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Anemia

Anemic

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.).


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].

Dyspnea
  • Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology.[ncbi.nlm.nih.gov]
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • The symptoms may include, but are not limited to: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo[stanfordchildrens.org]
  • Common symptoms are weakness, fatigue, general malaise and dyspnea on exertion. Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.). In the preliminary stages, mild form of anemia has no symptoms.[symptoma.com]
  • Case 1 A 35-year-old woman presented to clinic 35 weeks pregnant, with fatigue that started early in pregnancy, dyspnea on exertion, and restless sleep.[bloodjournal.org]
Fatigue
  • Important change scores were also estimated for the FACT-An Total score (6-9), the Anemia (3-5), and Fatigue subscale (2-4).[ncbi.nlm.nih.gov]
  • Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology.[ncbi.nlm.nih.gov]
  • A 27-year-old previously healthy woman was admitted with echymotic patches over the lower limbs for six months, multiple joint pain and fatigue for 2 months. She had severe pallor and multiple echymotic patches over the lower limbs.[ncbi.nlm.nih.gov]
  • We report a case of a 40-year-old Arabic woman who presented with a 25-cm abdominal mass, fatigue, and anemia evolving for 6 months. Her physical examination revealed anemic syndrome and an enormous splenomegaly extending beyond the umbilical area.[ncbi.nlm.nih.gov]
  • Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma.[ncbi.nlm.nih.gov]
Weakness
  • Symptoms Individuals with anemia suffer from fatigue, weakness, headache, and lightheadedness, pale color of the skin, brittle nails and concentration problems.[symptoma.com]
  • If carpal tunnel progresses, hand muscles may waste away leading to weakness, especially a decreased grip strength.[verywell.com]
  • Anemia results in weakness. Hemoglobin provides oxygen to the body tissues, if they are not healthy then it results in anemia.[imedpub.com]
  • It also increases susceptibility to infection, and the likelihood of experiencing weakness or fatigue symptoms. Among pregnant women, severe anemia can result in low birth weight and child mortality.[povertyactionlab.org]
  • Most people with anemia feel tired or weak. People with this symptom may have a harder time coping with the physical and emotional demands of treatment. About red blood cells Red blood cells contain hemoglobin.[cancer.net]
Pallor
  • She had severe pallor and multiple echymotic patches over the lower limbs. She was diagnosed with SLE with pernicious anemia and iron deficiency anemia. The rare association of SLE with pernicious anemia was reported previously in few patients.[ncbi.nlm.nih.gov]
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
  • Jennifer Cobelli Kett , MD Children’s National Medical Center Washington, DC Suggested Reading Anemia and Pallor . Kolb EA, Levy AS. In: McInerny TK, Adam HM, Campbell DE, Kamat DM, Kelleher KJ, eds.[pedsinreview.aappublications.org]
  • The most noticeable outward symptom of anemia is usually pallor of the skin, mucous membranes, and nail beds. Symptoms of tissue oxygen deficiency include pulsating noises in the ear, dizziness, fainting, and shortness of breath.[britannica.com]
Weight Loss
  • Researchers ... read more Long-Term Follow-Up After Weight-Loss Surgery Finds High Rate of Anemia Sep. 20, 2017 — Researchers found a high rate of anemia 10 years after patients received Roux-en-Y gastric bypass, suggesting that long-term follow-up with[sciencedaily.com]
  • People who have had gastric bypass surgery for weight loss or other reasons may also be iron deficient due to poor absorption.[hematology.org]
  • People with colon or rectal cancer may have weight loss, fatigue (excessive weakness), loss of appetite, and a family history of cancer. Everyone over the age of 50 should be screened with a sigmoidoscopy.[chemocare.com]
  • Loss of Appetite/Weight Loss Co-existing Conditions Pernicious Anaemia is an Autoimmune Disease. Autoimmune Diseases are characterised by the body somehow attempting to destroy itself.[pernicious-anaemia-society.org]
Malaise
  • Common symptoms are weakness, fatigue, general malaise and dyspnea on exertion. Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.). In the preliminary stages, mild form of anemia has no symptoms.[symptoma.com]
  • Others with anemia may feel: Tired Fatigue easily Appear pale Develop palpitations (feeling of heart racing) Become short of breath Additional symptoms may include: Hair loss Malaise (general sense of feeling unwell) Worsening of heart problems It is[medicinenet.com]
Loss of Appetite
  • Nausea, vomiting, and loss of appetite. Nausea and vomiting and loss of appetite may cause a lack of nutrients. The body needs these nutrients to make red blood cells. These include iron, vitamin B12, and folic acid. Excessive bleeding.[cancer.net]
  • People with colon or rectal cancer may have weight loss, fatigue (excessive weakness), loss of appetite, and a family history of cancer. Everyone over the age of 50 should be screened with a sigmoidoscopy.[chemocare.com]
  • Loss of Appetite/Weight Loss Co-existing Conditions Pernicious Anaemia is an Autoimmune Disease. Autoimmune Diseases are characterised by the body somehow attempting to destroy itself.[pernicious-anaemia-society.org]
Abdominal Pain
  • Inflammatory bowel disease -Diarrhea, abdominal pain and mucous in your bowel movements are caused by inflammation (swelling and redness) of the lining of the colon. This may cause rectal bleeding.[chemocare.com]
  • Extremely large spleens cause abdominal pain and a feeling of fullness after eating a small amount of food. Often, an enlarged spleen also traps platelets and white blood cells, thus reducing their number in the bloodstream.[merckmanuals.com]
Palpitations
  • Severe anemia may lead to shortness of breath, pale complexion, dry nails, palpitations etc. Children with anaemia, like adults, may appear pale, tired and short of breath.[news-medical.net]
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
  • Both anxiety and anemia cause: Shortness of breath Heart palpitations Tingling in extremities Fatigue Weakness However, while anemia may cause these symptoms, it also often leads to other, more serious problems that cause hospitalization.[calmclinic.com]
  • You have an irregular heartbeat/heart palpitations Romaset/Shutterstock Heart palpitations, or noticeable heartbeats, are another sign of iron deficiency anemia.[rd.com]
Tachycardia
  • Anemia may be suspected on a complete medical history and physical examination of your child, such as complaints of tiring easily, pale skin and lips, shortness of breath, or a fast heartbeat (tachycardia).[stanfordchildrens.org]
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • Cardiac exam for tachycardia (acute blood loss or sepsis), murmurs (hemolysis due to endocarditis or a mechanical valve), or signs of volume overload.[clinicaladvisor.com]
  • Low cobalamin is associated with an increased fetal risk of low lean mass and excess adiposity, increased insulin resistance, and impaired neurodevelopment. 13 Maternal risks include fatigue, pallor, tachycardia, poor exercise tolerance, and suboptimal[bloodjournal.org]
  • In severe anemia, there may be signs of a hyperdynamic circulation : tachycardia (a fast heart rate), bounding pulse , flow murmurs , and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure .[en.wikipedia.org]
Heart Murmur
  • Your physician may detect a heart murmur or note a significant decrease in your blood pressure when you stand. A blood sample will provide an overall count of your white blood cells , red blood cells and platelets .[radiologyinfo.org]
  • murmur increased heart rate enlarged spleen enlarged liver Hemolytic disease of the newborn is a condition that occurs when a mother and baby have incompatible blood types.[healthline.com]
  • A physical exam that your doctor does may show: high or low blood pressure pale skin jaundice increased heart rate heart murmur enlarged lymph nodes enlarged spleen or liver atrophic glossitis of tongue People with symptoms of anemia should seek medical[healthline.com]
  • murmur; and enlargement of the spleen with certain causes of anemia.[emedicinehealth.com]
Hypotension
  • Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.). In the preliminary stages, mild form of anemia has no symptoms.[symptoma.com]
  • In the euvolemic patient, hypotension may be a late, pre-terminal event and tachycardia, anxiety, and tachypnea may be important signs of instability. Maintaining optimal hydration may make the HGB appear to drop, but it improves survival.[clinicaladvisor.com]
  • […] stay in colloid suspension. 56 , 57 Currently available IV iron formulations are of acceptable safety and equivalent effectiveness in the general population. 58 , 59 All IV formulations may be associated with allergic reactions characterized by nausea, hypotension[bloodjournal.org]
Systolic Murmur
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
Tinnitus
  • Tinnitus This is extremely common in patients with PA and is probably due to slight nerve damage to the brain. Sensory Impairment Loss of smell, taste, touch Irritability/Frustration/Impatience A general feeling of unease.[pernicious-anaemia-society.org]
Dry, Brittle Hair
  • , brittle hair, and hair loss, especially near the outer edge of the eyebrows Brittle, dull, and thin nails Decreased sweating Swelling of the hands, face, and eyelids (called edema) "Brain Fog" Another symptom commonly described in connection with hypothyroidism[verywell.com]
Restless Legs Syndrome
  • Restless legs syndrome is more common in those with iron-deficiency anemia . [13] Causes [ edit ] Figure shows normal red blood cells flowing freely in a blood vessel.[en.wikipedia.org]
  • Ascertainment of iron deficiency and depletion in blood donors through screening questions for pica and restless legs syndrome . Transfusion , 53(8):1637-44.[womenshealth.gov]
Dizziness
  • Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma.[ncbi.nlm.nih.gov]
  • Other symptoms of the condition include spoon shaped or scooped nails, breathlessness, loss of consciousness, an irregular heartbeat, headaches, and dizziness.[the.ismaili]
  • You’re short of breath or dizzy often Gajus/Shutterstock Without enough iron or vitamin B12, the body cannot produce enough of a specific type of protein called hemoglobin, which is crucial to the functioning of red blood cells.[rd.com]
  • Several symptoms occur in all types of anemia, including: Feeling tired Shortness of breath Dizziness Headache Feeling cold Weakness Pale skin Cleveland Clinic News & More Cleveland Clinic News & More[my.clevelandclinic.org]
  • If you're anemic, you might experience the following: weakness feeling tired/fatigued cold dizziness crankiness You may bruise easily and may bleed more or longer than normal. You also might have frequent nosebleeds .[breastcancer.org]
Headache
  • Who Is at Risk for Iron Deficiency Headaches? As a general rule, women are more susceptible to both iron deficiencies and headaches. But this doesn’t mean that men can’t develop these types of headaches as well.[fergon.com]
  • Symptoms Individuals with anemia suffer from fatigue, weakness, headache, and lightheadedness, pale color of the skin, brittle nails and concentration problems.[symptoma.com]
  • You’re getting an abnormal amount of headaches Siriluk ok/Shutterstock Most of us get headaches every once in awhile, from stress, lack of sleep, illness, or a slew of other reasons.[rd.com]
  • Other symptoms of the condition include spoon shaped or scooped nails, breathlessness, loss of consciousness, an irregular heartbeat, headaches, and dizziness.[the.ismaili]
  • You may be short of breath or have a headache. Your doctor will diagnose anemia with a physical exam and blood tests. Treatment depends on the kind of anemia you have.[medlineplus.gov]
Vertigo
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • The symptoms may include, but are not limited to: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo[stanfordchildrens.org]
  • Vertigo The inability to cope with heights and wide open spaces. Patients will need a visual reference to compensate with what is probably damage to the brain’s balance mechanism.[pernicious-anaemia-society.org]
Neglect
  • SCD is a neglected hemoglobinopathy characterized by intense erythropoietic activity and anemia. Hepcidin is the hormone mainly responsible for iron homeostasis and intestinal absorption.[ncbi.nlm.nih.gov]
  • PLoS Neglected Tropical Diseases . 2 (9): e291. doi : 10.1371/journal.pntd.0000291 . PMC 2553481 . PMID 18820740 . Gyorkos TW, Gilbert NL, Larocque R, Casapía M (April 2011).[en.wikipedia.org]
Apathy
  • Fatigue, sleepiness, slowing of speech, in addition to a lack of interest in personal relationships and general apathy, are signs of depression and hypothyroidism.[verywell.com]
Amenorrhea
  • […] rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing Headache Irritability Irregular menstruation cycles Absent or delayed menstruation (amenorrhea[chop.edu]
  • […] rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo, especially when standing Headache Irritability Irregular menstruation cycles Absent or delayed menstruation (amenorrhea[stanfordchildrens.org]
  • Children 0-5 years and women % children % children % children % people following BCC messages to prevent and treat infectious diseases Family Planning Promote breastfeeding for lactatioinal amenorrhea method (LAM) and modern methods of contraceptives[web.worldbank.org]

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].
Erythrocytes Decreased
  • Throughout fetal life, erythrocytes decrease in size and increase in number: hematocrit increases from 30% to 40% during the second trimester to 50% to 63% at term.[pedsinreview.aappublications.org]
ST Elevation
  • However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS.[ncbi.nlm.nih.gov]

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].

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].

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].

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.

Summary

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]. 

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.

References

Article

  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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Last updated: 2017-08-09 18:21