Anemia due to hemorrhage

Anemia due to hemorrhage

Updated: 7/16/2024

© Jun Wang, MD, PhD

 

General features

Acute hemorrhage

  • Usually normocytic normochromic anemia unless iron reserve depleted or other disorders
  • Initially proportional loss of plasma and red cell mass: little to no change in hemoglobin or hematocrit
  • Presentations associated with volume loss
  • Plasma loss replaced by interstitial fluid rapidly
  • Slower replacement of cellular components leads to lower HGB, HCT, and RBC
  • Reticulocytosis 3-5 days post hemorrhage if adequate iron stores
  • Slightly elevated MCV due to reticulocytosis
  • Microcytic hypochromic anemia after iron reserve depleted, usually after 120 days

Chronic hemorrhage

  • Usually well compensated by increased erythropoiesis
  • Anemia occurs when

o   Rate of loss > rate of regenerative capacity of the marrow

o   Iron reserves depleted

o   Normocytic normochromic anemia unless iron depletion or other underlying disorders

o   Microcytic hypochromic anemia when iron reserves depleted

 

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