What is Anemia?
A decrease in the percentage of red blood cells is known as anemia. Instead of being a disease, it is a symptom of an underlying illness. A patient’s etiology, the severity of anemia, and the existence of other comorbidities, particularly cardiovascular disease, all influence whether patients will experience symptoms or not.
Etiology
Anemia’s etiology depends on whether it is hyperproliferative (corrected reticulocyte count <2%) or hyperproliferative (corrected reticulocyte count >2%). Hyperproliferative anemias are divided into microcytic (MCV<80 fl), normocytic (MCV 80-100 fl), and macrocytic (MCV>100 fl). Hypoproliferative microcytic anemia can be caused by iron deficiency, chronic disease, sideroblastic anemia, thalassemia, lead poisoning, renal failure, aplastic anemia, pure red cell aplasia, myelofibrosis, and multiple myeloma.
Hypoproliferative macrocytic anemia can be caused by alcohol, liver disease, hypothyroidism, folate and vitamin B12 deficiency, myelodysplastic syndrome, refractory anemia, drug-induced diuretics, and antiretroviral agents.
Why Are Females More Affected with Anemia?
Children under five, especially infants and kids under two, adolescents and women who are in menstruation, and pregnant women or just given birth are among the population groups most at risk for anemia.
Anemia in women is often caused by blood loss during and after childbirth, especially in conditions of postpartum hemorrhage, maternal blood volume increase during pregnancy, and regular severe menstrual bleeding.
Symptoms of Anemia in Women
Generally is dependent on the blood loss rate. Typical symptoms include the following:
- Weakness
- Fatigue
- Apathy
- Legs becoming restless
- Breathlessness, particularly with effort, close to syncope
- More severe anemia along with chest discomfort and decreased ability to exercise
- Want to eat unusual foods or non-dietary products?
- Otherwise, mild anemia can not cause any symptoms.
Diagnostic Signs of Anemia
- Anemia can be diagnosed through various signs, including cool skin, tachycardia, hypotension, and lymphadenopathy.
- An abdominal examination shows splenomegaly, hepatomegaly, and sickle cell anemia.
- Hemoglobin levels below 9 mg/dL are indicative of anemia.
- Rectal and pelvic examinations are often overlooked but are crucial for detecting neoplasm.
Differential Diagnosis
Anemia can be diagnosed through differential diagnosis, including hemolysis during phlebotomy, acute blood loss from trauma, chronic disease, bone marrow infiltration, macrocytic anemia with B12/folate deficiency, hemolytic anemia, jaundice, dark urine, and acute upper or lower gastrointestinal bleeding. It is important to question recent medication use and consider factors like renal failure, underlying malignancies, and autoimmune conditions.
Complications of Anemia in Women
Anemia can lead to multiple organ failure, death, premature labor, low birth weight babies, and increased blood loss during pregnancy. Older populations are more susceptible to complications due to multiple comorbidities. Chronic anemia affects the cardiovascular system, with common complications including myocardial infarction, angina, and high-output heart failure. Young anemia can cause neurological delays, which are unlikely to be manageable.
Effective Treatments for Anemia
- Anemia management involves treating the underlying causes, such as acute blood loss, nutritional deficiencies, bone marrow and stem cell defects, chronic disease, and increased red blood cell destruction.
- Treatment includes IV fluids, oxygen, iron supplementation, bone marrow transplantation, chronic disease, autoimmune and rheumatological conditions, and hemoglobinopathies like sickle anemia.
- Patients with cardiovascular disease require higher hemoglobin goals. Oral iron supplementation is the most common method for iron repletion, with IV iron being beneficial for rapid increases.
- Treatment also includes splenectomy, blood transfusions, exchange transfusions, hydroxyurea, and antifibrinolytic agents for life-threatening bleeding.
Summary
Anemia, a condition causing various diseases, requires effective management through inter-professional teamwork, medication, lifestyle modifications, and frequent follow-ups. It requires collaboration between the patient, primary care provider, and consultant physicians to prevent complications.
References:
Turner J, Parsi M, Badireddy M. Anemia. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499994/.
Walters, D., Kakietek, J., Eberwein, J. D., & Shekar, M. (2017). An investment framework for meeting the global nutrition target for anemia. Washington, DC: World Bank.
