Hematological changes

Normocytic anemia is always present, and hematocrit is around 30 to 35 per cent (B.ürgi.and..König 1988). Decreased erythropoietin secretion and erythrocyte production lead to low erythrocyte mass which is sometimes associated with relatively preserved hematocrit because of concomitant hypovolemia. If anemia is of the macrocytic type, pernicious anemia must be suspected (M.§lio.tiLeia/ 1995). If anemia is severe (hematocrit < 30 per cent), additional factors should be looked for such as blood loss by gastrointestinal bleeding, folic acid deficiency, and iron deficiency ( M§[!9itL.§L§.( 1995).

Thyroid hormone therapy increases volemia before erythrocyte production. Therefore hematocrit falls by 5 to 6 per cent during the first days of treatment because of 'dilution anemia' (B.y[g.i and...Kö.Di.g 1988).

The total leukocyte count decreases during hypothyroidism and rarely exceeds 10 000 even if infection is the precipitating event. If band cells are present, suspicion of sepsis is high (Nlcolo^. LoPresti,...1993).

Blood coagulation is often altered in hypothyroidism. Fibrinolytic activity is increased, with high plasminogen and reduced activation of the plasminogen inhibitor

(Bürgiand König.1988). These abnormalities may play a dramatic role in hemorrhages associated with severe hypothyroidism. Acquired von Willebrand's coagulopathy via non-specific action of thyroid hormones on protein synthesis has been described, but it is reversible after -thyroxine treatment (Tachman and Guthrie ...1984).

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