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ANEMIA RESOURCE CENTER
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Anemia is defined as an absolute reduction in the quantity of the oxygen-carrying pigment hemoglobin (Hgb) in the circulating blood. Anemia is further broadly subcategorized into acute and chronic. Viewing anemia as a symptom of a disease manifested by low Hgb rather than as an isolated diagnosis is often helpful. It is usually grouped into 3 etiologic categories: decreased red blood cell (RBC) production, increased RBC destruction, and blood loss. |
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Anemia, like a fever, is a symptom of disease that requires investigation to determine the underlying etiology. Often, practicing physicians overlook mild anemia. Anemia is strictly defined as a decrease in red blood cell (RBC) mass. Methods for measuring RBC mass are time consuming, are expensive, and usually require transfusion of radiolabeled erythrocytes. Thus, in practice, anemia is usually discovered and quantified by measurement of the RBC count, hemoglobin (Hb) concentration, and hematocrit (Hct). These values should be interpreted cautiously because they are concentrations affected by changes in plasma volume. For example, dehydration elevates these values, and increased plasma volume in pregnancy can diminish them without affecting the RBC mass.
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Anemia is characterized by a reduction in the number of circulating red blood cells (RBCs), the amount of hemoglobin, or the volume of packed red blood cells (hematocrit). Anemia is classified as acute or chronic. Acute anemia denotes a precipitous drop in the RBC population due to hemolysis or acute hemorrhage. In the emergency department (ED), acute hemorrhage is by far the most common etiology. This chapter also discusses other causes of acute anemia.
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Chronic anemia has no precise definition. Anemia that persists for 6 months or more (eg, hereditary spherocytosis [HS]) is clearly chronic; however, an anemia that lasts only 2 months (eg, iron deficiency that is being treated) also should be considered chronic anemia, and other explanations must be sought.
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Sickle cell anemia is a common reason patients of African descent seek emergency medical care. Although knowledge of the pathophysiological basis for sickle cell anemia has led to advances in its treatment, emergency physicians remain challenged by its varied clinical presentations, including vasoocclusive, hematologic, and infectious crises.
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Iron deficiency is defined as a decreased total iron body content. Iron deficiency anemia occurs when iron deficiency is sufficiently severe to diminish erythropoiesis and cause the development of anemia. Iron deficiency is the most prevalent single deficiency state on a worldwide basis. It is important economically because it diminishes the capability of individuals who are affected to perform physical labor, and it diminishes both growth and learning in children.
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Aessopos A, Deftereos S, Farmakis D, Corovesis C, Tassiopoulos S, Tsironi M, Georgonikou D, Moyssakis J. Cardiovascular adaptation to chronic anemia in the elderly: an echocardiographic study. Clin Invest Med. 2004 Oct;27(5):265-73. |
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El Guindi W, Pronost J, Carles G, Largeaud M, El Gareh N, Montoya Y, Arbeille P.
Severe maternal anemia and pregnancy outcome. J Gynecol Obstet Biol Reprod. 2004 Oct;33(6 Pt 1):506-9. |
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Pockros PJ, Shiffman ML, Schiff ER, Sulkowski MS, Younossi Z, Dieterich DT, Wright TL, Mody SH, Tang KL, Goon BL, Bowers PJ, Leitz G, Afdhal NH. Epoetin alfa improves quality of life in anemic HCV-infected patients receiving combination therapy.
Hepatology. 2004 Nov 24;40(6):1450-1458. |
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Arndt U, Kaltwasser JP, Gottschalk R, Hoelzer D, Moller B. Correction of iron-deficient erythropoiesis in the treatment of anemia of chronic disease with recombinant human erythropoietin. Ann Hematol. 2004 Nov 24. |
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Shah A. Hemoglobinopathies and other congenital hemolytic anemia.
Indian J Med Sci. 2004 Nov;58(11):490-3. |
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