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Diseases of Red Cells - Robbins, Chapter 14


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Define Anemia.
Anemia is a reduction in the oxygen transport capacity of blood, usually as a result of a reduction below normal limits of the total circulating red cell mass.
Name two things that are increased in MOST anemias.
1. Erythropoietin Production
2. Erythropoiesis
In most anemias, erythropoietin production and erythropoiesis are increased. This causes ___ ___ ___.
erythroid marrow hyperplasia
What is extramedullary hematopoiesis?
Extramedullary (outside the marrow) hematopoiesis may occur in organs such as the spleen and liver in severe anemias or when there is intrinsic disease in the marrow (e.g., myelofibrosis).
What is erythropoiesis?
The production of RBCs in the bone marrow.
List the 3 primary causes of the anemias.
1. Blood Loss

2. Increased Rate of RBC destruction. (Hemolytic Anemias
3. Impaired Red Cell Production.
What are the three features which characterize the Hemolytic Anemias?
1. Premature destruction of Red Cells.
2. Accumulation of the products of hemoglobin catabolism (e.g., bilirubin).
3. Marked increase in erythropoiesis within the marrow and associated reticulocytosis.
With hemolytic anemia, the hemolysis may occur ___ or ___.
intravascularly , extravascularly
Intravascular hemolysis occurs when red cells are damaged by ___ or ___.
mechanical injury (e.g., microangiopathic hemolytic anemia)

complement-mediated lysis (e.g., antibody-coated mismatched blood transfusion)
Intravascular hemolysis can be identified by 4 manifestations.
What are they?
1. Hemoglobinemia and Hemoglobinuria
2. Hemosiderinuria
3. Jaundice (conjugated hyperbilirubinemia)
4. Reduction in serum haptoglobin (a protein that binds free hemoglobin).
The manifestations of extravascular hemolysis are similar to those of intravascular hemolysis except for the absence of ___ and ___.
hemoglobinemia , hemoglobinuria
What are the three predisposing factors leading to extravascular hemolysis?
1. Injury to the red cell membrane.
2. Reduced deformability.
3. Opsonization.
Explain the major difference in the anemias caused by Acute Blood Loss, vs. those caused by Chronic Blood Loss.
Acute Blood Loss- alterations reflect principally the loss of blood volume. After several days, the marrow compensates by an increase in reticulocytes.

Chronic Blood Loss- anemia usually results when iron reserves are depleted, giving rise to iron deficiency anemia. The marrow is active (erythropoiesis) as iron BECOMES AVAILABLE.
A practical working definition of anemia (BRS, Ch. 11) is a decrease in ___ count, ___, or ___.
RBC, hemoglobin, hematocrit
Extravascular Hemolysis occurs within the mononuclear phagocytic cells of the ___ and other organs.

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