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THIEU MAU TR EM
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THIU MU, HUYT TN
2.PHN TCH XT NGHIM CTM &
PHT MU

C iM Hb &MCV TR EM

Definition anemia
Age/gender

Normal Hb range
(g/dl)

Anemic if Hb less than

(g/dl)

Birth (Full-term)

13.5 18.5

13.5

2-6 months

9.5-13.5

9.5

6 months - 6 years

11-14

11

6years-12years

11.5- 15.5

11.5

Adult female

12-15

12

Adult male

13- 17

13

Measuring Hb concentration & Hct

Hemoglobin concentration
Spectrophotometer or photoelectric photometer
Direct reading Hb
WHO Hb color scale
Copper sulphate method

WHO Hb color scale

Hct or packed cell volume
Centrifuging a small sample of blood in an
anticoagulated capillary tube and measuring the volume
of packed red cells as a percentage of the total volume.

Alterations of Hb in relation to plasma

Normal

Acute
Blood
loss

Chronic
blood
loss

Hb
dilution

Dehhydr
ate

RBC
volume

Plasma
volume

Hb level

Causes of anemia
1. Increased loss of RBC
1. Acute blood loss
2. Chronic blood loss ;GI, urinary ,reproductive tracts, parasitic infection, malignancy ,
inflammation, menorrhagia

2. Decreased production of RBC

1.
2.
3.
4.
5.
6.

Nutritional deficiencies: Iron, B12,folate,malnutrition

Viral infection: HIV
Bone marrow failure
Reduced erythropoietin production (chronic renal failure)
Chronic illness
Poisoning of bone marrow :lead poison

3. Increased destruction of RBC (hemolysis)

1.
2.
3.
4.
5.
6.

Infection: bacterial, viral, parasitic

Drugs
Autoimmune disorders
Inherited disorders: Thalassemia, G6PD deficiency
Hemolytic disease of the newborn
Other disorders: DIC, HUS, TTP

4. Increased physiological demand for RBC & iron

1. Pregnancy
2. Lactation

Anemia due to acute blood loss

1. Clinical condition of patient will depend on:
1. Patientssability to make compensatory responses
2. Degree of RC insufficiency
3. Whether it has occurred rapidly or gradually

2. Definition : (hemorrhage )there is both reduction in total amount of Hb in circmulation & loss of blood volume
3. Effects of blood loss
1. Reduced oxygen transport: hypovolemia reduced venous return CO oxygen supply to tissue: STAGNANT ANEMIA .
2. Reduced oxygen storage:loss of RBCHb in circulation :ANEMIA HYPOXIA. Hct in the early time may not be lower than normal because both RBC&
volume are lost.
3. Reduced oxygen transfer: CO partial pressure of oxygen in the pulmonary capillaries :HYPOXIC HYPOXIA

4. Compensatory responses to acute blood loss

1. Restoration of plasma volume: CO & Bd pressure hydrostatic pressure in capillary infux of water from interstitial fluid into plasma and water moves
from intracellular fluid to interstitial fluid.
2. Restoration of CO: CO baroreceptor (pressure receptors) activate the sympathetic nervous system in vasomotor center in the brain heart rate and
force of contraction CO.
3. Circulatory compensation:
1. sympathetic nerve vasocontriction of arterioles in tissues :gut, skin, muscle for preserving blood volume to essential organs and restoring the arterial blood pressure.
2. Contriction of veins ,venocontriction increased venous return CO.

4. Stimulation of ventilation: reduced blood flow metabolic acidosis, lowered partial pressure of oxygen in blood chemoreceptors in aorta ,carotid arteries
stimulate the respiratory center in brain respiratory rate.
5. Changes in the oxygen dissociation curve: hemorrhages acidosis the curve move to the right increased oxygen to tissue.
6. Hormonal changes :
1.
2.
3.
4.

blood volume ADH :reduced the water excreted by kidneys; increased vasocontriction blood pressure.
Renin angiotensin triggerted Aldosterol : causes retention of sodium restore the volume of extracellular
Erythropoeitein (hypoxia ) RBC in bone marrow (several days)
Others : adrenal steroids, catecholamine

7. Synthesis of plasma proteins : loss of protein and plateletes pre-formed albumin into circulation during acute blood loss.

5. Clinical features of acute blood loss: there variation in patients capacity to compensate for a given blood loss .The picture may therefore
vary
1. Minimal signs of hypovolemia (increased heart rate)
2. Hemorrhagic shock: thirst, cool pale skin, tachycardia, decreased pulse pressure, reduced blood pressure, increased respiratory rate, restlessness or confusion,
reduced urine out put.

Anemia due to chronic blood loss

1. Effects of chronic blood loss:
1. RBC contain less Hb ,the oxygen carrying-capacity of blood is reduced.

2. Compensatory responses to chronic blood loss

1. Cardiovascular compensation
oxygen to tissue vasodilation tissue blood flow venous return CO severe
anemia heart failure.

2. Changes in the oxygen dissociation curve:

1. 2,3 diphosphoglycerate change the oxygen dissociation curve to the right release oxy to
tissue.

3. Changes in blood viscosity:

red blood cell mass reduce viscosity of blood.

4. Hormonal responses
1. Blood volume is maintained by vasopressin, aldosterone.
2. RBC is procured by erythropoietin

3. Clinical features of chronic blood loss

1. Clinical symptoms & signs appear when there is a relative low Hb concentration .
2. Clinical features become apparent at an early stage when:
1. Limited capacity mount a compensatory response: respiratory.
2. Increase in demand for oxygen :infection, pain, fever, exercise .
3. Further reduction in oxygen supply: blood loss, pneumonia.

Chronic anemia due to other causes

Decreased production RBC
Increased destruction RBC
Others:
Nutritional deficiencies
Infection
Malignancy
Autoimmune dis
Inherited dis
Aplastic anemia

C iM THIU MU MN
Normal oxygen supply

Effect of chronic anemia

on oxygen supply
Restoration of oxygen
supply in chronic
anemic by increase
cardiac output

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