Understanding of Anemia. Types,causes and symptoms.
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Anemia is characterized by a deficiency of healthy red blood cells or hemoglobin, leading to symptoms like fatigue and pallor. There are several types of anemia, including iron-deficiency anemia, vitamin deficiency anemia, aplastic anemia, chronic disease anemia, hemolytic anemia, thalassemia, and sickle cell anemia, each with distinct causes, symptoms, and treatments. Diagnosis often involves blood tests, and treatment may include dietary changes, supplements, medications, or blood transfusions depending on the type.
Understanding of Anemia. Types,causes and symptoms.
- 1. Understanding of Anemia Prepared by Monnaf Ali MSc in OTAT
- 2. Introduction: Anemia is a condition where the blood lacks enough healthy red blood cells (RBCs) or hemoglobin, leading to decreased oxygen delivery to the body’s tissues. Hemoglobin, a protein within RBCs, is crucial because it binds to oxygen in the lungs and transports it to the body cells. Anemia can affect all organ systems and often presents as fatigue, pallor, shortness of breath, and, in severe cases, symptoms like dizziness or chest pain. According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men.
- 3. Types of Anemia 1.Iron-Deficiency Anemia: Iron-deficiency anemia is the most common form of anemia and occurs when the body lacks enough iron to produce adequate levels of hemoglobin, the oxygen-carrying component of red blood cells. Causes: ◦ Inadequate Iron Intake: Poor dietary intake of iron-rich foods e.g., red meat, beans, leafy greens. ◦ Blood Loss: Chronic blood loss from heavy menstrual periods, gastrointestinal bleeding e.g., ulcers, colon cancer. ◦ Increased Iron Demand: Pregnancy, lactation, or growth periods in children and teenagers increase the body's need for iron. ◦ Malabsorption: Conditions like celiac disease or surgeries e.g. gastric bypass that affect the intestine’s ability to absorb iron.
- 4. Symptoms: ◦ Fatigue and general weakness. ◦ Pale or "sallow" skin. ◦ Brittle nails and hair loss. ◦ Swollen or sore tongue (glossitis). ◦ Unusual cravings for non-food items, like ice, dirt, or starch (a condition known as pica). ◦ Shortness of breath, especially with physical activity ◦ Dizziness or lightheadedness.
- 5. Diagnosis: ◦ Complete Blood Count (CBC): Checks hemoglobin and hematocrit levels to assess anemia. ◦ Iron Studies: Includes serum iron, ferritin (iron storage protein), total iron-binding capacity (TIBC), and transferrin saturation to confirm iron deficiency. Treatment: ◦ Iron Supplements: Oral iron supplements (ferrous sulfate) are commonly prescribed, and intravenous iron may be used if oral iron is not tolerated or effective. ◦ Dietary Changes: Increasing intake of iron-rich foods (e.g., red meat, poultry, seafood, beans, spinach) and pairing with vitamin C-rich foods (e.g., citrus fruits) to enhance iron absorption. ◦ Addressing Blood Loss: Identifying and treating underlying causes of blood loss, such as ulcers or heavy menstrual periods.
- 6. 2.Vitamin Deficiency: Vitamin deficiency occurs when the body lacks essential vitamins needed for various physiological processes, including cell growth, immune function, and energy production. Vitamin deficiencies can lead to a range of health problems depending on the specific vitamin(s) that are lacking. Among the most critical deficiencies related to anemia are those involving vitamin B12, folate (vitamin B9), and, occasionally, vitamin C. Each deficiency impacts red blood cell production, leading to Vitamin Deficiency Anemia if untreated.
- 7. Types ofVitamin Deficiency Anemia a)Vitamin B12 Deficiency Anemia: ◦ Role of B12:Vitamin B12 is essential for DNA synthesis and proper red blood cell production in the bone marrow. ◦ Causes: Dietary Deficiency: Common in vegetarians or vegans, as B12 is found mainly in animal products (e.g., meat, dairy). Absorption Issues: Conditions like pernicious anemia, where the body lacks intrinsic factor (a protein needed to absorb B12), and digestive diseases (e.g., celiac, Crohn’s disease) interfere with absorption. Aging: Older adults often have reduced stomach acid, which is necessary to absorb B12. ◦ Symptoms: Fatigue, shortness of breath, pale skin, as well as neurological issues like tingling in hands and feet, memory loss, and mood disturbances.
- 8. b) Folate (Vitamin B9) Deficiency Anemia: ◦ Role of Folate: Folate is crucial for DNA production and cell division, especially in red blood cell formation. ◦ Causes: Dietary Deficiency: Folate is found in green leafy vegetables, beans, and fortified foods, so deficiencies may arise from poor diet. Increased Demand: Pregnancy, lactation, and periods of rapid growth (like in adolescence) increase folate requirements. Malabsorption: Digestive disorders and alcoholism can impair folate absorption. ◦ Symptoms: Similar to B12 deficiency—fatigue, pallor, shortness of breath, and, in severe cases, swollen tongue or mouth sores.
- 9. c)Vitamin C Deficiency (Scurvy): ◦ Role ofVitamin C:Although not directly related to red blood cell production, vitamin C helps with iron absorption, which is vital for preventing iron-deficiency anemia. ◦ Causes: Lack of vitamin C-rich foods in the diet (such as citrus fruits and vegetables), particularly in older adults, those with limited diets, or those with alcoholism. ◦ Symptoms: Gums that bleed easily, fatigue, joint pain, slow wound healing, and easy bruising. Causes : Poor Diet: Lacking fruits, vegetables, and, for B12, animal products. Malabsorption: Conditions like celiac disease, Crohn's disease, and gastric surgeries can impair the body’s ability to absorb vitamins. Increased Need forVitamins: Pregnancy, lactation, rapid growth, or illness can increase vitamin requirements. Medications: Certain drugs, including antacids and some diabetic medications, can interfere with vitamin absorption.
- 10. Symptoms ofVitamin Deficiency Anemia: Symptoms: ◦ Fatigue and weakness ◦ Pale or yellowish skin ◦ Shortness of breath ◦ Dizziness and lightheadedness B12 Deficiency-Specific Symptoms: ◦ Tingling or numbness in hands and feet ◦ Memory issues and mood disturbances Folate Deficiency-Specific Symptoms: ◦ Swollen or sore tongue ◦ Digestive issues like nausea and diarrhea Vitamin C Deficiency-Specific Symptoms: ◦ Bleeding gums, skin bruising, and slow wound healing
- 11. Diagnosis: Vitamin deficiency anemias are typically diagnosed through blood tests that measure levels of: Vitamin B12 and Folate: Directly measure the amount in the blood. Red Blood Cell Characteristics: Certain types of anemia are characterized by larger-than-normal red blood cells (macrocytic anemia) in B12 or folate deficiencies. Treatment: ◦ Vitamin B12: May be given orally or by injection if absorption is an issue. ◦ Folate: Folic acid supplements, especially recommended for pregnant women to prevent birth defects. ◦ Vitamin C: Supplements or increasing intake of vitamin C-rich foods. Dietary Changes: ◦ B12: Include animal products like meat, dairy, and eggs; fortified foods or supplements for vegetarians/vegans. ◦ Folate: Consume more leafy green vegetables, beans, and citrus fruits. ◦ Vitamin C: Increase fruits and vegetables, such as oranges, strawberries, and bell peppers.
- 12. 3. Aplastic Anemia: ◦ Aplastic anemia is a condition where the bone marrow does not produce sufficient blood cells. ◦ It affects red blood cells, white blood cells, and platelets, leading to pancytopenia (deficiency in all three types of blood cells). Bone Marrow Function: ◦ The bone marrow is responsible for producing new blood cells, which are crucial for oxygen transport, immune response, and blood clotting. ◦ In aplastic anemia, the bone marrow becomes "aplastic," meaning it has reduced function and may be replaced by fatty tissue.
- 13. Causes: ◦ Autoimmune Reaction:The body’s immune system attacks bone marrow stem cells, preventing blood cell production. ◦ Toxins and Chemicals: Exposure to pesticides, benzene, or arsenic can damage bone marrow. ◦ Medications: Certain antibiotics, anti-seizure medications, and chemotherapy drugs can cause marrow suppression. ◦ Infections:Viral infections like hepatitis, Epstein-Barr virus (EBV), HIV, and cytomegalovirus (CMV) have been linked to aplastic anemia. ◦ Inherited Conditions: Rare genetic disorders, such as Fanconi anemia and dyskeratosis congenita, predispose individuals to aplastic anemia. ◦ Idiopathic: In many cases, the cause of aplastic anemia is unknown.
- 14. Diagnosis: ◦ BloodTests: Complete blood count (CBC) to check for low levels of red and white blood cells and platelets. Reticulocyte count to measure young red blood cells, indicating bone marrow activity. ◦ Bone Marrow Biopsy: A biopsy is often done to assess the bone marrow's cellular content and confirm a diagnosis of aplasia (absence or reduction of blood- forming cells).
- 15. Treatment: ◦ BloodTransfusions: Temporarily manage symptoms by replenishing red blood cells and platelets. ◦ ImmunosuppressiveTherapy: Medications such as antithymocyte globulin (ATG) and cyclosporine can suppress immune activity that may be attacking the bone marrow. ◦ Bone Marrow (Stem Cell)Transplant: For eligible patients, especially younger individuals with a matching donor, a transplant can replace defective bone marrow. ◦ Growth Factors: Medications like granulocyte-colony stimulating factor (G-CSF) may be given to stimulate white blood cell production. ◦ Antibiotics and Antivirals: Prevent and treat infections due to low white blood cell counts.
- 16. 4.Chronic disease Anemia: ◦ ACD is a type of anemia that occurs as a secondary condition to long- term inflammatory, infectious, or malignant diseases. ◦ Characterized by low to moderate hemoglobin levels, often mild compared to other types of anemia. Causes: ◦ Chronic Infections:Tuberculosis, HIV, chronic bacterial or fungal infections. ◦ Chronic Inflammatory Diseases: Rheumatoid arthritis, inflammatory bowel disease, lupus. ◦ Cancer:Various types of cancer, especially those causing chronic inflammation, such as lymphoma or leukemia. ◦ Kidney Disease: Often accompanies chronic kidney disease due to reduced erythropoietin production.
- 17. Mechanism: ◦ Iron Metabolism: Chronic inflammation affects the body’s ability to properly use iron. Iron gets sequestered (stored) in macrophages and liver cells rather than being available for red blood cell production. ◦ Hepcidin Regulation: In response to inflammation, the liver releases more hepcidin, a hormone that prevents iron from being released into the bloodstream and reduces iron absorption from the diet. ◦ Red Blood Cell Production: Inflammatory cytokines (e.g., IL-6) inhibit erythropoietin production, reducing red blood cell formation in the bone marrow. Symptoms: ◦ Symptoms often overlap with those of the underlying chronic condition. ◦ General anemia symptoms may include fatigue, pale skin, weakness, and shortness of breath. ◦ Symptoms may be mild because ACD typically results in only a moderate decrease in hemoglobin levels.
- 18. Diagnosis: Complete Blood Count (CBC): Shows low to moderate anemia with normal or low MCV (mean corpuscular volume). Iron Studies: Low Serum Iron: Low iron in the bloodstream due to sequestration. High or Normal Ferritin: Reflects iron storage levels, often normal or elevated in ACD due to inflammation. LowTransferrin andTIBC: Transferrin levels are often reduced, indicating less iron transport in the bloodstream. ◦ Differential Diagnosis: ACD is often differentiated from iron- deficiency anemia by higher ferritin levels and lower transferrin levels in ACD, whereas both are typically low in iron-deficiency anemia.
- 19. Treatment: ◦ Treat Underlying Condition: Managing the chronic disease or inflammation can help improve anemia. ◦ Erythropoiesis-Stimulating Agents (ESAs): In some cases, ESAs are prescribed to stimulate red blood cell production, especially in chronic kidney disease. ◦ Iron Supplementation:Typically ineffective for ACD alone due to sequestration of iron; however, may be used if ACD is combined with iron deficiency. ◦ BloodTransfusions: Rarely used unless anemia is severe, as transfusions are generally only a temporary solution.
- 20. 5. Hemolytic Anemia: Hemolytic Anemia is a condition where red blood cells are destroyed faster than the bone marrow can produce them, leading to anemia. Causes: It can be caused by autoimmune diseases, infections, inherited conditions (e.g., sickle cell anemia, thalassemia), or exposure to toxins, medications, or mechanical stress (e.g., heart valves). Symptoms: Fatigue, jaundice (yellowing of the skin and eyes), dark urine, rapid heart rate, and an enlarged spleen or liver. Diagnosis: Blood tests showing low red blood cell count, high reticulocyte count, and increased levels of bilirubin. Treatment: Includes addressing the underlying cause, blood transfusions, corticosteroids, or immunosuppressive drugs, and in some cases, splenectomy.
- 21. 6.Thalassemia Anemia: Thalassemia Anemia is a genetic blood disorder characterized by the body’s inability to produce enough hemoglobin, leading to the destruction of red blood cells and anemia. Types: ◦ AlphaThalassemia: Caused by mutations in the alpha-globin gene. ◦ BetaThalassemia: Caused by mutations in the beta-globin gene. Symptoms: Fatigue, weakness, pale skin, jaundice, delayed growth, and in severe cases, heart problems or bone deformities. Diagnosis: Blood tests showing abnormal hemoglobin levels and genetic testing to identify mutations. Treatment: Includes regular blood transfusions, iron chelation therapy to remove excess iron, and in severe cases, bone marrow or stem cell transplant.
- 22. 7. Sickle Cell Anemia: Sickle Cell Anemia is a genetic blood disorder where red blood cells, which are normally round, become crescent or "sickle" shaped. These misshapen cells cause blockages in blood flow, leading to pain, organ damage, and other complications. Cause: Caused by a mutation in the hemoglobin gene (specifically hemoglobin S). It is inherited in an autosomal recessive pattern, meaning a person needs two copies of the mutated gene to have the disease. Symptoms: ◦ Painful episodes (called sickle cell crises). ◦ Fatigue. ◦ Jaundice (yellowing of skin and eyes). ◦ Swelling in the hands and feet. ◦ Frequent infections. ◦ Delayed growth in children.
- 23. Diagnosis: Blood tests showing sickle-shaped red blood cells and hemoglobin electrophoresis to identify hemoglobin . Treatment: ◦ Pain management during crises. ◦ Blood transfusions. ◦ Hydroxyurea medication to reduce crises. ◦ Bone marrow or stem cell transplants (curative for some cases).
- 24. Any Questions?