Anaemia is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood,or a lowered ability of the RBCs to carry oxygen.
Anemia is a very common blood disorder, affecting about one – third of the global population.
It is more common in women than men, during pregnancy, and in children and the elderly.
SIGNS & SYMPTOMS OF ANAEMIA
- Weakness and/or fatigue
- Poor concentration
- Shortness of breath
- Palpitations i.e. the irregular beating of the heart.
- Angina i.s. chest pain due blockage of the arteries of the heart.
- Pain, numbness or impairment of the legs.
- Pallor i.e. paleness of the skin, especially face and hands.
- Blue coloration of sclera
- Koilonychia i.e. abnormally thin nails that have lost their convexity and become flat or even concave in shape.
- Bone deformations
- Leg ulcers in sickle cell anemia
- Pica: It is a psychological disorder characterized by an appetite for substances that are largely non-nutritive, such as ice,hair, paper, paint, sharp objects, chalk, etc.
- Restless leg syndrome
CAUSES & RISK FACTORS
Anaemia can be caused by the various factors stated below:
Impaired RBC production
- Pure red cell aplasia (PRCA): In PRCA, the bone marrow ceases to produce red blood cells.
- Deficiency or impaired absorption of vitamin B12.
- Deficiency or impaired absorption of iron.
- Certain diseases such as HIV/AIDS, cancer, etc may cause decrease in production of red blood cells.
- Genetic factors may change the shape of red blood cells ( in particular sickle shape).
- Myelophthisic anemia
Increased destruction of RBCs
- Hereditary spherocytosis
- Enzyme deficiency
- Warm autoimmune hemolytic anemia
- Rh disease
- Infections like malaria
- Heart surgery
Anemia from blood loss
- Anemia of prematurity
- Trauma, Surgery causing severe blood loss
- GIT lesions like peptic ulcer
- Gynecologic disturbances
- From menstruation
- From various types of cancer like colon cancer
- From fluid overload
- Infection from H.pyroli
- Untreated celiac disease
- Diet lacking in iron & vitamins.
- Intestinal infections by hookworm
- Drugs like methotrexate
COMPLICATIONS ARISING FROM ANAEMIA
- Severe fatigue
- Complications in pregnancy
- Low immunity
- Fast heart rate
- Thickening of the walls of the ventricles.
- Heart failure
- Kidney failure
- Liver damage
- Early gallstones
- Bone damage
- Low blood pressure
- Hypovolemic short
The following tests are conducted to confirm anaemia:
- A complete blood count (CBC): In this test, the number of all types of cells is calculated, thus determining if the number of cells found in the sample of blood is normal or abnormal.
- Size of red blood cells is also determined using flow cytometry, which also distinguishes between different causes of anemia.
- Reticulocyte count: The quantitative measure of bone marrow’s production of new RBCs.
- Reticulocyte production index: calculation of ration between level of anemia & rise in reticulocyte count.
- Pathological tests used, ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12.
- Bone Marrow Examination.
- Classification of anemia in adult males & females on the basis of severity:
a) mild (110 g/L to normal)
b) moderate (80 g/L to 110 g/L)
c) severe anemia (less than 80 g/L)
TYPES OF ANAEMIA
- Microcytic Anemia: Primarily arises due to hemoglobin insufficiency. A particular cause is iron deficient anemia that is a result of low dietary intake of iron or inability to absorb iron.
- Macrocytic Anemia: Megaloblastic anemia, the most common cause of macrocytic anemia, is due to a deficiency of either vitamin B12, folic acid, or both.
- Normocytic Anemia: A decrease in the overall hemoglobin levels although the RBC size remains normal. Can be due to acute blood loss.
- Dimorphic Anemia: Result of iron deficient anemia & complicated due to nutritional macrocytic anemia.
- Heinz Body Anemia: An abnormal presence of heinz bodies that cause damage to hemoglobin, can be drug induced.
- Hyperanemia: Severe form of anemia, in which the hematocrit is below 10%
- Refractory Anemia: An anemia that does not respond to treatment.
- Transfusion dependent Anemia: It is a form of anemia in which constant blood transfusions are required.
TREATMENT & MANAGEMENT
- Iron supplements, either in the form of tablets, or injections, Eg: Ferrous Sulfate.
- Vitamin C helps in absorbing iron.
- Parenteral Iron where oral iron has failed.
- Patients having severe anemia may be recommended to have blood transfusion, although transfusion is recommended only when hemoglobin is below 60 to 80 g/L.
- Erythropoiesis stimulating agents: These agents aid in increasing the hemoglobin levels to a point where blood transfusions are not needed, but the patient’s needs are met.
- Use of hyperbaric oxygen (HBO) in severe blood loss to meet the needs for oxygen.