The term ‘anemia’ is the Latinized version of the Greek word ‘anaimia’. The meaning could be understood by splitting up the word into two syllables as, ‘an’ meaning ‘without’ and ‘haima’ meaning ‘blood’.Thus directly translating, the term anemia means without blood.
It is a very common condition and a lot of people suffer from it. The World Health Organization (WHO) estimates that about 42% of children under the age of 5 and 40% of pregnant women are anemic worldwide. The incidence of anemia is globally high, especially in low-income settings. Studies have shown that this condition is more common in females than in the male population. This is markedly significant during the childbearing years, during pregnancy and menstrual cycles.
It can be defined as, a decrease in the number of red cells or a decrease in the quantity of hemoglobin leading to a decrease in oxygen-carrying capacity.
It is important to know about the various types in order to know the cause of the underlying conditions,
Based on the appearance of the red blood cells,
When the sizes of the red blood cells are normal and the content of hemoglobin is within the normal range as in hemorrhage, anemia as a result of chronic conditions liked prolonged infection, inflammatory diseases, and certain malignant diseases
When the red blood cells are smaller in size and appear pale as in iron deficiency anemias.
MACROCYTIC OR MEGALOBLASTIC:
When the red blood cells are larger in size and hemoglobin is less comparatively as in vitamin B12 or folic acid deficiencies.
Based on the origin:
It occurs due to deficiency of, iron, folic acid, proteins, vitamin C, and B12.
Anemia as a result of exposure to long hours of radiation treatment or any form of radiation as such, industrial chemical exposure, etc. It is basically a failure of the bone marrow with a reduction in the number of stem cells.
This occurs as a result of excessive destruction of the red blood cells and the bone marrow trying to compensate it by increasing the red blood cell production. Hence in this type red cells are destroyed quickly. Thus, the difference in the production and the renewal cause hemolytic anemia.
The cause might be congenital as in red cell membrane defects like hereditary spherocytosis and elliptocytosis or an enzyme defect as in glucose-6-phosphate deficiencies and pyruvate kinase deficiencies.
Hemoglobin abnormalities include conditions like sickle cell and thalassemia.
Other acquired conditions include,
- Erythroblastosis fetalis
- Infections like malaria
- Drugs and chemicals like dapsone (anti-leprosy agents).
Having seen the basic definition and classification let’s take a look at the normal levels and various symptoms, and a look at how they are linked with the various common conditions of the body.
NORMAL LEVELS OF HEMOGLOBIN IN THE BODY:
The level of hemoglobin differs between various genders, ages and conditions like pregnancy etc.
- MEN: 13-17 gm/dl
- WOMEN: 12-15 gm/dl
- CHILDREN (between the age of 5 and 11) : 11.9 -15 gm/dl
- DURING PREGNANCY:
According to the center for disease control (CDC), hemoglobin levels during the 1st and 3rd trimester of pregnancy should not go below 11gm/dl and during the 2nd trimester, the levels should not drop below 10.5gm/dl. Thus it’s advisable to maintain the levels between 12 and 16 during the entire duration of the pregnancy.
According to the world health organization’s (WHO) classification during pregnancy,
- MILD: Between 9-10 gm/dl
- MODERATE : Between 7-8.9 gm/dl
- SEVERE: Less than 7 gm/dl.
WHO cut-off criteria,
MEN- 130 g/l
HEMATOCRIT VALUES: (SI units)
Men become anemic at levels less than 0.41 volume fractions
Women become anemic at levels less than 0.36 volume fractions
SYMPTOMS OF ANEMIA:
The symptoms vary between various types of anemia like iron deficiency, sickle cell, thalassemia, blood loss anemia, megaloblastic anemia, etc. Yet there are certain features in common for all of them. Let us discuss the symptoms individually for each type of anemia,
IRON DEFICIENCY ANEMIA:
This is a type of anemia that occurs when the body does not have enough iron. Blood lacks adequate or healthy red blood cells which are required to carry oxygen to the body tissues. We might experience the following symptoms,
- Fatigue or weakness that occurs more often than usual
- The nails might become brittle and in severe forms of anemia it might become ‘spoon-shaped’, a condition referred to as ‘koilonychia’.
- The papilla of the tongue might become atrophied.
- Dysphagia or difficulty in swallowing might occur, known as ‘Plummer Vinson syndrome’.
BLOOD LOSS ANEMIA:
In cases of acute hemorrhage, the body replaces the fluid portion of the plasma in 1-3 days leading to normocytic normochromic type. Replacement of RBC takes place in 4–6 weeks. Whereas in cases of chronic hemorrhage, the intestinal mucosa cannot absorb iron adequately, leading to a microcytic hypochromic type of anemia. As a result, the following are seen,
- Weakness, fatigue, lassitude or lethargy, difficult or labored breath, a slower heart rate than normal (bradycardia) etc.
MEGALOBLASTIC ANEMIA (MACROCYTIC):
This anemia is also known as vitamin B12 or folate deficiency anemia. The red blood cells are not produced properly and the cells are too large in size that makes it difficult for these cells to exit the bone marrow and enter into the bloodstream to deliver oxygen to the various tissues. Vitamin B12 and folate deficiency are the most causes of this type of anemia. The symptoms include,
- An inflamed tongue or glossitis
- Inflammation of the oral mucosa
- A pricking sensation present in the fingers and toes
- Loss of myelin in the lateral and posterior column fibers of the spinal cord might occur.
Hemoglobinopathies are a group of blood disorders or diseases that affect the red blood cells.
The hemoglobin variant of anemia is sickle-cell anemia and congenital dyserythropoietic anemia.
Let us correlate the symptoms that occur during anemia and try to understand the actual mechanism behind it,
ANEMIA AND BLOOD PRESSURE:
High blood pressure can be defined as a blood pressure greater than 140/90 mm/Hg.
High blood pressure and anemia are not directly associated, but in certain severe cases of anemia, the oxygen-carrying capacity of the red blood cells are very low that the heart doesn’t receive enough blood or oxygenation, this might lead to heart attacks. Frequently getting your pressure levels checked is very important to avoid these circumstances.
ANEMIA AND CARDIAC HEALTH:
Anemia can worsen cardiac function by making the heart work too much to compensate for the reduced oxygenation and blood flow to various organs. This might cause problems like tachycardia, reduce blood flow to the kidneys, and fluid retention, causing further stress to the heart. Left ventricular hypertrophy is very common in anemia.
ANEMIA AND JOINT DISORDERS:
Anemia can be associated with conditions like rheumatoid arthritis. Since rheumatoid arthritis is a chronic inflammatory condition normochromic normocytic anemias are common. Iron deficiency anemia is also found in these patients.
ANEMIA AND WEIGHT ISSUES:
Anemia is known to cause unhealthy weight loss. Unintentional weight loss along with anemia might be due to other underlying causes as well. It is important to check and address the low iron level in the blood since overweight persons might benefit if the issues are addressed.
ANEMIA AND HAIR LOSS:
Hair loss is common in a lot of patients with anemia, but it is doubtful whether anemia actually causes hair loss. The hair loss might also be due to low levels of iron in the blood.
ANEMIA AND HEADACHES:
Headaches are a common manifestation of anemia. It is common in certain types like iron deficiency, sickle cell, etc. The basic reason is the same, in anemia the oxygen-carrying capacity of the red blood cells is reduced.
ANEMIA AND SPLEENOMEGALY:
Certain types of anemia like hemolytic anemia can cause Splenomegaly. Under these conditions, the red blood cells are damaged and fragmented that might cause the spleen to enlarge. The problem arises when these abnormal red blood cells try to squeeze through the small and delicate capillary blood vessels. This phenomenon is common in sickle cell anemia, thalassemia, and spherocytosis.
ANEMIA AND JAUNDICE:
Again hemolytic anemia may cause the breakdown of the red blood cells causing jaundice. Apart from jaundice certain long-term complications include gallstones and pulmonary hypertension.
ANEMIA AND PREGNANCY:
Anemia that is very common during pregnancy is the iron deficiency type. It is commonly due to folic acid deficiency. A certain extra amount of folate is needed. Proper supplements should be taken during pregnancy. Failing to do so or the body’s insufficiency might cause anemia during pregnancy.
ANEMIA AND GENERAL HEALTH:
Anemia can feel like we overworked even after very simple tasks (fatigue), weakness, shortness of breath, feeling dizzy or giddiness, regular headaches, and palpations. Irregular heartbeats are also common.
ANEMIA AND MENTAL HEALTH:
It can cause a host of psychological problems like irritability, anxiety, depression, and poor focus and concentration.
ANEMIA AND MENSTRUAL CYCLES:
Women with anemia might feel weak and tired. They may experience abnormally heavy periods, which is one big sign of anemia.
ANEMIA AND THYROID ISSUES:
Abnormal thyroid levels such as hypothyroidism and hyperthyroidism are not directly associated with anemia. However, these conditions could be potential causes of anemia. All of these conditions are known to produce fatigue.
ANEMIA AND DIABETES:
These conditions co-exist with one another in patients with certain conditions like albuminuria and reduced renal function. Certain additional factors present in diabetes may contribute or increase the risk of anemia.
ANEMIA AND CHRONIC KIDNEY DISEASES:
This condition could be due to more than one cause. When the kidneys are damaged in the disease process, they produce less amount of ‘erythropoietin’, which is a hormone produced by the kidney and small amounts by the liver, that plays an important role in the production of the red blood cells by signaling our bone marrow.
The decrease in the production of this hormone, decreases the production of red blood cells paving way for anemia. Studies show left ventricular hypertrophy (LVH) of the heart and anemia are highly prevalent in certain moderate cases of chronic kidney diseases.
ANEMIA AND GENETIC MUTATION:
Anemia can also have underlying causes like genetic mutation. Mutations in genes like TMPRSS6 (Transmembrane protease serine 6 aka martipase-2) causes a condition called ‘iron-refractory iron deficiency anemia. The protein component of the gene is martipase-2 which requires instructions from TMPRSS6 for it’s production. This protein and gene are ultimately required to regulate the iron levels of the body. This explains the failure of certain oral iron supplements to improve the iron levels in certain patient’s bodies. These set of people might be suffering from this genetic mutation of the TMPRSS6 gene.
ANEMIA AND PANCYTOPENIA:
Pancytopenia and certain types of anemia are associated with one another. Pancytopenia is a condition wherein all the three types of blood cells like the red blood cells, white blood cells, and platelets are low. This condition has several underlying causes. Certain studies show some of the most common causes include megaloblastic anemia, acute myeloid leukemia, and aplastic anemia. This can be confirmed in a person by means of bone marrow examination.
- Having seen some of the most common conditions and how anemia is associated with them, let’s take a look at how anemia is diagnosed. Diagnosis usually begin by getting a detailed personal and family history
Diagnosing anemia requires certain tests like,
- Running a complete blood count (CBC), a small amount of blood is drawn from the patient as a sample and it is analyzed.
- Hematocrit levels to determine the number of red blood cells present in the blood
- Hemoglobin levels estimation
- Red cell indices
- Peripheral blood smear
- Reticulocyte count
- Estimating iron content in serum
- Serum iron-binding capacity.
- Apart from these sometimes bone marrow smear could be done if certain types of anemia are doubted.
TREATMENT OF ANEMIA:
Treatment of anemia depends on the severity of the condition.
Severe anemia is treated by administering packed cell transfusion. This is helpful in preventing volume overload and hence the sudden congestive cardiac failure.
Mild and moderate forms of anemia are treated by giving iron and B12.
- It is essential to take proteins since they aid in globin formation.
- Certain minerals that are required for erythropoiesis or red blood cell production and maturation are iron, cobalt, copper, and zinc.
- Sometimes the problem may not be due to deficiency, in such cases, hookworm infestations are common, which might prevent the proper iron availability in the body. Thus deworming by means of administering albendazole (anti-anthelmintics) could be useful to solve the issue
- Vitamins that are necessary are Vitamin B12 and folic acid that are necessary for the synthesis of DNA and Vitamin C that promotes iron absorption from the gut.
- In some cases antibiotics are administered, an anti-cancer drug called ‘hydroxyurea’ (droxia, Hydrea, and siklos) is used to treat conditions like sickle cell anemia.
Thus, we can conclude that anemia is a curable condition if it is properly diagnosed in the early phases and supplements are taken on doctor’s advice. Anemia should not be feared and at the same time if diagnosed should be taken seriously and solid changes in the diet and lifestyle should be made to prevent further complications.