Anaemia: Signs, Causes, Treatment & Prevention!

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
  • Dizziness
  • 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
  • Haemodialysis

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

Other factors

  • From fluid overload
  • Infection from H.pyroli
  • Untreated celiac disease
  • IBS
  • Diet lacking in iron & vitamins.
  • Intestinal infections by hookworm
  • Alcoholism
  • Hypothyroidism
  • Drugs like methotrexate
  • Pregnancy 

COMPLICATIONS ARISING FROM ANAEMIA

  • Severe fatigue
  • Complications in pregnancy
  • Low immunity
  • Fast heart rate
  • Thickening of the walls of the ventricles.
  • Heart failure
  • Thalassemia
  • Jaundice
  • Kidney failure
  • Liver damage
  • Early gallstones
  • Bone damage
  • Sepsis
  • Low blood pressure
  • Hypovolemic short
  • Death 

DIAGNOSIS

The following tests are conducted to confirm anaemia:

  1. 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.
  2. Size of red blood cells is also determined using flow cytometry, which also distinguishes between different causes of anemia.
  3. Reticulocyte count: The quantitative measure of bone marrow’s production of new RBCs.
  4. Reticulocyte production index: calculation of ration between level of anemia & rise in reticulocyte count.
  5. Pathological tests used, ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12.
  6. Bone Marrow Examination.
  7. 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.