F
Conditions associated with a significant disproportion between the hematocrit and RBC?

Spurious anemia (假性贫血) - relative increase in plasma volume hydremia of pregnancy overhydration in oliguric renal failure or congestive heart failure chronic diseases and hypoalbuminemia congestive splenomegaly recumbency (斜卧)
Anemia - General aspects
Department of Hematology Rui Jin Hospital
Anemia
Biblioteka Most important Related to many diseases Diagnosed properly Treated properly
• Deficiency state (iron, vitamin B12, folate) • Anemia of chronic disease (inflammation, infection, or malignancy) • Sideroblastic anemia • Primary marrow disorders-pure red cell aplasia, myelodysplasia, myelofibrosis, leukemia • metastasis to bone marrow, osteogenic sarcoma
Normal range - adult
Hemotocrit RBC （g/L） HGB （×1012／L） M
4.0-5.5 120-160 0.4-0.5 (400-550万／ (12-16g/dl) (40-50％) 3 mm ) 3.5-5.0 110-150 0.37-0.45 (350-500万／ (11-15g/dl) (37-45％) 3 mm )
Pronormoblast
Normoblasts
Regulation of erythropoiesis

How many are produced?
25 billion /24 hours The entering cells are reticulocytes which should be 1% of the total population of circulating erythrocytes Erythrocytes last 120 days and are destroyed by the spleen Red cell production should equal red cell destruction
What is anemia?


A reduction below normal in the - concentration of hemoglobin - red blood cells in the blood - hematocrit （红细胞比容） The blood hemoglobin concentration often preferred - accuracy and reproducibility - value most indicative of the pathophysiologic consequences of anemia
贫血的病理生理 (pathophysiology of anemia)

Disseminated Intravascular Coagulation Lead poisoning
Conditions Associated with Anemias Due to Reduced Erythrocyte Production
Anemias due to decreased erythropoietin production

Anemia: Etiologies

Production defects
Blood loss Blood destruction


RBC loss without RBC Destruction




Hemorrhage - Due to trauma - Due to disorders: e.g. cancer, ulcers, tuberculosis, and irritable bowel syndrome (including ulcerative colitis and Crohn’s disease) Menstrual flow Gynecological disorders (e.g. endometriosis) Pregnancy, especially at gestation Parasitism - Hookworms
RBC Destruction
Intrinsic Abnormalities


Thalassemia G6PD Sickle Cell Anemia Hereditary Spherocytosis
Extrinsic Abnormalities

Infections

Malaria (Plasmodiumm species) Mycoplasma (支原体）
• Renal disease • Endocrine deficiency (pituitary, adrenal, thyroid, testis) • Starvation • Hemoglobinopathy (reduced oxygen affinity)
Anemias due to inadequate marrow response to erythropoietin