Anemia

Anemia is defined as a decrease in red blood cell mass. The three main causes include blood loss, increased red blood cell destruction (hemolysis) and decreased production of red blood cells. Iron deficiency is thought to be the most common cause of anaemia globally. Common symptoms are weakness, fatigue, general malaise and dyspnea on exertion. Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.).

Overview

Anemia is characterized by decrease in the number of red blood cells or hemoglobin in the blood. In other words, when the blood loses its capacity to carry oxygen, the individual is known to have developed anemia. Individuals with anemia often complain of tiredness and weakness. Anemia is of several types, and all have different causative factors. It is a common occurrence and can affect individuals of any age group. If the condition is not treated on time, it can lead to serious and long term debilitating complications [1]. 

Etiology

Anemia occurs due to any of the 3 causes which include; loss of blood, decreased production of red blood cells and hemolysis characterized by increased destruction of red blood cells. There are several causative factors such as genetic, nutritional, physical and underlying disease conditions that can give rise to anemia.

  • Genetic factors such as development of thalassemia, heredity xerocytosis, Fanconi anemia, Rh null disease and defects in RBC cytoskeleton can lead to anemia.
  • Nutritional deficiencies including deficiency of iron, folate and vitamin B12 can cause anemia to set in.
  • Physical factors that can cause blood loss include burns, trauma, prosthetic valves and frostbite can lead to development of anemia.
  • Underlying disease conditions such as neoplasia, renal disease, liver disease and collagen vascular disease can predispose an individual to develop anemia [2].

Epidemiology

It has been estimated that, about 1 billion individuals across the globe suffer from iron deficiency anemia. Women and children are more affected than men. According to WHO, men and women having hemoglobin levels below 12.5g/dL are considered to be suffering from anemia. For the US population, levels of 12.5g/dL for women and 13.5g/dL for men are considered to be cut off values. Based on these values, 4% men and 8% women are known to have lower than normal hemoglobin levels in the US [3].

Sex distribution
Age distribution

Pathophysiology

Under normal physiologic conditions, the red blood cells (RBCs) of the body contain hemoglobin. The RBCs with the help of hemoglobin are responsible for carrying oxygen to the lungs and various other parts of the body. They also carry carbon dioxide from parts of the body to the lungs for it to be exhaled. Red blood cells are made regularly in the bone marrow. For the bone marrow to produce RBCs and hemoglobin, it needs adequate amounts of iron, vitamin B12, folate and other essential nutrients. Deficiency in any of these nutrients means inadequate amounts of hemoglobin is being produced, leading to anemia [4].

Prognosis

The prognosis depends on the type of anemia and the causative factors. Mild forms can be successfully treated with supplements and intake of iron rich diet. However, certain forms can be severe and require a more rigorous treatment regime. Such types include sickle cell anemia, thalassemia and aplastic anemia. Anemia that results from aortic rupture has a very poor prognosis with about 80% mortality rate [5].

Presentation

In the preliminary stages, mild form of anemia has no symptoms. However, when the condition progresses, then the individuals experience the following:

  • Poor concentration
  • Feeling tired more often than usual
  • Occurrence of headaches
  • Chest pain
  • Hands and feet become cold
  • Shortness of breath
  • Irregular or fast heartbeat
  • Dizziness 
  • Development of pale skin

In more severe cases, individuals would also develop lightheadedness especially when they stand up, development of bluish color in the eyes; nails become brittle and sore tongue [6].

Workup

The following methods are employed to diagnose anemia:

  • Physical examination is done to carefully evaluate the signs and symptoms of anemia. In this, the heartbeat is studied along with other physical parameters such as size of the liver and spleen [7].
  • Blood tests to obtain a complete blood count would be made. The levels of hemoglobin are of primary interest. According to the values provided by WHO, males with hemoglobin values lower than 13.5g/dL and women with less than 12.5g/dL are considered to anemic. Blood tests in most cases also help identify the presence of underlying disease condition if any.
  • Other tests would be carried out to establish the size and shape of the red blood cells. This is necessary because the size and shape of the cells changes with the type of anemia present. Individuals with iron deficiency anemia have smaller sized red blood cells; whereas those with vitamin deficiency anemia have enlarged RBCs [8].

Treatment

Treatment of anemia depends on its type. The following methods are employed to treat different types of anemia:

  • Iron deficiency anemia is treated with iron supplements and changes in dietary pattern [9].
  • B12 deficiency anemia can be treated with providing supplements of folate and vitamin B12. These nutrients are also provided through diet. In case, the body is unable to absorb these through diet then vitamin B12 injections are given.
  • Anemia due to chronic disease condition has no specific treatment regime. In this, modes are employed for treating the underlying disease condition. When symptoms turn severe then, blood transfusion may be necessary.
  • Aplastic anemia is treated through blood transfusions and bone marrow transplantation.
  • Sickle cell anemia may require blood transfusions, antibiotics and supplements of folic acid. In certain cases, bone marrow transplant may be indicated.
  • Thalassemia is primarily treated through blood transfusions. In many instances, splenectomy and bone marrow transplant would be required [10].

Prevention

Some forms of anemia can be prevented. Those that occur due to iron and vitamin deficiency can easily be prevented by choosing a diet rich in these nutrients. Those who are vulnerable towards anemia, for eg; children and pregnant women should consider taking supplements. There are other forms of anemia which cannot be prevented. However, treatment should be initiated right when preliminary signs develop to prevent complications from setting in.

Patient Information

Definition

Anemia is a condition defined by significant reduction in hemoglobin levels, like below 12.5g/dL. In this condition, the body does not produce adequate red blood cells. Anemia is more prevalent in women and children. It has been estimated that about 1.5 billion individuals across the globe suffer from anemia.

Cause

Causes of anemia include blood loss due to trauma or other disease conditions and inadequate production or early destruction of red blood cells.

Symptoms

Individuals with anemia suffer from fatigue, weakness, headache, and lightheadedness, pale color of the skin, brittle nails and concentration problems.

Diagnosis

Diagnosis of anemia includes physical examination followed by blood tests to determine complete blood count. In addition, specialized tests to determine the size and shape of red blood cells would also be required.

Treatment

Anemia is treated through supplements and modification in diet. Many forms of anemia may require blood transfusions and bone marrow transplants.

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References

  1. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107:1747.
  2. Young NS, Scheinberg P, Calado RT. Aplastic anemia. CurrOpinHematol. May 2008;15(3):162-8.
  3. Patel KV. Epidemiology of anemia in older adults.SeminHematol 2008; 45:210.
  4. Nutritional anaemias.Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968; 405:5
  5. DeLoughery TG. Microcytic anemia. N Engl J Med. Oct 2 2014;371(14):1324-31.
  6. Means RT, Glader B. Anemia: General Considerations. In: Wintrobe's Clinical Hematology, 12 Ed, Greer JP, Foerster J, Rodgers GM, et al. (Eds), Lippincott Williams and Wilkins, Philadelphia 2009. Vol 1, p.784.
  7. Rapaport SI. Diagnosis of anemia. In: Introduction to hematology, JB Lippincott, Philadelphia 1987. p.15
  8. Kuku I, Kaya E, Yologlu S, Gokdeniz R, Baydin A. Platelet counts in adults with iron deficiency anemia.Platelets. Aug 3 2009;1-5.
  9. Mozaffari-Khosravi H, Noori-Shadkam M, Fatehi F, Naghiaee Y. Once weekly low-dose iron supplementation effectively improved iron status in adolescent girls. Biol Trace Elem Res. Aug 4 2009;epub ahead of print.
  10. Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. Oct 2004;89(10):1187-93.

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