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anemia

By Earl Harrison,2014-11-02 12:47
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anemia

Anemia [Robbins 623];lowered oxygen content of the circulating blood

    1. Deficiency of red blood cells (normal: female-12.0-15.0g/dL;male-13.6-17.2g/dL) 2. Measurement: hematocrit, hemoglobin, RBC count

    3. Location of hematopoiesis from fetus till adult: yolk sac;liver;bone marrow[621]

    4. Until 18 years old, we left sternum, vertebrae, skull, pelvis retained as red marrow which

    means still able to perform hematopoiesis. Other sites has transform into yellow marrow

    which are lipid that not function in hematopoiesis. However, when there is increase

    demand of blood cells, yellow marrow might reverse to red marrow. Anemia only occurs

    after this compensatory mechanisms are outstripped, leading to extramedullary

    hematopoiesis(liver, spleen, lymph node).

    5. Dysfunction of bone marrow;stem cells dysfunction

    6. Bone marrow: provides unique environment for orderly proliferation, differentiation and

    release of blood cells, hematopoietic cells and fat cells differentiated into blood cells and

    enter sinusoids through endothelial cells. Distortion of bone marrow architecture will

    disturb normal function and cause abnormal release of precursor cells into peripheral

    blood(PB) stream;blast cells in PB.

    7. Acute blood loss

    - Decrease intravascular volume;cardiovascular collapse, shock, death;blood volume

    rapidly restored by shift of water from interstitial fluid compartment;dilution of

    hematocrit;production of erythropoietin in renal juxtaglomerular

    cells;proliferation of CFU-E in marrow

    - If blood loss internally, iron can be hemoglobin is recaptured by liver and spleen. If

    loss blood externally, iron loss, might cause iron deficiency.

    - Leukocytosis- migration of granulocyte from marginal pool

    - Thrombocytosis- increase platelet production

    8. Chronic blood loss

    - Rate of lost > regenerative capacity of marrow/iron reserved depleted

Bleeding disorder

    - Increase fragility of blood vessel, platelet deficiency/dysfunction, derangement of

    coagulation

    - Prothrombin time (PT) is to test the extrinsic and common coagulation pathways.

    (prolonged PT can be due to deficiency and dysfunction of factor V, VII, X,

    prothrombin and fibrinogen)

    - Partial Thromboplastin Time(PTT) is to test intrinsic and common coagulation

    pathways. (prolonged PTT can be due to deficiency or dysfunction of factor V, VIII, IX,

    X, XI, XII, prothrombin, fibrinogen)

- If decrease platelet, normal PT and normal PTT with prolonged bleeding time;

thrombocytopenia

- If platelet, bleeding time, PT and PTT all normal; vascular abnormalities

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