CC CJM | Blood Disorders

Clinician’s 80/20 Hematologic & Anemia Summary

Core Clinical Concepts Blood disorders disrupt homeostasis. Key pathological threads include:

• Fatigue: Secondary to tissue hypoxia (anemia, cancer).
• Infection Risk: Compromised immunity and risk for infection is a major concern in hematologic cancers and a common side effect of therapy.
• Pain: Common and classic in sickle cell disease (SCD) and oncology.
• Perfusion & Clotting: Excessive clotting impairs perfusion; inadequate clotting causes blood loss and fluid volume deficit[1].

Anemia: Definition & Pathophysiology Anemia is not a disease but a manifestation of an underlying pathologic process[2]. It is defined as a deficit in red blood cell (RBC) count, hemoglobin (Hgb) quantity/quality, and/or volume of packed red blood cells (hematocrit)[2]. Tissue hypoxia drives all clinical findings[3]. The body compensates via cardiopulmonary escalation, increasing heart rate (HR) and stroke volume to maintain cardiac output (CO)[4]. Low blood viscosity contributes to systolic murmurs and bruits[4]. If O2 demand exceeds supply, angina or MI occurs[4]. Chronic overwork leads to heart failure (HF), cardiomegaly, congestion, and peripheral edema[4].

Diagnostics & Classification Diagnostics rely on CBC, reticulocyte count, and peripheral smear[2]. Anemia is classified by:

1. Morphology (RBC size/color): Most accurate framework[5].

• Normocytic, Normochromic (MCV 80–95 fL, MCH 27–31 pg): Caused by acute blood loss, hemolysis, CKD, cancers, or SCD[6].
• Microcytic, Hypochromic (MCV <80 fL, MCH <27 pg): Caused by iron deficiency, thalassemia, lead poisoning, B6/copper deficiency[6].
• Macrocytic, Normochromic (MCV >95 fL, MCH >31 pg): Caused by B12 (cobalamin) deficiency, folic acid deficiency, or liver disease[6].

1. Etiology (Cause): Best for structuring care[5]. Divided into decreased RBC production, blood loss, or increased RBC destruction (hereditary like SCD/G6PD vs. acquired like DIC, HELLP, prosthetic valves, or bypass)[7].

Severity & Clinical Manifestations Symptoms depend on onset speed, severity, and Hgb level[3]:

• Mild (Hgb 10–12 g/dL): Often asymptomatic. Heavy exercise triggers compensatory palpitations, mild fatigue, and dyspnea[3].
• Moderate (Hgb 6–10 g/dL): Cardiopulmonary symptoms (dyspnea, palpitations) occur both during activity and at rest[11].
• Severe (Hgb <6 g/dL): Multi-system decompensation occurs[11].
  • Integumentary: Pallor (shunted blood flow), jaundice (bilirubin from RBC hemolysis), and severe itching (accumulation of skin bile)[11].
  • Cardiopulmonary: Marked tachycardia, angina, murmurs, and congestive failure[4].