Anemia ~ Pureheal96

Anemia:

It is a condition in which the level of red blood cells or hemoglobin concentration decreases according to age, sex or race.

Anemia is the major concern in today’s era. Almost 1/3^rdof the global population is suffering from anemia. But not all develop the clinical symptoms.

Normal range:

13.5 to 18 gm. /dl in men

12 to 15 gm. /dl in women

11 to 16 gm. /dl in children

During pregnancy it should be at least 10 gm. /dl or more

Most of the individual suffers from symptoms when the Haemoglobin is < 7 gm. /dl.

Erythropoietin (EPO) is the hormone which is produced by the kidneys, helps in the production of the RBCs. Hypoxia (decrease in oxygen level in body) is the triggering factor for the EPO. Oxygen level is inversely proportional to the EPO level. Renal failure leads to anemia.

The condition is common in old age group and nursing age group by 20% and 50% - 60% respectively. In elderly population, 1/3^rd of them have nutritional deficiency anemia. Another 1/3^rd have either renal failure or chronic inflammation.

Types and etiology:

Signs and Symptoms:

Signs:

· Cold skin

· Tachypnea (abnormal rapid breathing)

· Decrease blood pressure

· Pale conjunctiva and mucous membrane

· Glossitis and Cheilitis

· Jaundice in case of hemolysis

· Abdominal examination: Suggestive of splenomegaly, or hepatomegaly.

· Cardiovascular: Tachycardia, systolic murmur, Koilonychia, and petechiae.

Symptoms:

· Weakness/ tiredness

· Lethargy

· Restless leg

· Difficulty in breathing

· Pain in chest

· Reduce in exercise tolerance

· Increased desire to eat non dietary substance

How to evaluate?

Individual with above signs is likely to have anemia, however to evaluate the disease work up study is required.

· Complete blood count (CBC): It shows decrease amount of hemoglobin

· From CBC further evaluation is needed to know the type of anemia. Calculate the corrected reticulocyte count = % reticulocytes x (patient’s HCT/ normal HCT). If result is >2, it is suggestive of acute blood loss or hemolysis. If <2, it is suggestive of hypoproliferation.

· Look out the value of MCV whether it is, <80fL, 80-100fL or >100fL.

· In case of hemolytic anemia LDH increases.

· Corrected reticulocyte count >2%.

· Increased indirect bilirubin.

· Decreased hepatoglobin.

· In extra-vascular hemolysis: Spherocytes are present; urine hemosiderin- negative; urine hemoglobin- negative. Whereas in intravascular hemolysis: urine hemosiderin- elevated; urine hemoglobin- elevated

· Other investigations: Esophagogastroduodenoscopy, colonoscopy, ultrasonography, or MRI study.

Treatment:

· In case of acute blood loss: IV fluids are found to be effective. Oxygen therapy to compensate the demand of the tissues.

· In nutritional deficiency anemia: Oral/IV iron, Vitamin B12 and folate supplements are to be prescribed.

· If there is defect in bone marrow: stem cells therapy or bone marrow transplantation is effective.

· Underlying conditions such as, renal failure or autoimmune diseases needs to be treated.

· Red cell destruction: avoid medication which are responsible for causing more RBC destruction. Persistent haemolytic anemia requires splenectomy.

· In case of sickle cell anemia, thalassemia major, blood transfusion is must. Hydroxyurea decrease the sickling effect.

· Antifibrinolytic agents, in life threatening bleeding is required.

Prognosis depends on the type of anemia.

Complications:

· As soon as anemia is detected, the treatment should be started immediately. If left untreated for longer time, it leads to Multiple Organ Dysfunction Syndrome (MODS).

· In pregnant women, it can cause premature labor or low birth weight baby.

· In old age patients: Mainly cardiovascular system is affected, causes angina, myocardial infarction, and high output failure. Other than this it can even cause arrhythmia and cardiac hypertrophy.

· Severe decrease in iron level leads to, restless leg syndrome and esophageal web.

· At very young age, anemia have major effect on nervous system. There is cognitive, mental, and developmental delay. Milestones are delayed.

Questions to be asked during case taking related to anemia:

· Presence of blood in stool

· Black, tarry and offensive stool

· Hemorrhoids

· Diet history

· Any surgical history

· Family history

· About medicines, if taken daily