EMS Pathophysiology - Anemia

Anemia is a condition marked by a reduction in the number of red blood cells (RBCs) or hemoglobin, impairing the blood’s ability to carry oxygen.

Recognizing and understanding the different types of anemia is crucial for EMS Providers, as this knowledge can guide appropriate prehospital care and improve patient outcomes.

Key Types of Anemia

* Iron Deficiency Anemia

• Cause: Inadequate iron intake or absorption, blood loss.

• Characteristics: Microcytic (small) and hypochromic (pale) RBCs.

• Symptoms: Fatigue, weakness, pallor, shortness of breath

• EMS Considerations: Assess for sources of bleeding (e.g., gastrointestinal), monitor vitals, consider oxygen therapy if indicated.

* Vitamin B12/Folate Deficiency Anemia

• Cause: Insufficient dietary intake or absorption of Vitamin B12 or folate.

• Characteristics: Macrocytic (large) and normochromic (normally colored) RBCs.

• Symptoms: Fatigue, glossitis (inflamed tongue), neurological symptoms (e.g., numbness, tingling).

• EMS Considerations: Assess neurological status, provide supportive care, monitor for signs of severe anemia.

* Hemolytic Anemia

• Cause: Increased RBC destruction due to autoimmune disorders, infections, or genetic conditions like sickle cell disease.

• Characteristics: Increased reticulocyte count (immature RBCs), jaundice.

• Symptoms: Fatigue, jaundice, dark urine, pain (especially in sickle cell crises).

• EMS Considerations: Pain management (especially for sickle cell crises), hydration, oxygen therapy, rapid transport for severe cases.

* Aplastic Anemia

• Cause: Bone marrow failure leading to decreased production of RBCs, white blood cells (WBCs), and platelets.

• Characteristics: Pancytopenia (reduced levels of all blood cells).

• Symptoms: Fatigue, frequent infections, easy bruising, bleeding.

• EMS Considerations: Monitor for signs of infection or bleeding, avoid invasive procedures when possible, supportive care, rapid transport.

* Anemia of Chronic Disease

• Cause: Chronic infections, inflammatory diseases, malignancies.

• Characteristics: Normocytic (normal size) and normochromic (normal color) RBCs, often with low iron availability.

• Symptoms: Fatigue, weakness, symptoms related to the underlying chronic condition.

• EMS Considerations: Assess and manage symptoms of the underlying condition, provide supportive care, monitor vitals.

General EMS Management of Anemia

• Assessment: Conduct a thorough history and physical examination. Look for signs of pallor, jaundice, tachycardia, hypotension, and other symptoms indicative of anemia.

• Oxygen Therapy: Administer oxygen as needed to improve tissue oxygenation. IV Access and Fluids: Establish IV access for potential fluid resuscitation, especially in cases of acute blood loss.

• Monitor Vitals: Continuously monitor vital signs to detect any signs of deterioration.

• Pain Management: Provide appropriate pain relief, particularly for patients with conditions like sickle cell disease.

• Transport: Ensure rapid and safe transport to the appropriate medical facility for further evaluation and treatment.

Understanding the types and causes of anemia can help EMS Providers deliver better care and make informed decisions in the prehospital setting, ultimately improving patient outcomes.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell