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Anemia Extrinsic factor

Certain medications Diseases such as cancer or rheumatoid arthritis Pregnancy Surgery to the stomach or intestines that reduces the absorption of iron, vitamin B12, or folic acid

>. Hemodilution occurs in response to decreased blood volume when fluid moves from the interstitium into the intravascular space to expand the plasma volume. The decrease in blood viscosity from the lower number of red blood cells, along with increased intravascular fluid, causes the blood to flow faster through the CV system and the flow becomes more turbulent. This process causes pressure on the ventricles, the heart dilates, and heart valve dysfunction develops
Signs and symptoms:

Intrinsic factor

Genes -- some forms of anemia can be inherited Kidney failure Blood loss (for example, from heavy menstrual periods) Poor diet Problems with bone marrow (where blood cells are made) Problems with the immune system that cause the destruction of blood cells

Shortness of breath- breathing


difficulty or breathlessness Fatigue- lacking energy or strength; drowsiness (sleepiness), lethargy, tiredness, malaise, listlessness, or weakness (including muscular weakness)

Organs Affected by Anemia: blood, red blood cells

Headache Pale skin Chest pain Fatigue or lack of energy

Laboratory test:
Pathophysiology: >All blood cells are produced by hematopoiesis in the bone marrow. The major raw material essentials for this process are proteins, vitamin [B.sub.12], folic acid, and iron. >. Acute or chronic red blood cell loss, inadequate production of red blood cells in the bone marrow, or an increased hemolysis can produce anemia > When anemia develops because of hemorrhage, the reduction in red blood cell numbers causes a decrease in blood volume and the cardiovascular (CV) system becomes hypovolemic. Anemia becomes evident when the maximum level of hemodilution occurs, usually within 3 days after the acute blood loss.

Complete blood count:


White blood cell count normal: 4.3 to 10.8 x 109 cells per liter. Red cell count Normal: 4.2 to 5.9 x 1012 cells per liter. Hemoglobin (Hb) Normal: 8.1 to 11.2 millimoles/liter for men, 7.4 to 9.9 for women). Platelet count Normal: 150 to 400 x 109/liter

Hemoglobin level test: Low levels of hemoglobin may be a result of:

Anemia.

Normal levels: Hemoglobin is measured in grams per deciliter of blood. The normal levels are:

Women: 12.1 to 15.1 gm/dl Men: 13.8 to 17.2 gm/dl Children: 11 to 16 g/dl Pregnant women: 11 to 12 g/dl

Myelodysplastic syndrome (MDS) can be classified as primary (no known exposure) or secondary as a complication of aggressive treatment of other cancers with exposure to radiation, alkylating agents, or topoisomerase II inhibitors and heavily pretreated patients with autologous bone marrow transplants. The initial hematopoietic stem cell injury can be from cytotoxic chemotherapy, radiation exposure, viral infection, chemical exposure to genotoxins like benzene, or genetic predisposition. A clonal mutation predominates over bone marrow, suppressing healthy stem cells. In early stages, the main cause of cytopenias is increased apoptosis (programmed cell death). As the disease progresses and converts into leukemia, further (a rare) gene mutation occurs, and a proliferation of leukemic cells overwhelms the healthy marrow. Symptoms:

bone marrow biopsy


Normal Results

The marrow has normal cells that are the correct types and numbers.
Abnormal-The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Myelodisplastic syndrome Organ: bone marrow stem cells


Risk for development of MDS has been linked to the following: smoking, benzene, organic chemicals, heavy metals, herbicides, pesticides, fertilizers, and petroleum and diesel derivatives. Other predisposing factors include prior therapy with chloramphenical, radiation, and chemotherapeutic agents such as melphalan, chlorambucil, cycylophosphamide, or procarbazine. Pathophysiology

Lack of red blood cells causes anemia (leading to fatigue and shortness of breath) Lack of white blood cells leaves the body open to infection Lack of platelet cells makes it difficult for the blood to clot (leading to unusual bruising or bleeding) Anemiachronic tiredness, shortness of breath, chilled sensation, sometimes chest pain Neutropenia (low neutrophil count) increased susceptibility to infection Thrombocytopenia (low platelet count) increased susceptibility to bleeding and ecchymosis (bruising), as well as subcutaneous

hemorrhaging resulting in purpura or petechia[5] Many individuals are asymptomatic, and blood cytopenia or other problems are identified as a part of a routine blood count:

What Abnormal Results Mean


High numbers of RBCs or a high hematocrit may be due to:

neutropenia, anemia and thrombocytopenia (low cell counts of white and red blood cells, and platelets, respectively); splenomegaly or rarely hepatomegaly; abnormal granules in cells, abnormal nuclear shape and size; and/or chromosomal abnormalities, including chromosomal translocations and abnormal chromosome number.

Dehydration (such as from severe diarrhea) Kidney disease with high erythropoietin production Low oxygen level in the blood: o Congenital heart disease o Cor pulmonale o Pulmonary fibrosis Polycythemia vera Smoking

Low numbers of RBCs or low hematocrit indicates anemia, which can result from:

Complete blood count

normal Results

RBC (varies with altitude): o Male: 4.7 to 6.1 million cells/mcL o Female: 4.2 to 5.4 million cells/mcL WBC: 4,500 to 10,000 cells/mcL Hematocrit (varies with altitude): o Male: 40.7 to 50.3 % o Female: 36.1 to 44.3 % Hemoglobin (varies with altitude): o Male: 13.8 to 17.2 gm/dL o Female: 12.1 to 15.1 gm/dL MCV: 80 to 95 femtoliter MCH: 27 to 31 pg/cell MCHC: 32 to 36 gm/dL

Autoimmune/collagen-vascular diseases such as lupus erythematosus or rheumatoid arthritis Blood loss (hemorrhage) Bone marrow failure (for example, from radiation, infection, or tumor) Erythropoietin deficiency (secondary to kidney disease) Hemolysis (red blood cell destruction) Leukemia Malnutrition (nutritional deficiencies of iron, folate, vitamin B12, or vitamin B6) Multiple myeloma

A lower-than-normal white blood cell count is called leukopenia. A decreased WBC may be due to:

Autoimmune/collagen-vascular diseases (such as lupus erythematosus) Bone marrow failure (for example, due to infection, tumor, radiation, or fibrosis) Disease of the liver or spleen

High numbers of WBCs is called leukocytosis. It can result from:


The marrow has normal cells that are the correct types and numbers.

Infectious diseases Inflammatory disease (such as rheumatoid arthritis or allergy) Leukemia Severe emotional or physical stress Tissue damage (such as burns)

What Abnormal Results Mean


Abnormal results may be due to cancers of the bone marrow (leukemia or Hodgkin's disease). The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Low hemoglobin values may indicate:


Anemia (various types) Blood loss

Blood smear
Normal Results

Red cells normally are the same in size and color and have a lighter-colored area in the center. The blood smear is considered normal if there is:

Normal differential Normal appearance of cells

What Abnormal Results Mean Abnormal results mean there is an abnormalities in the size, shape, coloring or coating of the red blood cells. Some abnormalities may be graded on a 4point scale:

1+ means 25% of cells affected 2+ means half of cellsare affected 3+ means 75% of cells are affected 4+ means all of the cells are affected

Bone marrow biopsy

Normal Results