Megaloblastic anemia (MA) is a heterogeneous group of anemias characterized by the presence of large red blood cell precursors in the bone marrow, which are...
Anemia | Types, Causes, Symptoms, and Treatments
Introduction
Anemia is defined as a reduction in the amount of red blood cells or hemoglobin in the circulation.
It is a common nutritional deficiency disorder and a global public health problem that affects both developing and developed countries with serious consequences for human health and social and economic development.
It affects up to one-third of the world’s population. In many cases, it is asymptomatic and does not require treatment.
Symptoms depend on the cause, the acuity of onset, and the presence of other comorbidities, particularly cardiovascular disease.
When hemoglobin falls below 7.0 g/dL, the majority of patients experience symptoms.
Prevalence
Globally, 1,62 billion people are affected by anemia, which corresponds to 24.8% of the people. Preschool-aged children have the highest prevalence, while men have the lowest. Nevertheless, the population group most affected are non-pregnant women (468.4 million).
The prevalence increases with age and is higher in reproductive-age women, pregnant women, and the elderly.
The prevalence is higher than 20% among people over the age of 85. It affects 50% to 60% of the nursing home population.
A nutritional deficiency, such as iron, folate, or vitamin B12 deficiency, is the cause of anemia in approximately one-third of the elderly. There is evidence of renal failure or chronic inflammation in another one-third of patients.
Mild iron deficiency anemia (IDA) occurs in women of childbearing age, usually as a result of inadequate iron intake and monthly loss with menstrual cycles. Anemia is also common in the elderly, often as a result of inadequate nutrition, particularly iron and folic acid. Other vulnerable groups include alcoholics, the homeless, and those who have experienced neglect or abuse.
New-onset anemia, particularly in people over 55, should be investigated and treated as cancer unless proven otherwise. This is especially true for men of any age who have anemia.
Anemia in Pre-school age Children
Anemia in Non-Pregnant Women
Anemia in Pregnant Women
Erythropoietin Levels and Anemia
Anemic patients with low hemoglobin has elevated EPO levels. However, EPO levels in anemic patients with renal failure are lower than expected.
EPO levels are generally elevated in anemia of chronic disease (AOCD), but not as high as they should be, indicating a relative deficiency of EPO.
Pathophysiology of Anemia
Pathophysiology differs significantly depending on the underlying cause.
It is caused by an imbalance in RBC production to removal or destruction.
In acute hemorrhagic anemia, for example, it is the restoration of blood volume with intracellular and extracellular fluid that dilutes the remaining red blood cells (RBCs), resulting in anemia.
In both plasma and red cells, a proportionate decrease results in falsely normal hemoglobin and hematocrit.
RBCs are made in the bone marrow and then released into the bloodstream daily, about 1% of RBCs are removed from circulation.
Main Mechanisms Involved in Anemia
- Increased RBC destruction
a. Blood loss
- Acute- hemorrhage, surgery, trauma, menorrhagia.
- Chronic- heavy menstrual bleeding, chronic gastrointestinal blood losses (in the setting of hookworm infestation, ulcers, etc.), urinary losses (BPH, renal carcinoma, schistosomiasis).
b. Hemolytic anemia
- Acquired- immune-mediated, infection, microangiopathic, blood transfusion-related, and secondary to hypersplenism.
- Hereditary- enzymopathies, disorders of hemoglobin (sickle cell), defects in red blood cell metabolism (G6PD deficiency, pyruvate kinase deficiency), defects in red blood cell membrane production (hereditary spherocytosis and elliptocytosis).
Deficient/defective erythropoiesis
- Microcytic.
- Normocytic, normochromic.
- Macrocytic.
Causes of Anemia
This condition has multiple causes that can be attributed to one of 3 processes
- Reduced red blood cell (RBCs) production: Because RBCs have a limited lifespan of 90 to 120 days, hematopoiesis must be a continuous process to keep up with natural attrition. Any hematopoiesis-disrupting process can result in a net loss of RBC mass over time, resulting in anemia.
- Increased RBCs destruction: Anemia is caused by any process that destroys RBCs or significantly shortens the lifespan of the cell to the point where hematopoiesis cannot keep up with the destruction.
- Loss of Blood: Anemia is caused by any loss of blood, whether microscopic or macroscopic, that exceeds hematopoiesis will result in anemia.
Processes Involved in Causes
- Blood loss caused by trauma, as well as bleeding from an organ or visceral system [otolaryngology (ENT), gastrointestinal (GI), genitourinary (GU), and gynecological (GYN), among others].
- Lack of a nutritional substrate for hematopoiesis, such as iron, vitamin B-12, or folate, or generalized malnutrition.
- Chronic disease and/or chronic inflammation. Chronic hepatic or renal disease, cancer, chronic infection, and collagen vascular disease are all common culprits.
- Genetic illness: Common syndromes include, but are not limited to, thalassemia, hemoglobinopathies, and enzyme abnormalities of the glycolytic pathways. Abetalipoproteinemia, and hereditary xerocytosis are less common genetic syndromes.
- Bacterial, viral, and protozoan infections are examples of infectious etiologies. Malaria is a major infectious cause worldwide.
- Drug and chemical exposure are common causes of bone marrow suppression.
- Primary or idiosyncratic bone marrow suppression.
- Autoimmune disease.
Causes are also determined by whether it is hypoproliferative (i.e., a corrected reticulocyte count of less than 2%) or hyperproliferative (i.e., a corrected reticulocyte count of greater than 2%).
The mean corpuscular volume (MCV) expressed in femtoliters (fL) further divides hypoproliferative anemias into microcytic (MCV<80 fL), normocytic (MCV 80-100 fL), and macrocytic anemias (MCV>100 fL).
| Type | MCV range | Possible Causes | Comment |
|---|---|---|---|
|
Hypoproliferative Microcytic Anemia |
MCV<80 fL |
IDA. (AOCD). Sideroblastic anemia. Thalassemia. Lead poisoning. |
— |
|
Hypoproliferative Normocytic Anemia |
MCV 80-100 fL |
AOCD. Renal failure. AA. Pure red cell aplasia. Myelofibrosis or myelophthisic processes. Multiple myeloma. |
— |
|
Hypoproliferative Macrocytic Anemia |
MCV>100 fL |
Alcohol. Liver disease. Hypothyroidism. Folate and Vitamin B12 deficiency. Myelodysplastic syndrome (MDS) such as refractory anemia (RA), refractory anemia with ringed sideroblasts (RA-RS), refractory anemia with excess blasts (RA-EB) Chronic myelomonocytic leukemia (CMML). Drug-induced such as diuretics, chemotherapeutic agents, hypoglycemic agents antiretroviral agents, antimicrobials, and anticonvulsants. |
A hypoproliferative disorder, hemolysis, or both can cause macrocytic anemia. Thus, when evaluating a patient with macrocytic anemia, it is important to calculate the corrected reticulocyte count. |
|
Hemolytic anemia |
— |
Extravascular hemolysis due to:
Intravascular hemolysis due to:
|
In Extravascular hemolysis: red cells are prematurely removed through the liver and spleen from circulation. This accounts for the vast majority of HA cases. In intravascular hemolysis: the red cells lyse throughout the circulation. (Less Common). |
Signs and Symptoms of Anemia
a. Symptoms of Anemia
- Fatigue. (Most common).
- Weakness.
- Tiredness.
- Lethargy.
- Restless legs.
- Shortness of breath, especially on exertion, near syncope.
- Chest pain and reduced exercise tolerance- with more severe anemia.
- Pica- desire to eat unusual and non-dietary substances.
- Dizziness.
- Headache.
- Coldness in your hands or feet.
- Pale skin, gums, and nail beds.
- pallor or jaundice.
- Tachycardia.
- Palpitations.
b. Signs of Anemia
- The skin may be cool to touch.
- Tachypnea.
- Hypotension (orthostatic).
a. HEENT examination:
- Pallor of the conjunctiva.
- Boxcars or sausaging of retinal veins → Suggestive of hyperviscosity that can be seen in myelofibrosis.
- Jaundice – elevated bilirubin → Seen in several hemoglobinopathies, liver diseases, and other forms of hemolysis. Lymphadenopathy → Suggestive of lymphoma or leukemia.
- Glossitis (inflammation of the tongue) and cheilitis (swollen patches on the corners of the mouth): iron/folate deficiency, alcoholism, PA.
b. Abdominal examination
- Splenomegaly: hemolysis, lymphoma, leukemia, myelofibrosis
- Hepatomegaly: alcohol, myelofibrosis.
- Gastrectomy scar: decreased absorptive surface with loss of terminal ileum results in vitamin B12 deficiency.
- Cholecystectomy scar: Cholesterol and pigmented gallstones are common in (SCA).
c. Cardiovascular
- Tachycardia.
- Systolic flow murmur.
- Severe anemia may lead to high output heart failure.
d. Neurologic examination
- Decreased proprioception/vibration: vitamin B12 deficiency
e. Skin
- Pallor of the mucous membranes/nail bed or palmar creases → Suggests hemoglobin < 9 mg/dL.
- Petechiae: thrombocytopenia, vasculitis.
- Dermatitis herpetiformis (in iron deficiency due to malabsorption – Celiac disease).
- Koilonychia (spooning of the nails): iron deficiency.
Rectal and pelvic examinations are frequently overlooked and underperformed in the evaluation of anemia. If a patient has severe rectal bleeding, it is necessary to look for hemorrhoids or hard masses that suggest neoplasm as possible causes of the bleeding.
Common Types of Anemia
There are different types and classifications of this condition.
It is caused by a variety of red cell defects, including the production defect (AA), the maturation defect, hemoglobin synthesis defect (iron deficiency anemia), hemoglobin maturation genetic defects (thalassemia), or abnormal hemoglobin synthesis (hemoglobinopathies, SCA, and thalassemia) and physical loss of red cell (hemolytic anemias).
Iron is required for a variety of human body activities, particularly hemoglobin synthesis.
IDA is a condition in which the body’s bloodstream contains insufficient iron.
This type is more prevalent in adolescents and women prior to menopause.
This disease can be caused by blood loss from heavy periods, internal bleeding from the gastrointestinal tract, or donating too much blood.
It is caused by a lack of iron, which can be caused by a variety of factors.
1.1. Causes of IDA
- Pregnancy or childhood growth spurts.
- Heavy menstrual periods. Read more about the relationship between anemia and menstruation.
Poor absorption of iron.
- Bleeding from the gut (intestines).
- Dietary factors (iron-poor or restricted diet). Here is a list of iron-rich foods.
- Medication (aspirin ibuprofen, naproxen and diclofenac).
- Lack of certain vitamins (folic acid and vitamin B12), Bleeding from the kidney, Hookworm infection, Red blood cell problems.
- Bone marrow problems.
1.2. Symptoms of Iron-Deficiency Anemia
- Tiredness
- Lethargy.
- Feeling faint and becoming breathless easily.
- Headaches.
- Irregular heartbeats (palpitations).
- Altered taste.
- Sore mouth and ringing in the ears (tinnitus).
- Anemia during pregnancy increases the risk of complications for both mother and baby, such as low birth weight, preterm (premature) delivery, and postnatal depression.
- Low iron reserves in the baby may also lead to anemia in the newborn baby.
2. Pernicious anemia (PA)
Vitamin B12 deficiency is most often caused by PA. Vitamin B12 is required for life.
It is needed for the body to produce new cells, such as the many new red blood cells produced each day.
Meat, fish, eggs, and milk all contain vitamin B12. Anemia and other problems may result from a lack of vitamin B12.
2.1. Causes of PA
- It is most common in people over the age of 50. Women are more likely to be affected than men, and it runs in families.
- People with other autoimmune disorders are more likely to develop it.
- Vitamin B12 absorption can also be affected by the use of some medications i.e., Metformin, colchicine, neomycin, and certain anticonvulsants are some of the most common examples.
2.2 Symptoms of PA
- Psychological problems i.e., depression, confusion, difficulty with memory or even dementia.
- Nervous problems i.e., numbness, pins and needles, vision changes, and unsteadiness. can develop.
“As a result, a long-term or severe vitamin B12 deficiency could result in permanent brain or nerve damage.“
3. Hemolytic Anemia
Hemolytic anemia occurs when red blood cells are destroyed and removed from the bloodstream before they reach the end of their normal lifespan.
People of all ages, races, and sexes can be affected by hemolytic anemia. It can cause various health problems such as fatigue, pain, arrhythmias, an enlarged heart, and heart failure, among other things.
3.1. Inherited hemolytic anemias include the following:
- Thalassemia.
- Hereditary spherocytosis.
- Hereditary elliptocytosis.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency.
- Pyruvate kinase deficiency.
- SCA.
3.2. Acquired hemolytic anemias include the following:
- Immune hemolytic anemia.
- Autoimmune hemolytic anemia.
- Alloimmune hemolytic anemia.
- Drug-induced hemolytic anemia.
- Mechanical hemolytic anemias.
- Paroxysmal nocturnal hemoglobinuria.
- Certain infections and substances can also damage red blood cells and lead to hemolytic anemia.
3.3. Symptoms of Hemolytic Anemia include the following:
- Jaundice.
- Pain in the upper abdomen.
- Leg ulcers and pain.
- A severe reaction to a blood transfusion.
3.4. Treatments for hemolytic anemia include the following:
- Blood transfusions.
- Medicines.
- Plasmapheresis.
- Surgery.
- Blood and marrow stem cell transplants.
- Lifestyle changes.
4. Sickle cell anemia (SCA)
It is a lifelong inherited disease that is most prevalent in Africa, South and Central America, the Caribbean islands, Mediterranean countries, India, and Saudi Arabia.
In SCA the body produces sickle-shaped (“C”-shaped) red blood cells.
It contains abnormal hemoglobin, which gives it a sickle shape and makes it difficult to move through blood vessels. The clumps of sickle cells block blood flow that is leading to the limbs and organs.
The blocked blood vessels cause pain, serious infection, and damage to the organ.
Sickle cells usually die after 10 to 20 days, and the body can’t produce enough red blood cells to replace the ones that are dying, resulting in anemia.
4.1. Symptoms of SCA
- Fatigue.
- Shortness of breath.
- Dizziness.
- Headache.
- Coldness in the hands and feet, Pale skin, Chest pain.
5. Thalassemia
Thalassemia is a genetic blood disorder that causes the body to produce fewer healthy red blood cells and less hemoglobin.
Thalassemia has two major types alpha- and beta-thalassemia.
The most severe form of alpha thalassemia is called alpha thalassemia major or hydrops fetalis, while the severe form of beta-thalassemia is referred to as thalassemia major or anemia of Cooley.
Thalassemia affects males and females, most frequently among Italians, Greeks, Middle Easterns, Asians, and Africans.
In red blood cells, hemoglobin has two types of protein chains: alpha-globin and beta-globin. Red blood cells do not form properly and cannot carry enough oxygen if your body does not produce enough of these protein chains.
Genes control how the body synthesizes hemoglobin protein chains. Thalassemia occurs when these genes are missing or altered.
Thalassemia is genetically transmitted from parents to children.
A lack of oxygen in the bloodstream causes symptoms.
The severity of symptoms is proportional to the severity of the disorder.
Those with alpha or beta-thalassemia may have mild anemia and persons with beta-thalassemia intermedia have mild to moderate anemia. They can also experience other health problems such as slow growth and delayed puberty, bone problems, and enlarged spleen.
5.1. Symptoms of thalassemia
People with hemoglobin H disease or beta-thalassemia major, have severe thalassemia, as well as other serious health problems such as: –
- Pale and listless appearance.
- Poor appetite.
- Dark urine.
- Slowed growth and delayed puberty.
- Jaundice.
- Enlarged spleen, liver, and heart.
- Bone problems.
5.2 There are three standard treatments for moderate and severe thalassemia, which are as follows: –
- Blood transfusions.
- Iron chelation therapy.
- Folic acid supplements.
6. Aplastic Anemia (AA)
It is a blood disorder that occurs when the body’s bone marrow fails to produce enough new blood cells.
This can lead to a variety of health issues such as arrhythmias, an enlarged heart, heart failure, infections, and bleeding. It is caused by damage to the stem cells in the bone marrow.
6.1. Causes of AA Include:
- Toxins, such as pesticides, arsenic, and benzene.
- Radiation and chemotherapy.
- Medicines such as chloramphenicol.
- Infectious diseases such as hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV,
- Autoimmune disorders such as lupus and rheumatoid arthritis.
- Inherited conditions, such as Fanconi anemia, Shwachman-Diamond syndrome, dyskeratosis, and Diamond-Blackfan anemia may also cause AA.
6.2. Symptoms of AA Include:
- Fatigue.
- Shortness of breath.
- Dizziness.
- Headache.
- Coldness in your hands or feet.
- Pale skin, gums, and nail beds.
- Chest pains.
6.3. Treatment for AA includes:
- Blood transfusions.
- Blood and marrow stem cell transplants.
- Medications.
These treatments can help to prevent or limit complications, alleviate symptoms, and improve the overall quality of life. Transplants of blood and marrow stem cells may be used to treat the disease.
Complications of Anemia
If anemia is not diagnosed or left untreated for a long time, multi-organ failure and even death can occur.
Pregnant women with anemia are more likely to go into premature labor and have babies with low birth weight.
Anemia during pregnancy increases the risk of anemia in the baby as well as increased blood loss.
Due to multiple comorbidities, complications are more common in the elderly.
Chronic anemia most commonly affects the cardiovascular system.
Complications such as myocardial infarction, angina, and high-output heart failure are common. The development of arrhythmias and cardiac hypertrophy are two other cardiac complications.
Restless leg syndrome and esophageal webs are associated with severe iron deficiency.
Severe anemia at a young age can impair neurological development, resulting in cognitive, mental, and developmental delays. These complications are unlikely to be treatable medically.
Diagnosis and Laboratory Findings for Anemia
The history is extremely useful for the diagnostic workup.
A family history should include details about the family’s ethnic heritage, as well as any history of anemia, splenectomy, jaundice, gallbladder disease, sickle cell trait, or thalassemia.
A nutritional history is an important part of the history in determining the potential for chronic anemia by evaluating the child’s growth over time.
The physical examination should also include an evaluation for pallor, jaundice, petechiae, bruising, murmurs, adenopathy, organomegaly, frontal bossing, and congenital anomalies in the child.
Vital signs such as blood pressure, heart rate, and respiratory are all measured using the appropriate normative values for the child’s age and height.
The American Academy of Pediatrics recommends screening all children for anemia by the 12-month visit.
Measurements of hemoglobin, hematocrit, and red cell provide information about red cells that helps in the diagnosis of anemia’s underlying cause.
Red cell indices include the mean cell volume, mean hemoglobin, mean cell hemoglobin concentration, and red blood cell distribution width.
Serum ferritin concentration measures iron storage and helps in the diagnosis of iron deficiency.
Transferrin saturation evaluates iron absorption and transport in the body.
A method of classifying anemia is to describe cell morphology.
A peripheral film and mean corpuscular volume can be used to determine cell morphology.
Red blood cells are described as microcytic, normocytic, or macrocytic.
Normal Hemoglobin (Hgb) Laboratory Values:
- 13.5 to 18.0 g/dL in men.
- 12.0 to 15.0 g/dL in women.
- 11.0 to 16.0 g/dL in children.
- In pregnancy, it varies depending on the trimester, but generally greater than 10.0 g/dL.
- In pregnancy, it varies depending on the trimester, but generally greater than 10.0 g/dL.
Laboratory Tests for Anemia
| Test | Comment |
|---|---|
|
Complete blood count (CBC) |
Includes hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). |
|
Reticulocyte count |
Serves as an estimate of bone marrow red blood cell output. |
|
Iron profile |
Includes serum iron, ferritin, and total iron-binding content (TIBC). |
|
Peripheral blood smear |
Microscopic evaluation of red blood cell morphology. |
|
Serum creatinine |
Serves to assist in the evaluation of renal function. |
|
Thyroid function tests |
Includes thyroxine (T4) and thyroid-stimulating hormone level (TSH). |
|
Coagulation screen |
Includes activated partial thromboplastin time (APTT), prothrombin time/international normalized ratio (PT/INR), and thrombin time (TT). |
|
Liver function tests (LFT) |
LFT panels may vary but should include calcium, transaminases, total protein, bilirubin, albumin, and alkaline phosphatase. Additional tests that may provide information about the liver function include lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), 5'- nucleotidase. |
|
Hemolysis profile |
The profile contains haptoglobin, lactate dehydrogenase (LDH), and indirect bilirubin. |
|
Macrocytosis profile |
The profile contains vitamin B-12, folate, methylmalonic acid, and homocysteine. |
|
Hemoglobin electrophoresis |
Evaluates the hemoglobin amino acid chains. |
|
Abdominal sonogram |
Evaluates the size of the spleen size. |
|
Bone marrow analysis |
A hematology consult is required to obtain this. |
Laboratory Findings for Anemia
1. Microcytic Hypochromic Anemia
| Condition | Serum Iron | TIBCa | Serum Ferritin | Bone Marrow Iron | Comment |
|---|---|---|---|---|---|
|
IDA |
↓ |
↑ |
↓ |
0 |
Responds to iron therapy |
|
AOCD |
↓ |
↓ |
↑ |
++ |
Unresponsive to iron therapy |
|
β-Thalassemia major |
↑ |
N |
↑ |
++++ |
Indirect bilirubinemia and reticulocytosis |
|
β-Thalassemia minor |
N |
N |
N |
++ |
Elevation of A2 or fetal hemoglobin |
|
α-Thalassemia |
N |
N |
N |
++ |
— |
|
Hemoglobin H disease |
N↑ |
N |
N↑ |
+++ |
— |
|
Hemoglobin C & E disease |
N |
N |
N |
++ |
— |
|
Lead intoxication |
N |
N |
N |
++ |
— |
|
Sideroblastic anemias |
↑ |
N |
↑ |
++++ |
Ring sideroblasts in marrow. |
2. Macrocytic Anemia
| Megaloblastic Bone Marrow | Non-megaloblastic Bone Marrow |
|---|---|
|
Deficiency of vitamin B12 |
Liver disease |
|
Deficiency of folic acid |
Hypoplastic and AA |
|
Drugs affecting DNA synthesis |
Myelophthisic anemias |
|
Inherited disorders of DNA synthesis |
Hypothyroidism and hypopituitarism |
|
Erythroleukemia |
Accelerated erythropoiesis (reticulocytosis) |
3. Morphological Abnormalities of Red Blood Cells
| Morphology | Description |
|---|---|
|
Macrocyte |
Larger than normal (>8.5 μm diameter). |
|
Microcyte |
Smaller than normal (<7 μm diameter). Often hypochromic. |
|
Hypochromic |
Less hemoglobin in the cell. Enlarged area of central pallor. |
|
Spherocyte |
Loss of central pallor, stains more densely, often microcytic. Hereditary spherocytosis and certain acquired hemolytic anemias. |
|
Target cell |
Hypochromic with central "target" of hemoglobin. Liver disease, thalassemia, hemoglobin D. Post splenectomy. |
|
Leptocyte |
Thin hypochromic cell with a normal diameter and decreased MCV. Thalassemia. |
|
Elliptocyte |
Oval to cigar-shaped. Hereditary elliptocytosis, certain anemias particularly B12 and folate deficiency. |
|
Schistocyte |
Fragmented helmet-shaped or triangular red blood cell. Microangiopathic anemias, artificial heart valves, uremia, malignant hypertension. |
|
Stomatocyte |
Slit-like area of central pallor in the erythrocyte. Liver disease, acute alcoholism, malignancies, hereditary stomatocytosis, and artifact. |
|
Tear-shaped RBC |
Drop-shaped erythrocyte, often microcytic. Myelofibrosis and infiltration of marrow with tumor, thalassemia. |
|
Acanthocyte |
Five to 10 spicules of various lengths and at irregular intervals on the surface of red cell. |
|
Echinocyte |
Evenly distributed spicules on the surface of red cell, usually 10 to 30. Uremia, peptic ulcer, gastric carcinoma, pyruvic kinase deficiency, preparative artifact. |
|
Sickle cell |
Elongated cell with pointed ends. Hemoglobin S and certain types of hemoglobin C and 1. |
Morphological Abnormalities of Red Blood Cells
Diagnostic work-up
Red Flags of Anemia
- Hb <60 g/L (including iron deficiency).
- Tachycardia, cardiac murmur, or signs of cardiac failure.
- Features of hemolysis (dark urine, jaundice, scleral icterus).
- Associated reticulocytopenia.
- Presence of nucleated red blood cells on blood film.
- Associated thrombocytopenia or neutropenia may indicate malignancy or an infiltrative disorder.
- Severe vitamin B12 or folate deficiency.
- Need for red cell transfusion: Where possible defer transfusion until a definitive diagnosis is made.
Who should you Consult?
- Gastroenterologist if a gastrointestinal bleed is suspected.
- Nephrologist if AOCD in the setting of renal failure is suspected.
- Hematologist if a bone marrow disorder is suspected.
- Gynecologist if intractable menorrhagia is suspected.
- Cardiologist if severe anemia leads to angina, myocardial infarction, heart failure, or arrhythmias.
You must seek immediate medical attention if RED FLAGS are identified
Treatment & Management of Anemia
Treatment focuses primarily on treating the underlying cause.
- Anemia due to acute blood loss
IV fluids, crossmatched packed red blood cells, and oxygen. Always remember to have at least two large-bore IV lines for the administration of fluids and blood products.
In the majority of patients, hemoglobin levels should remain above 7 g/dL. Those suffering from cardiovascular disease require a higher hemoglobin target of more than 8 g/dL.
- Anemia due to nutritional deficiencies
Oral/IV iron, B12, and folate.
Oral iron supplementation is by far the most common method of iron repletion.
The amount of iron given to the patient is determined by his or her age, calculated iron deficit, rate of correction required, and ability to tolerate side effects.
Metallic taste and gastrointestinal side effects such as constipation and black tarry stools are the most common side effects. Individuals with these side effects are advised to take oral iron every other day to help with GI absorption.
Hemoglobin levels usually return to normal in 6-8 weeks, with an increase in reticulocyte count occurring in just 7-10 days.
In patients who require a rapid increase in iron levels, IV iron may be beneficial. Patients with acute and ongoing blood loss, as well as those experiencing intolerable side effects, are candidates for IV iron.
- Anemia due to defects in the bone marrow and stem cells
Conditions such as AA require bone marrow transplantation.
- Anemia due to chronic disease
Anemia in the setting of renal failure, responds to erythropoietin.
If it is caused by autoimmune and rheumatological conditions it will require treatment of the underlying disease.
- Anemia due to increased red blood cell destruction
Hemolytic anemia caused by faulty mechanical valves will need replacement.
If it occurs due to medications it will require the removal of the offending drug.
Persistent hemolytic anemia requires splenectomy.
To reduce the incidence of sickling in hemoglobinopathies such as sickle anemia, blood transfusions, exchange transfusions, and even hydroxyurea are used.
The uncontrolled coagulation and thrombosis of DIC require the removal of the offending stimulus. Antifibrinolytic agents are required for patients with life-threatening bleeding.
Nutritional Treatments for Anemia
The amount of food we eat that aids in hemoglobin synthesis is important in treating that condition. In general, foods high in iron, copper, zinc, folic acid, Vitamin B-12, and protein should be focused in the treatment of anemia. The combination of iron and B-vitamins is particularly good for anemia treatment.
- Vitamin B12
PA can be caused by low vitamin B12. Vitamin B12 supplements are frequently used to treat this type.
Breakfast cereals with added vitamin B12 are good sources of vitamin B12. Meats like beef, liver, fish, and poultry; Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers, Eggs, and dairy products (such as milk, yogurt, and cheese).
- Folic Acid
Folic acid (folate) is a type of B vitamin found in foods. To make and maintain new cells, your body needs folic acid.
Also, for pregnant women, folic acid is very important. It helps them prevent anemia and encourages healthy fetal growth.
Bread, rice with added folic acid, spinach, and other dark green leafy plants, black-eyed peas, and dried beans, beef, eggs, bananas, oranges, and other fruit and juices are good sources of folic acid.
- Vitamin C
Vitamin C aids iron absorption in the body.
Vegetables and fruits, particularly citrus fruits, are high in vitamin C. Citrus fruits such as oranges, grapefruits, tangerines, and similar fruits.
Fresh and frozen fruits, vegetables, and juices typically contain more vitamin C than canned fruits, vegetables, and juices.
Kiwi fruit, strawberries, and cantaloupes are also high in vitamin C.
Broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach are high in vitamin C.
- Honey
Honey is a potent source of iron, copper, and manganese. When these elements are combined, they aid in hemoglobin synthesis. Honey is, therefore, a powerful weapon against that condition.
- Legumes and Nuts
Legumes and nuts such as pulses, almonds, whole grain cereals, dry dates, peanuts, and walnuts are effective against the symptoms and causes.
Summary
Anemia is defined as a decrease in the number of red blood cells or hemoglobin in the blood. It is a common nutritional deficiency disorder and a global public health problem that affects both developing and developed countries. It is a disease that affects up to one-third of the global population, but in many cases, it is mild and asymptomatic and does not require management. Pathophysiology varies greatly depending on the underlying cause.
It is caused by one of three different processes. Reduced red blood cells (RBCs) production, increased RBCs destruction, and blood loss the causes of anemia are also determined by whether it is hypoproliferative or hyperproliferative.
The signs and symptoms are weakness, lethargy, restless legs, shortness of breath, particularly on exertion, near-syncope, chest pain, and reduced tolerance to exercise. The majority of patients experience symptoms when hemoglobin falls below 7.0 g/dL.
Common types include IDA, PA, hemolytic anemia, SCA, thalassemia, and AA. If that condition undiagnosed or untreated for a long time, it may result in multiorgan failure and even death. Chronic anemia most often affects the cardiovascular system. Anemia during pregnancy increases the risk of anemia in the baby as well as increased blood loss.
Family history, nutritional history, evaluation of vital signs, and laboratory measurements are all important in diagnosis. Treatment depends mainly on treating the underlying cause, i.e., Anemia due to acute blood loss can be treated with IV fluids while Anemia due to nutritional deficiencies oral/IV iron, B12, and folate. Focusing on foods high in iron, copper, zinc, folic acid, Vitamin B-12, and protein. The combination of iron and B vitamins is particularly beneficial in the treatment of that condition.
References
- Turner, J. (2020, September 10). Anemia. Retrieved April 19, 2021, from PubMed
- N. (n.d.). (PDF) a review ON anemia – types, Causes, symptoms and their treatments. Retrieved April 19, 2021, from Researchgate
- SM;, C. (n.d.). Anemia: Diagnosis and management. Retrieved April 19, 2021, from PubMed
- I;, C. (n.d.). Anemia in clinical practice-definition and classification: Does hemoglobin change with aging? Retrieved April 19, 2021, from PubMed
- Conrad, M. (1990, January 01). Anemia. Retrieved April 19, 2021, from PubMed
- Freeman, A. (2020, August 04). Anemia screening. Retrieved April 19, 2021, from PubMed
- The Royal Children’s Hospital Melbourne. (n.d.). Retrieved April 19, 2021, from The Royal Children’s Hospital
Global anaemia prevalence and number of individuals affected. (2008, July 09). Retrieved April 20, 2021, from WHO
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