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Chapter 26
Alterations of Erythrocyte Function
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Alterations in Erythrocytes
Too many cells
Too few cells
Polycythemias
Anemias
Normal number of cells with altered
components
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Anemia
Reduction in the total number of erythrocytes
in the circulating blood or in the quality or
quantity of hemoglobin
Impaired erythrocyte production
Acute or chronic blood loss
Increased erythrocyte destruction
Combination of the above
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Anemia
Classifications
Etiology
Morphology
• Based on MCV, MCH, and MCHC values
• Size
Identified by terms that end in “-cytic”
Macrocytic, microcytic, normocytic
• Hemoglobin content
Identified by terms that end in “-chromic”
Normochromic and hypochromic
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Anemia
Anisocytosis
Red cells are present in various sizes
Poikilocytosis
Red cells are present in various shapes
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Anemia
Physiologic manifestation
Variable symptoms based on severity and the
ability of the body to compensate
Classic anemia symptoms
Reduced oxygen carrying capacity
Fatigue, weakness, dyspnea, and pallor
Other
Due to hypoxemia and tissue hypoxia
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Anemia
Cardiovascular function
Respiratory function
Dyspnea
Nervous system function
Increased preload, heart rate, and stroke volume;
reduced afterload
Myelin degeneration
Gastrointestinal function
Pain, nausea, vomiting, anorexia
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Normochromic-Macrocytic
Anemias
Also termed megaloblastic anemias
Defective DNA synthesis
Due to deficiencies in vitamin B12 or folate
• Coenzymes for nuclear maturation and the DNA
synthesis pathway
Ribonucleic acid (RNA) processes occur at a
normal rate
Results in unequal growth of the nucleus and
cytoplasm
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Normochromic-Macrocytic
Anemias
Pernicious anemia
Caused by a lack of intrinsic factor from the gastric
parietal cells
Required for vitamin B12 absorption
Results in vitamin B12 deficiency
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Normochromic-Macrocytic Anemias
Pernicious anemia
Typical anemia symptoms
Neurologic manifestations
• Nerve demyelination
Loss of appetite, abdominal pain, beefy red tongue
(atrophic glossitis), icterus, splenic enlargement
Treatment
• Parenteral or high oral doses of vitamin B12
Often unrecognized in older adults due to subtle, slow
onset and presentation
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Pernicious Anemia
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Normochromic-Macrocytic
Anemias
Folate deficiency anemia
Absorption of folate occurs in the upper small
intestine
Not dependent on any other facilitating factor
Similar to pernicious anemia except neurologic
manifestations generally not seen
Treatment requires daily oral administration of folate
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Hypochromic-Microcytic Anemias
Characterized by red cells that are
abnormally small and contain reduced
amounts of hemoglobin
Related to:
Disorders of iron metabolism
Disorders of porphyrin and heme synthesis
Disorders of globin synthesis
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Hypochromic-Microcytic Anemias
Iron deficiency anemia
Most common type of anemia worldwide
Nutritional iron deficiency
Metabolic or functional deficiency
Progression of iron deficiency causes:
• Brittle, thin, coarsely ridged, spoon-shaped nails
• A red, sore, painful tongue
Symptomtic Hgb 7-8 g/dl
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Hypochromic-Microcytic Anemias
Sideroblastic anemia
Group of disorders characterized by anemia
Altered mitochondrial metabolism causing
ineffective iron uptake and resulting in
dysfunctional hemoglobin synthesis
Ringed sideroblasts within the bone marrow are
diagnostic
• Sideroblasts are erythroblasts that contain iron granules
that have not been synthesized into hemoglobin
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Hypochromic-Microcytic Anemias
Sideroblastic anemia
Dimorphism
Myelodysplastic syndrome
Erythropoietic hemochromatosis
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Normochromic-Normocytic
Anemias
Characterized by red cells that are relatively
normal in size and hemoglobin content but
insufficient in number
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Normochromic-Normocytic
Anemias
Aplastic anemia
Pancytopenia
Pure red cell aplasia
Fanconi anemia
Posthemorrhagic anemia
Acute blood loss from the vascular space
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Normochromic-Normocytic
Anemias
Hemolytic anemia
Accelerated destruction of red blood cells
Autoimmune hemolytic anemias
Immunohemolytic anemia
Warm antibody immunohemolytic anemia
Drug-induced hemolytic anemia
Cold agglutinin immunohemolytic anemia
Cold hemolysin hemolytic anemia
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Drug-Induced Hemolytic Anemia
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Normochromic-Normocytic
Anemias
Sickle cell anemia
Anemia of chronic inflammation
Mild to moderate anemia seen in:
• AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis,
renal failure, and malignancies
Pathologic mechanisms
• Decreased erythrocyte life span
• Ineffective bone marrow response to erythropoietin
• Altered iron metabolism
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Anemia of Chronic Inflammation
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Myeloproliferative RBC Disorders
Polycythemia
Overproduction of RBCs
Relative polycythemia
Result of dehydration
Fluid loss results in relative increases of red cell
counts and Hb and Hct values
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Polycythemia
Absolute polycythemia
Primary absolute
• Abnormality of stem cells in the bone marrow
• Polycythemia vera (PV)
Secondary absolute
• Increase in erythropoietin as a normal response to
chronic hypoxia or an inappropriate response to
erythropoietin-secreting tumors
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