What is Anemia? -Types, common symptoms, causes and treatment - Simplified Study

Introduction

RBC is response for transporting oxygen and nutrition around the body and to provide energy to our muscle and organ

Table of Contents

Anemia

1.Decrease amount of hemoglobin or Reduced number of RBC

2.According WHO, Hemoglobin below 13 gm/dl for adult male, 12gm/dl for non-pregnant woman and below 11gm/dl for pregnant woman (according ICMR 1 gm/di below WHO).

Anemia may be due to

1.Blood loss anemia

2.Anemia of chronic disease (e.g. malignancy, bone marrow, immunodeficiency syndrome, renal & liver disease).

3.Nutritional anemia (deficiency of iron, folic acid, protein or vitamin B12).

4.Hereditary anemia (e.g. thalassemia & sickle cell).

Common signs and symptoms of All types of Anemia

General appearance

Fatigue, Weakness, Weight loss, Decrease muscle tone so disturbance in gait & balance. Beefy red tongue (sore mouth) in pernicious anemia and megaloblastic anemia. Pancytopenia (deficiency of all type of blood cells) in aplastic anemia.

Skin

• Pallor (lack of color)
• Delayed wound healing and cold intolerance.

Respiration

• Tachypnea
• Dyspnea

Cardio vascular system

• Tachycardia
• Increase cardiac output
• Angina
• Cardiomegaly

Genitourinary

• Hematuria
• Irregular menses
• Loss of libido in male & female and impotence

Neurological

• Headache
• Irritability
• Apathy
• Numbness

Gl tract

• Anorexia
• Nausea
• Diarrhea
• Constipation

Types of anemia

1. Iron deficiency anemia
2. Pernicious anemia or Addison's anemia
3. Megaloblastic Anemia
4. Aplastic or Hypoplastic Anemia
5. Thalassemia
6. Sickle Cell Anemia (hemoglobinopathies)

Iron deficiency anemia

It is a most common type of anemia.
It occurs due to deficiency of iron in diet, inadequate absorption or excessive loss of iron. RBC are microcytic and hypochromic. It is commonly present in developing countries (like India) especially in menstruating woman and young children.

Causes of iron deficiency Anemia

• Iron lost through sweat (15mg/month).
• Hookworm infestation (each worm extracts up to 0.05ml blood/days)
• Repeated pregnancy at short interval.
• Excessive blood loss during menstruation due to atonic uterus and chronic malaria.

Diagnosis of iron deficiency Anemia

• Assess serum ferritin (tissues store iron in this form) level to detect iron deficiency into serum.
• An iron-phosphorus-protein complex containing about 23% iron.

Medical management

Advise to take iron rich food (dark green vegetables e.g. spinach, jaggery, dried fruits, egg yolk, liver & meats) with vitamin C (multivitamin or fruit juice) to increase iron absorption.
Take iron supplement between meals and not take with milk or antacids.

Oral iron preparation

Ferrous sulphate (most absorbable form of iron), ferrous fumarate, ferrous gluconate, ferrous succinate (elementary iron 30 to 35%) nursing

Most common side effect of oral iron

1. Nausea
2. vomiting
3. staining of teeth
4. metallic taste
5. constipation & black stool

Advise to take liquid iron preparation through a straw to avoid staining of teeth, also brush teeth immediately after giving iron preparation via mouth.

Parenteral iron preparation - There are two preparation used parenterally

Iron dextran (50 Img elementary iron/ml), Iron sorbitol-citre acid example Jectofer (50 mg elementary iron/ml) and Iron sucrose

Route

Intramuscular - Deep into gluteal muscle by Z track method or air lock method to prevent backward leakage of irritating drugs. Never rub or massage the site after injection.

Intravenous - Mix 2 ml injection with glucose/saline solution and infused within 6 to 8 hour.

Estimation of iron requirement in mg - 4.4x body weight (kg) x Hb deficit (gm/dl) Note - If Hb level below 6 gm%, blood transfusion is the choice of treatment.

Pernicious anemia or Addison's anemia

Anemia due to decrease absorption of vitamin B12, because of absence of intrinsic factor due to atrophy of gastric mucosa.

Intrinsic factor secreted by parietal cells of gastric mucosa/gland, which is essential for absorption of vit. B12.

It is more common in female. It is macrocytic, normochromic anemia.

Diagnosis- of pernicious anemia

Schilling test is use to assess the gastrointestinal absorption of the vitamin by giving oral radioactive vitamin B12 (cyanocobalamin) and injected non-radioactive Biz.

It is used primarily to diagnose pernicious anemia

Treatment-of pernicious anemia

Injection of vitamin B12

Megaloblastic Anemia

Anemia due to dietary deficiency of mainly by folic acid (main cause) and also by vitamin B12. Vitamin B12 and folic acid are necessary for DNA synthesis and cell division, so in absence of vitamin B12 and folic acid cells are unable to divide and increase in size so it called megaloblastic anemia . It is a macrocytic, hypochromic anemia.

Treatment

Vitamin B, & folic acid rich diet like green leafy vegetables (e.g. spinach).

Administer leucovorin calcium (the calcium salt of folinic acid).

Leucovorin calcium used to treat megaloblastic anemia and to antagonize the effect of methotrexate when methotrexate is being used to treat malignancies. on normal cells

Aplastic or Hypoplastic Anemia

Anemia due to bone marrow failure or bone marrow depression.

It may be primary (present at birth) or secondary (acquired).

Its cause includes like chronic exposure to myelotoxic agents (e.g. cytotoxic drugs), radiation, viral infection (ex. HIV, hepatitis virus) and TB.

Bone marrow depression may be genetic or idiopathic (unknown cause).

It is normocytic, normochromic anemia. It causes pancytopenia (decrease number of all blood cells of the blood).

Diagnosis

Bone marrow aspiration show conversion of red bone marrow to fatty bone marrow.

Treatment

Bone marrow transplantation (BMT) is the choice of treatment.

Thalassemia

It is congenital anemia that transmits from one generation to another generation. This is also known as Cooley's anemia or Mediterrancan anemia. Beta thalassemia major is an autosomal recessive disorder. It occurs due to loss of one or both gene from 16 chromosomes. It is microcytic, hypochromic anemia.

Types of Thalassemia

Thalassemia minor (one abnormal gene, it may be completely asymptomatic)

Thalassemia major (both abnormal gene)

1. Alfa thalassemia (defect into alfa globulin chain of hemoglobin).
2. Beta thalassemia (defect into beta globulin chain of hemoglobin) - It is most common type of thalassemia.

Treatment

Blood transfusion is the choice of treatment.

Sickle Cell Anemia (hemoglobinopathies)

RBC contains abnormal hemoglobin, which in absence of O₂ convert to a sickle shape, cells become rigid and clumped together, so obstructing blood capillaries.

It occurs due to substitution of glutamic acid to valine (an amino acid) at position of 6 of beta globulin polypeptides.

Sickle cells block the blood vessels of various organs and damage them e.g. brain, kidney, lungs and spleen.

It is also inherited autosomal recessive trait like thalassemia. Precipitating factors for sickling (sickle cell crisis) are fever, dehydration, stress and any condition that increase oxygen need.

Sickle cell crisis includes vaso-occlusive crisis (clumping of cells in microcirculation), splenic sequestration (pooling and clumping of blood in spleen) and hyper-hemolytic crisis (increased rate of RBC destruction). Patient with sickle cell disease are resistance to falciparum malaria in early childhood.

Treatment

Blood transfusion is the choice of treatment.

Administer adequate oxygen and fluid to prevent or reverse the sickling process/crisis.

Splenectomy, if there is recurrent splenic sequestration.

Diagnosis

Decrease level of - Hemoglobin, Erythrocyte count, Packed cell volume (PCV)

• Mean corpuscles hemoglobin concentration (MCHC) -% of hemoglobin in one RBC (Normal MCHC is 33%).
• Mean corpuscles hemoglobin level (MCH)- Amount of hemoglobin in one RBC (Normal MCH is 30 picogram)
• Mean corpuscles volume (MCV)-Average volume of single RBC (Normal MCV is 90 cubic µm).