Anemia

Anemia refers to decreased capacity of the blood to carry oxygen.

Anemia can occur due to various causes, especially the ones resulting in reduced iron or hemoglobin in the body. This can be due to:

-       Blood loss

-       Reduced production of red blood cells

-       Destruction of red blood cells due to any reason

Causes of Anemia

Several conditions that may lead to anemia include:

-       Impaired production of red blood cells

o   Disturbances in stem cells proliferation and differentiation

§  Pure red cell aplasia

§  Aplastic anemia

§  Insufficient erythropoietin production due to renal failure

§  Anemia related to various endocrine disorders

o   Disturbances in erythroblasts proliferation and differentiation

§  Pernicious anemia (vitamin B12 deficiency)

§  Folic acid deficiency

§  Anemia of prematurity

§  Iron deficiency anemia

§  Thalassemia, resulting in deficient synthesis of globin

§  Congenital dyserythropoeitic anemias, resulting in ineffective erythropoiesis

§  Anemia caused by renal failure, causing dysfunction of stem cells too

o   Other impaired RBC production mechanisms

§  Myelodysplastic syndrome

§  Myelophthistic anemia, when the bone marrow is replaced by granulomas, malignant tumors or other materials

§  Anemia of chronic inflammation

-       Increased destruction of red blood cells (hemolytic anemias)

o   Intrasorpuscular abnormalities

§  Hereditary elliptocytosis

§  Hereditary spherocytosis

§  Abetalipoproteinemia (resulting in membrane lipids defects)

§  Enzyme deficiencies

·      G6PD and glutathione deficiencies, resulting in increased oxidative stress

·      Hexokinase deficiency

·      Pyruvate kinase deficiency

§  Hemoglobinopathies

·      Sickle cell anemia

·      Unstable hemoglobin

§  Paroxysmal nocturnal hemoglobinuria

o   Extracorpuscular abnormalities

§  Mediated by antibodies

·      Warm autoimmune hemolytic anemia

·      Cold agglutinin hemolytic anemia

·      Rh disease

·      Transfusion reaction

§  Mechanical trauma to red blood cells

·      Microangiopathic hemolytic anemias, including:

o   Thrombotic thrombocytopenic purpura

o   Disseminated intravascular coagulation

·      Infections, including:

o   Malaria

·      Heart surgery

·      Haemodialysis

-       Blood loss anemia

o   Due to trauma

o   Anemia of prematurity

o   Lesions in gastro intestinal tract

o   Gynecologic issues, resulting in acute or chronic blood loss

o   Menstrual blood loss

o   Intestinal nematodes infections (worm infestations)

-       Fluid overload, causing decreased hemoglobin concentration

o   Excessive fluid or sodium intake or retention

o   Anemia of pregnancy

Symptoms of Anemia

Anemia doesn’t always present with obvious symptoms in all patients and that’s why it goes unnoticed in many patients.

The symptoms of anemia are related to the underlying cause mainly. Common symptoms of anemia include:

-       Weakness

-       Fatigue

-       Malaise

-       Lack of concentration

-       Dyspnea on exertion

In patients with moderate or severe anemia, the symptoms can be more serious too, like:

-       Increased cardiac output, presenting as:

o   Angina

o   Palpitations

o   Intermitted claudication

o   Symptoms of heart failure

-       Pallor (discoloration and paleness of skin, mucosal lining, nail beds and conjunctiva)

-       Spleen enlargement

-       Low blood pressure

-       Heart murmurs

-       Ventricular hypertrophy

-       Bounding pulse

-       Change in the color of stools

Certain signs are specific for various types of anemia, like:

-       Koilonychia – iron deficiency anemia

-       Jaundice – hemolytic anemia

-       Leg ulcers – sickle cell disease

-       Bone deformities – thalassemia major

-       Restless leg syndrome and Pica (consumption of non food items like paper, grass, wax, ice, hair, dirt, etc.) – iron deficiency anemia (although not always necessarily associated with it)

Chronic anemia can result in several changes and disturbances in the behavior of the patient too, especially children. In infants, it can result in impaired neurological development while in school age children it can result in reduced performance in school.

Diagnosing Anemia

Anemia is diagnosed on the basis of history, physical examination and laboratory investigations.

Tell your complete past and current medical history to your doctor. If he’ll suspect anemia in you, he will evaluate you in detail during physical examination and ask questions accordingly.

He might advice blood tests or other laboratory investigations to confirm his diagnosis and to find out the underlying cause of your condition.

Laboratory investigations usually performed depend upon the underlying cause and the type of anemia.

Usually, tests done for anemia are:

-       Blood complete picture (also called: blood cp, cbc)

-       Blood electrophoresis – for thalassemia usually

-       Stool examination for occult blood

Treatment of Anemia

Treatment of anemia depends upon the causative underlying cause of the condition.

Common treatments include:

-       Dietary improvements

o   Diet rich in green leafy vegetables

o   Apple and other iron rich foods

-       Supplements

o   Iron supplements

o   Vitamin B12 supplements

o   Folic acid supplements

-       Medication to cure or control the underlying cause of anemia

-       Blood transfusion

Your doctor will evaluate your condition and advice the best possible treatment options available in your specific case. Don’t self medicate and consult a doctor when you’re having any of the symptoms of anemia.

Several forms of anemia can’t be prevented, especially the ones caused due to genetic disorders including enzyme deficiencies and thalassemia. However, best way to avoid and prevent anemia is to keep a healthy diet and don’t take any blood loss condition lightly and consult your doctor immediately in case of any blood loss or suspicion of anemia.