Physiological compensatory mechanisms for anemia

In the presence of anemia, cardiac output increases to maintain oxygen delivery. This occurs whether the anemia arises from acute blood loss or is of gradual onset. Less immediately, the red cell content of 2,3-diphosphoglycerate rises, shifting the oxygen dissociation curve to the right so that, at any given level of hemoglobin oxygen saturation, oxygen is given up more readily to the tissues. Provided that normal blood volume is maintained, oxygen delivery is enhanced by a moderate degree of anemia. This is due to a reduction in blood viscosity and increased cardiac output, leading to increased extraction of oxygen from blood perfusing the tissues (Wi.llkerso.D §L§L 19,8,7). However, ischemia may result if severe acute anemia occurs in the presence of coronary or cerebral atherosclerosis.

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