ANEMIA PROFILE

What is Anemia (Anaemia)?

Blood contains RBC (red blood cells), which carries oxygen from lungs to tissues. Hemoglobin (Hb) found in RBCs binds oxygen and delivers it to the peripheral tissue. Fall in hemoglobin level in blood is called anemia. Fall in the hemoglobin content carries less oxygen to the tissue and causes hypoxia.

What are the symptoms of Anemia?

Sign and symptoms of anemia may vary according to the underlying cause and severity. Mild cases may be asymptomatic. The most common symptoms are:

Generalised weakness
Breathlessness
Palpitations
Dizziness
Headache
Pale skin
Irritability
Loss of apatite
Generalised/ pedal/ facial swelling

What are the causes of anemia?

Anemia may be classified according to the cause of anemia:

A) Congenital anemia- Anemia present since birth are inherited disorder present in families.

· Hemoglobinopathies are most common genetic diseases of hemoglobin- Thalassemia, Sickle cell anemia

· Red cell enzyme deficiencies -G6PD

· Red cell membrane disorders- hereditary spherocytosis

B) Acquired Anemia

Nutritional anemias (e.g. iron deficiency anemia, and folate deficiency)
Disorders of heme production (e.g. sideroblastic anemia)
Polycythemia (increased red blood cells)
Hemochromatosis
Hemorrhage
Malignancies

Anemia may be classified as-

1. Decreased red cell production e.g. aplastic anemia

2. Increased red cell destruction- Hemolytic anemia

3. Nutritional deficiency anemia

Depending on size of red cell:

1. Macrocytic/ Megaloblastic anemia

2. Microcytic anemia

Different types of anemia have different causes such as:

Iron deficiency anemia: This type of nutritional deficiency anemia is most common type of anemia is caused by a deficiency of iron in the body. Iron is needed to be incorporated in hemoglobin to carry oxygen. Less iron supply will lead to less hemoglobin production. Iron deficiency causes microcytic anemia.
Vitamin deficiency anemia: Besides iron, folate and vitamin B-12 (methyl cobalamin) are required to produce hemoglobin. B 12 and or Folic acid deficiency causes macrocytic anemia.
Anemia of chronic disease/ inflammation: Such as HIV/AIDS, cancer, tuberculosis, chronic kidney disease, Crohn's disease, rheumatoid arthritis, and other acute or chronic inflammatory diseases can interfere with the production of red blood cells.
Anemia associated with bone marrow diseases: A variety of diseases, such as aplastic anemia, leukemia and myelofibrosis can cause anemia by affecting red cell production.
Hemolytic anemia: RBCs are destroyed faster than the production. Red cell defects like congenital abnormalities e.g. Thalassemia, Spherocytosis leads to increased red cell destruction which causes hemolytic anemia.
Hemorrhagic anemia: Hemorrhage due to injury or other diseases like hemorrhagic hemorrhoids, hemorrhagia may cause anemia.

What are the risk factors of anemia?

A diet deficient in vitamins and minerals: A diet consistently low in iron, vitamin B12, folic acid and mineral like copper, magnesium can increases the risk of developing or aggravating anemia.
GIT disorders: Gastrointestinal disorder may affects the absorption of nutrients.
Menstruation: Menstruation causes regular loss of blood putting female on increased risk of anemia before menopause.
Pregnancy: During pregnancy nutrients requirement increases which causes anemia if not supplemented.
Chronic diseases: chronic diseases also increase the risk of development of anemia.
Family history: Family history of an inherited anemia such as Thalassemia, Sickle cell anemia increases the risk of anemia.
Socioeconomic status: Nutritional deficiencies are more common in low socioeconomic group.
Age: Children/ infants solely on milk and elders over age 65 are at increased risk of anemia.

What are the complications of anemia?

Untreated anemia can cause many complications such as:

Extreme fatigue: Severe anemia may cause disturbance of even everyday routine tasks.
Abnormal fetal growth: Anemia during pregnancy can cause fetal hypoxia and folic acid deficiency may cause congenital abnormalities.
Cardiac effects: Severe anemia is a hyper dynamic state increasing workload on heart. Heart failure may occur.

How anemia is diagnosed?

Anemia is diagnosed by laboratory investigations along with clinical sign and symptoms
Lab investigations:
Hemoglobin: Hb level in male less than 13 and in female less than 12 gm%
Hematocrit values less than 40% in men and less than 35% in female.
Lab investigations to detect the cause of anemia
Peripheral blood film: To see the size, color and variation in RBC size.
Serum Iron studies: Serum iron, TIBC, UIBC, Transferrin saturation, Serum Ferritin
Serum B 12 level
Serum Folic acid level
Hb Electrophoresis/ HPLC
Bone marrow examination

What is the treatment of anemia?

· Anemia is treated by treating the underlying specific cause of anemia.

Nutrient supplementation: Supplementation of deficient nutrient treats the deficiency anemia. Sometimes supplementation may be needed parentral administration.
If the cause of iron deficiency is blood loss other than menstruation then the source of the bleeding must be diagnosed and treated.
Routine supplementation of iron and folic acid during pregnancy and lactation.
In severe cases blood transfusion may be required. In some inherited disorders/ aplastic anemia blood transfusion may be required lifelong.