circulating
blood)
• The degree to which young RBCs proliferate in the bone
marrow and the manner in which they mature (as observed
on bone marrow biopsy)
• The presence or absence of end products of RBC destruction
within the circulation (eg, increased bilirubin level, decreased
haptoglobin level)