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 

EMS Particular Patient Presentations - Crohn's Disease

EMS Providers should have an understanding of Crohn's Disease and its potential implications for prehospital care. 

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, from the mouth to the anus. It is characterized by inflammation, ulceration, and thickening of the intestinal wall, leading to a variety of symptoms and complications.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Crohn's disease, which may include:

Abdominal Pain: Patients with Crohn's disease often experience abdominal pain, cramping, and discomfort, which may be intermittent or persistent and can vary in severity.

Diarrhea: Chronic diarrhea is a common symptom of Crohn's disease, which may be accompanied by urgency, frequency, and passage of bloody or mucus-containing stools.

Weight Loss: Patients with Crohn's disease may experience weight loss due to malabsorption of nutrients, reduced appetite, or increased metabolic demands associated with chronic inflammation.

Fatigue: Chronic inflammation and malnutrition associated with Crohn's disease can lead to fatigue, weakness, and decreased energy levels.

Extraintestinal Manifestations: Crohn's disease can affect other organs and systems outside the gastrointestinal tract, leading to extraintestinal manifestations such as arthritis, skin rashes, eye inflammation, and liver involvement.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Dehydration & Electrolyte Imbalances: Chronic diarrhea and fluid loss can lead to dehydration, electrolyte imbalances, and metabolic disturbances. EMS providers should be prepared to assess and manage dehydration, including fluid resuscitation and electrolyte replacement as needed.

Pain Management: Abdominal pain and discomfort associated with Crohn's disease can be severe and debilitating. EMS providers should be equipped to provide appropriate pain management interventions, such as analgesics or non-pharmacological techniques, to alleviate patient discomfort.

Inflammatory Flare-Ups: Patients with Crohn's disease may experience periods of disease exacerbation or flare-ups characterized by worsening symptoms and complications. EMS providers should be prepared to assess and manage acute exacerbations of Crohn's disease, including supportive care and prompt transport to a medical facility for further evaluation and treatment.

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The discovery of Crohn's disease is credited to Dr. Burrill B. Crohn, an American gastroenterologist, along with his colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer. 

In 1932, they published a landmark paper titled "Regional Ileitis: A Pathologic and Clinical Entity" in the Journal of the American Medical Association, describing a distinct inflammatory bowel disorder affecting the terminal ileum and other parts of the gastrointestinal tract. 

This condition, later named Crohn's disease in honor of Dr. Crohn, represented a significant contribution to the understanding of inflammatory bowel diseases and revolutionized their diagnosis and management.

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 Volume 1 (6th Ed) Pearson.  

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