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Thread: Anemia

  1. #1
    PharmD Year 1 TomHsiung's Avatar
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    Default Anemia

    Anemia refers to an abnormally low number of circulating red cells, caused by blood loss, hemolysis, or underproduction of cells by the bone marrow. In patients with acute blood loss, the abnormal vital signs of hypovolemia are the most prominent physical findings, but in chronic anemia, physical findings instead reflect changes in the color of the skin and conjunctiva.

    Chronic anemia causes the skin and conjunctiva to appear abnormally pale because of reduced amounts of red-colored oxyhemoglobin circulating in the dermal and subconjunctival capillaries and venues. Nonetheless, pallor does not always indicate anemia, because skin color also depends on the diameter of these minute vessels, the amount of circulating deoxyhemoglobin, and the patient's natural skin pigments.

    Most clinicians assess for pallor subjectively, by comparing the patient's skin color with their own color or their recollection of normal skin color. One definition of pallor, however, is more objective: conjunctival rim pallor is present if examination of the inferior conjunctiva reveals the color of the anterior rim to have the same pale fleshy color of the deeper posterior aspect of the palpebral conjunctiva. In persons without anemia, the normal bright red color of the anterior rim contrasts markedly with the fleshy color of the posterior portion.

    EBM BOX
    Anemia-screen-shot-2017-03-07-at-10-33-51-pm-png
    Last edited by TomHsiung; Tue 7th March '17 at 9:35pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  2. #2
    PharmD Year 1 TomHsiung's Avatar
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    Default Re: Anemia

    Pivotal points
    • General mechanism of the anemia (acute blood loss, underproduction, hemolysis)
      • First, always assessing for signs and symptoms of acute blood loss (signs: hypotension, tachycardia, large ecchymoses; symptoms: hematemesis, melena, rectal bleeding, hematuria, vaginal bleeding, hemoptysis)
      • Second, distinguishing underproduction from hemolysis by RPI

    • Relatively acute drop in HCT
    • Determine the cause of underproduction or hemolysis


    Frame of underproduction anemia (traditionally by MCV)


    • Microcytic anemias (MCV <80 mcm3)
      • Iron deficiency
      • Thalassemia
      • Anemia of inflammation/chronic disease
      • Sideroblastic anemia, rare
      • Copper deficiency or zinc poisoning, rare

    • Macrocytic anemia (MCV >100)
      • Megaloblastic anemias
        • Vitamin B12 deficiency
        • Folate deficiency
        • Antimetabolite drugs

      • Nonmegaloblastic anemias
        • Alcohol abuse
        • Liver disease
        • Hypothyroidism
        • Myelodysplastic syndrome

    • Normocytic anemias
      • Anemia of inflammation/chronic disease
      • Early iron deficiency
      • Bone marrow suppression
        • Invasion by malignancy or granulomas
        • Acquired pure red cell aplasia
        • Aplastic anemia

      • Endocrine


    Frame of hemolysis (pathophysiologic)

    • Hereditary
      • Enzyme defects, such as pyruvate kinase or glucose-6-phosphate dehydrogenase (G6PD) deficiency
      • Hemoglobinopathies
      • RBC membrane abnormalities

    • Acquired
      • Hypersplenism
      • Immune
        • Autoimmune
        • Drug induced

      • Mechanical
        • Macroangiopathic
        • Microangiopathic

      • Infections
      • Toxins
    Last edited by TomHsiung; Tue 4th April '17 at 1:56pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  3. #3
    PharmD Candidate
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    Default Re: Anemia

    Such kind of prominent health diseases just need proper diet, sometimes hygienic living conditions and also regular visits to doctors. I think taking an affordable package from private health services for full body check of all our family members is a great idea. Our reports would ensure us of our perfect health.

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