1. Red blood Cell Changes and Circulatory problems
Hematology-Oncology Course

2. Erythrocytes - Characteristics
Red cells
% of blood volume, 5 x 106 cells /mL
“bag” of hemoglobin: non-nucleated, no proliferation, cell membrane in excess so that deformation does not rupture
Shape
Biconcave disc, 8 mm in diameter, 2.7 mm thick, volume ~ 90 mm3, area ~ 160 mm2
Men - ery 5,0  0,8 x 1012/l, Hb g/l, hematocrit 0,45  0,06.
Women - ery 4,4  0,8 x 1012/l, Hb g/l, hematocrit 0,40  0,06.
MCV fl, MCH pg, Reticulocytes 0,5-2%.

3. RBC MORPHOLOGY ON A PERIPHERAL SMEAR

4. DEFINITION OF ANEMIA
Anemia is usually associated with decreased levels of hemoglobin and/or a decreased RBC count, and/or a decreased packed cell volume (hematocrit).
Anemia is a functional inability of the blood to supply the tissue with adequate O2 for proper metabolic function.
Occasionally there is an abnormal hemoglobin with an increased O2 affinity resulting in an anemia with normal or raised hemoglobin levels, hematocrit, or RBC count.
In summary, anemia may develop:
When RBC loss or destruction exceeds the maximal capacity of bone marrow RBC production or
When bone marrow production is impaired
Various diseases and disorders are associated with decreased hemoglobin levels.

5. Symptoms and Signs of Anemia
Decreased oxygenation
Exertional dyspnea, Dyspnea at rest
Fatigue, Lethargy, confusion
Bounding pulses
Trophic changes
Decreased volume
Fatigue
Muscle cramps
Postural dizziness
Syncope

6. COMPENSATORY MECHANISMS
Cardiovascular
Respiratory
Tissue Adjustation
CNS

8. CLASSIFICATION OF ANEMIAS
Anemias may be classified morphologically based on the average size of the cells and the hemoglobin concentration into:
Macrocytic
Normochromic, normocytic
Hypochromic, microcytic
Anemias may also be classified functionally into:
Hypoproliferative (when there is a proliferation defect)
Ineffective (when there is a maturation defect)
Hemolytic (when there is a survival defect)
Anemias may also be classified due to life span into:
Decreased production
Increase loss - hemolytic
Chronic posthemorrhagic
Acute posthemorrhagic - mostly loss of volume
Anemias may also be classified biochemically due to:
Genetic, enzyme, AA, protein defects

9. Anemia in General General Effects of Anemia  O2 carrying capacity
Tissue hypoxia
Compensatory mechanisms to restore tissue oxygenation
Compensation for Anemia
General Compensatory Mechanisms to Anemia
 Pulmonary and Cardiac function  O2 supply
 O2 Extraction at the tissue level
Specific Compensatory Mechanisms to  Oxygenated Blood Flow
 in Heart rate (HR)
 Cardiac output (CO)
 Circulatory rate
Preferential  in blood flow to vital organs
Specific Compensatory Mechanisms to  O2 Utilization by Tissues
 in 2,3-DPG in erythrocytes
Enhances O2 release at the cell
 O2 Affinity in the cells
Extent of Compensation Determined by:
Severity of the anemia
Competency of cardiovascular-pulmonary systems
O2 Requirements of the individual
Duration of the anemia
Underlying disease process
Presence or absence of co-existing disease

10. Polycythemia
Increased number of RBCs causing increased blood volume & viscosity
Relative causes
normal amount of RBCs but decrease in plasma volume, seen in: dehydration, increased fluid losses (diuretics, vomiting, burns, fever) decreased fluid intake, crushing injuries, stress
Absolute cause
increased number of RBCs
Primary (polycythemia vera)
Secondary polycythemia