빈혈은 주로 적혈구 생산의 감소에 기인한다; 적혈구 생존의 단축에 의해 악화될 수 있다. 급성 및 만성 감염, 자가면역 장애, 만성 질환, 악성, 주요 외상, 수술 또는 중증 질환 이후 및 노년층에서 흔히 볼 수 있습니다.
만성 질환의 빈혈은 만성 염증성 질환, 대부분 만성 감염, 자가면역 질환(특히 류머티스 관절염), 신장 질환 또는 암의 일부로 발생하지만, 동일한 과정이 외상이나 후유증을 포함한 거의 모든 감염 또는 염증 중에 급성적으로 시작되는 것으로 보인다.
증상
피곤하거나 기운이 없음
창백한 피부
숨이 가쁨
땀
어지럽거나 현기증이 남
심장 박동이 빠름
두통이 있음
치료
통증을 줄이고 합병증을 예방하기 위한 산소, 진통제, 경구 및 정맥주사액 등이 치료에 포함될 수 있습니다.
의사들은 수혈, 엽산 보충제, 항생제 등을 추천할 수도 있습니다.
히드록시레아라고[hydroxyurea (Droxia, Hydrea, Siklos)] 불리는 암약 또한 겸상세포 빈혈을 치료하는데 사용됩니다.
이 질병에 잘 걸릴 위험요소
빈혈을 유발할 수 있는 가장 일반적인 질병은 다음과 같습니다.
암
만성 신장병
자가면역질환
류마티스 관절염, 관절의 만성 염증
이식된 장기에 대한 만성 거부반응
심부전
비만
문제
A 40-year-old woman presents to the physician with complaints of frequent headaches and fatigue that have lasted for a month. Her headaches are mild and occur randomly, and are relieved by over-the-counter analgesics. Furthermore, she frequently feels tired and occasionally feels short of breath with exertion. She denies low mood, loss of interest, inability to concentrate, sleep disturbance, or suicidal ideation. She was diagnosed with Crohn's disease 20 years ago for which she currently takes methotrexate. Additionally, she takes a folic acid-containing multivitamin daily. Her medical history is otherwise non-significant, and she does not smoke, drink, or use recreational drugs. She has a pulse rate of 110/min, respiratory rate of 20/min, and temperature of 37.0°C (98.6°F). Physical examination reveals pallor in her palms and lower palpebral conjunctiva. Which of the following arterial blood findings for the partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and oxygen concentration (CaO2) are expected in this patient?
A. Normal PaO2, normal SaO2, normal CaO2 B. Low PaO2, low SaO2, low CaO2 C. Low PaO2, normal SaO2, normal CaO2 D. Normal PaO2, normal SaO2, low CaO2 E. High PaO2, normal SaO2, normal CaO2
Explanation: Correct answer D: Arterial blood contains oxygen either reversibly bound to hemoglobin (oxyhemoglobin, about 98% of blood oxygen) or dissolved in plasma (about 2% of total blood oxygen). Since oxygen is poorly soluble in plasma, only a small portion of the total oxygen concentration is dissolved in plasma and the partial pressure of oxygen (PaO2) reflects this dissolved oxygen concentration. The oxygen saturation (SaO2) shows the percentage of hemoglobin that is saturated with oxygen, and it reflects the binding of oxygen to hemoglobin. The total concentration of oxygen in the blood (CaO2) is determined by the total number of oxygen molecules in the blood, whether freely dissolved or bound to hemoglobin. This patient most likely has anemia of chronic disease due to her long history of Crohn's disease. Methotrexate can also lead to anemia due to folic acid deficiency, but this patient is taking a supplement to enhance her folate levels. Headache, fatigue, shortness of breath, tachycardia, and pallor are all signs and symptoms of anemia. Decreased blood hemoglobin concentrations are responsible for the reduced CaO2. PaO2 and SaO2 are normal, as there is no shortage of available oxygen, which binds free hemoglobin and dissolves in the plasma. Option A: These parameters are normal and represent normal arterial oxygenation in healthy individuals. Option B: Low values of all 3 oxygenation parameters indicate acute hypoxia. Decreased availability of oxygen, either due to mechanical obstruction or decreased atmospheric oxygen, results in decreased oxygen concentration in the blood. Option C: A low PaO2 with normal SaO2 and CaO2 is typically seen at high altitudes. The low PaO2 is due to a decreased atmospheric pressure of oxygen, which is reflected in the arterial blood. Option E: A high PaO2 with normal SaO2 and CaO2 can be seen with hyperbaric oxygen administration. The PaO2 is reflective of the oxygen pressure in the alveoli. Learning objective: Three parameters can be used to assess arterial blood oxygenation: partial pressure of oxygen (indicates freely dissolved oxygen in plasma), oxygen saturation (indicates hemoglobin saturation with oxygen), and oxygen concentration (indicates the total amount of oxygen present in the blood). In anemia, the total oxygen concentration is reduced, but the partial pressure and saturation of oxygen remain normal.
Related Videos: Anemia of Chronic Disease: Pathogenesis02:59 min 0% Complete
Book References: First Aid for the USMLE Step 1 (2021, 31st ed): 690 First Aid for the USMLE Step 1 (2020, 30th ed): 421, 666 First Aid for the USMLE Step 1 (2019, 29th ed): 413, 653 First Aid for the USMLE Step 1 (2018, 28th ed): 409, 649 First Aid for the USMLE Step 1 (2017, 27th ed): 399, 632
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