ANAEMIA

 (also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in
the blood,[3][4] or a lowered ability of the blood to carry oxygen

Symptoms

There are many potential causes of anemia.

The most common symptom of all types of anemia is a feeling of fatigue and a

lack of energy.

Other common symptoms may include:

 paleness of skin

 fast or irregular heartbeat

 shortness of breath

 chest pain

 headache

 light-headedness

In mild cases, there may be few or no symptoms.

Some forms of anemia can have specific symptoms:

 Aplastic anemia: fever, frequent infections, and skin rashes

 Folic acid deficiency anemia: irritability, diarrhea, and a smooth tongue

 Hemolytic anemia: jaundice, dark colored urine, fever, and abdominal

pains

 Sickle cell anemia: painful swelling of the feet and hands, fatigue, and
jaundice

Anemia Caused by Iron Deficiency

 People with an iron deficiency may experience these symptoms:
 A hunger for strange substances such as paper, ice, or dirt (a condition called pica)
  Upward curvature of the nails, referred to as koilonychias
 Soreness of the mouth with cracks at the corners

 Anemia Caused by Vitamin B12 Deficiency

 People whose anemia is caused by a deficiency of Vitamin B12 may have these
symptoms:
 A tingling, "pins and needles" sensation in the hands or feet
 Lost sense of touch
 A wobbly gait and difficulty walking
 Clumsiness and stiffness of the arms and legs
 Dementia
Anemia Caused by Chronic Lead Poisoning
 Chronic lead poisoning may lead to these symptoms:
 A blue-black line on the gums referred to as a lead line
 Abdominal pain
 Constipation
 Vomiting
Anemia Caused by Chronic Red Blood Cell Destruction
 Anemia caused by chronic red blood cell destruction may include these symptoms:
 Jaundice (yellow skin and eyes)
 Brown or red urine
 Leg ulcers
 Failure to thrive in infancy
 Symptoms of gallstones
Anemia Caused by Sudden Red Blood Cell Destruction
 Symptoms of anemia caused by sudden red blood cell destruction may include:
 Abdominal pain
 Brown or red urine
 Jaundice (yellow skin)
 Small bruises under the skin
 Seizures
 Symptoms of kidney failure

 Causes
 The body needs red blood cells to survive. They carry hemoglobin, a complex
protein that contains iron molecules. These molecules carry oxygen from the
lungs to the rest of the body.
Some diseases and conditions can result in a low level of red blood cells.
 There are many types of anemia, and there is no single cause. It can sometimes
be difficult to pinpoint the exact cause.
 Below is a general overview of the common causes of the three main groups of
anemia:
Anemia caused by blood loss
 The most common type of anemia—iron deficiency anemia—often falls into this
category. It is caused by a shortage of iron, most often through blood loss.
 When the body loses blood, it reacts by pulling in water from tissues outside the
bloodstream in an attempt to keep the blood vessels filled. This additional water
dilutes the blood. As a result, the red blood cells are diluted.
 Blood loss can be acute and rapid or chronic.
 Rapid blood loss can include surgery, childbirth, trauma, or a ruptured blood
vessel.
 Chronic blood loss is more common in cases of anemia. It can result from a
stomach ulcer, cancer, or tumor.
 Causes of anemia due to blood loss include:
 gastrointestinal conditions, such as ulcers, hemorrhoids, cancer, or gastritis
 use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and
ibuprofen
 menstrual bleeding
Anemia caused by decreased or faulty red blood cell production
 Bone marrow is a soft, spongy tissue found in the center of bones. It is essential
for the creation of red blood cells. Bone marrow produces stem cells, which
develop into red blood cells, white blood cells, and platelets.
 A number of diseases can affect bone marrow, including leukemia, where too
many abnormal white blood cells are produced. This disrupts normal production
of red blood cells.
 Other anemias caused by decreased or faulty red blood cells include:
 Sickle cell anemia: Red blood cells are misshapen and break down abnormally
quickly. The crescent-shaped blood cells can also get stuck in smaller blood
vessels, causing pain.
 Iron-deficiency anemia: Too few red blood cells are produced because not
enough iron is present in the body. This can be because of a poor diet,
menstruation, frequent blood donation, endurance training, certain digestive
conditions, such as Crohn's disease, surgical removal of part of the gut, and
some foods.
 Bone marrow and stem cell problems: Aplastic anemia, for example, occurs
when few or no stem cells are present. Thalassemia occurs when red blood cells
cannot grow and mature properly.
 Vitamin deficiency anemia: Vitamin B-12 and folate are both essential for the
production of red blood cells. If either is deficient, red blood cell production will
be too low. Examples include megaloblastic anemia and pernicious anemia.
Anemia caused by the destruction of red blood cells
 Red blood cells typically have a life span of 120 days in the bloodstream, but
they can be destroyed or removed beforehand.
 One type of anemia that falls into this category is autoimmune hemolytic anemia,
where the body's immune system mistakenly identifies its own red blood cells as
a foreign substance and attacks them.
 Excessive hemolysis (red blood cell breakdown) can occur for many reasons,
including:
  infections
 certain drugs, for example, some antibiotics
 snake or spider venom
 toxins produced through advanced kidney or liver disease
 an autoimmune attack, for instance, because of hemolytic disease
 severe hypertension
 vascular grafts and prosthetic heart valves
 clotting disorders
 enlargement of the spleen
Risk factors

These factors place you at increased risk of anemia:

 A diet lacking in certain vitamins and minerals. A diet consistently

low in iron, vitamin B-12 and folate increases your risk of anemia.

 Intestinal disorders. Having an intestinal disorder that affects the

absorption of nutrients in your small intestine — such as Crohn's
disease and celiac disease — puts you at risk of anemia.

 Menstruation. In general, women who haven't had menopause have

a greater risk of iron deficiency anemia than do men and
postmenopausal women. Menstruation causes the loss of red blood
cells.

 Pregnancy. If you're pregnant and aren't taking a multivitamin with

folic acid and iron, you're at an increased risk of anemia.

 Chronic conditions. If you have cancer, kidney failure, diabetes or

another chronic condition, you could be at risk of anemia of chronic
disease. These conditions can lead to a shortage of red blood cells.

Slow, chronic blood loss from an ulcer or other source within your
body can deplete your body's store of iron, leading to iron deficiency
anemia.

 Family history. If your family has a history of an inherited anemia,

such as sickle cell anemia, you also might be at increased risk of the
condition.

 Other factors. A history of certain infections, blood diseases and

autoimmune disorders increases your risk of anemia. Alcoholism,
exposure to toxic chemicals, and the use of some medications can
affect red blood cell production and lead to anemia.
  Age. People over age 65 are at increased risk of anemia.

Complications

Left untreated, anemia can cause many health problems, such as:

 Severe fatigue. Severe anemia can make you so tired that you can't
complete everyday tasks.

 Pregnancy complications. Pregnant women with folate deficiency

anemia may be more likely to have complications, such as premature
birth.

 Heart problems. Anemia can lead to a rapid or irregular heartbeat

(arrhythmia). When you're anemic your heart must pump more blood to
make up for the lack of oxygen in the blood. This can lead to an
enlarged heart or heart failure.

 Death. Some inherited anemias, such as sickle cell anemia, can

lead to life-threatening complications. Losing a lot of blood quickly
results in acute, severe anemia and can be fatal.

TYPES
In general, there are three major types of anemia, classified according to the size of the red blood cells:

If the red blood cells are smaller than normal, this is called microcytic anemia. The major causes of this

type are iron deficiency (low level iron) anemia and thalassemia (inherited disorders of hemoglobin).

If the red blood cells size are normal in size (but low in number), this is called normocytic anemia, such as

anemia that accompanies chronic disease or anemia related to kidney disease.

If red blood cells are larger than normal, then it is called macrocytic anemia. Major causes of this type

are pernicious anemia and anemia related to alcoholism.

Anemia related to pregnancy: Water weight and fluid gain during pregnancy dilutes the blood, which may

be reflected as anemia since the relative concentration of red blood cells is lower.

Anemia related to poor nutrition: Vitamins and minerals are required to make red blood cells. In addition

to iron, vitamin B12 and folate (or folic acid) are required for the proper production of hemoglobin (Hgb).

Deficiency in any of these may cause anemia because of inadequate production of red blood cells. Poor

dietary intake is an important cause of low folate and low vitamin B12 levels. Strict vegetarians who do not

take sufficient vitamins are at risk to develop vitamin B12 deficiency.

Pernicious anemia: There also may be a problem in the stomach or the intestines leading to poor

absorption of vitamin B12. This may lead to anemia because of vitamin B12 deficiency known as pernicious

anemi

Thalassemia: This is another group of hemoglobin-related causes of anemia. There are many types of

thalassemia, which vary in severity from mild (thalassemia minor) to severe (thalassemia major). These are

also hereditary, but they cause quantitative hemoglobin abnormalities, meaning an insufficient amount of

the correct hemoglobin molecules is made. Thalassemia is more common in people from African,

Mediterranean, and Southeast Asian ancestries.

Alcoholism: Poor nutrition and deficiencies of vitamins and minerals are associated with

alcoholism. Alcohol itself may also be toxic to the bone marrow and may slow down the red blood cell

production. The combination of these factors may lead to anemia in alcoholics.

Anemia related to medications: Many common medications can occasionally cause anemia as a side

effect in some individuals. The mechanisms by which medications can cause anemia are numerous

(hemolysis, bone marrow toxicity) and are specific to the medication. Medications that most frequently

cause anemia are chemotherapy drugs used to treat cancers (chemotherapy-induced anemia). Other

common medications that can cause anemia include some seizure medications, transplant

medications, HIV medications, some malaria medications, some antibiotics (penicillin, chloramphenicol),

antifungal medications, and antihistamines.

Other less common causes of anemia include

1. thyroid problems,
2. cancers,
3. liver disease,
4. autoimmune diseases (lupus),
5. paroxysmal nocturnal hemoglobinuria (PNH),
6. lead poisoning,
7. AIDS,
8. malaria,
9. viral hepatitis,
10. mononucleosis,
11. parasitic infections (hookworm),
12. bleeding disorders, and
13. insecticide exposure.
Sideroblastic Anemia
In this group of blood disorders, your body can't use iron to make hemoglobin -- the protein that
carries oxygen in your blood. The iron buildup causes the formation of abnormal red blood cells
called sideroblasts.
There are two main types of sideroblastic anemia:
Acquired sideroblastic anemia can be caused by exposure to certain chemicals or drugs.
Hereditary sideroblastic anemia happens when a gene mutation disrupts normal hemoglobin
production. This gene produces “heme,” the part of hemoglobin that carries oxygen.
Symptoms for both types include:
Chest pain
Fast heartbeat, or tachycardia
Headaches
Trouble breathing
Weakness and fatigue
Treatment for sideroblastic anemia depends on the cause. If you have acquired anemia, you'll need
to avoid the chemical or drug that caused it. Other treatments include vitamin B6 therapy and bone
marrow or stem cell transplants.
Myelodysplastic Syndromes
Myelodysplastic syndromes (MDS) are diseases that are caused when your bone
marrow is damaged and can't make enough healthy blood cells. MDS is a type
of cancer.
Some people are born with a gene that causes MDS. These genes are usually
passed down from one or both parents. If you have certain inherited syndromes,
including Fanconi anemia, Shwachman-Diamond syndrome, Diamond Blackfan
anemia, familial platelet disorder, and severe congenital neutropenia, you could be
more likely to develop MDS.
A small number of people also get MDS after radiation or chemotherapy treatment
for cancer. Another risk is exposure to chemicals like benzene, which is found
in tobacco smoke.
Some people don’t have symptoms with MDS, but others do, including:

 Bruising or bleeding
 Infection
 Fever
 Shortness of breath
 Weakness and fatigue
 Weight loss
 Oncologists (cancer doctors) and hematologists (blood doctors) treat MDS with
chemotherapy, hematopoietic growth factors, and stem cell or bone marrow transplants.

Autoimmune Hemolytic Anemia

 Autoimmune hemolytic anemia happens when your body's immune system attacks and
destroys red blood cells faster than it can make new ones.
 If you have an autoimmune disease like lupus, you’re also more likely to get this type of
anemia. Medicines such as methyldopa (Aldomet), penicillin, and quinine (Qualaquin) can
also cause autoimmune hemolytic anemia.
 Symptoms include fatigue, pale skin, fast heartbeat (tachycardia), trouble breathing, chills,
backache, and yellow skin (jaundice).
  Treating the disease that caused the anemia can also stop your red blood cell damage. If you
have an autoimmune disease, your doctor might treat you with steroid drugs to calm
your immune system, which can help the anemia.

Congenital Dyserythropoietic Anemia (CDA)

 CDA is a group of inherited anemias that reduce the number of healthy red blood cells in the
body. All CDAs are passed down through families.
 There are three types of CDA, types 1, 2, and 3. Type 2 is the most common and type 3 is the
rarest. Symptoms include chronic anemia, fatigue, yellow skin and eyes (jaundice), pale skin,
and missing fingers and toes at birth.
 Some people never need treatment. But depending on the severity of the disease, your
doctor might recommend a blood transfusion, a stem cell transplant, or with medicines to
lower iron levels or interferon alfa-2A, a drug typically used for
treating leukemia and melanoma.
Diamond-Blackfan Anemia
If you have Diamond-Blackfan anemia, your bone marrow doesn't make enough red blood cells.
Doctors think it is caused by changes to your genes.
Symptoms of Diamond-Blackfan anemia include:

 Fast heartbeat (tachycardia)

 Fatigue
 Heart murmur
 Pale skin
 Short height
 Weak bones
 Treatments include everything from steroids that can help produce more red blood cells to
red blood cell transfusions and bone marrow transplants.
Megaloblastic Anemia
 With this type of anemia, your bone marrow produces abnormally structured red blood cells
that are too large and too young. Because they’re not mature or healthy, they can't carry
oxygen throughout your body very well.
 Megaloblastic anemia is caused by too little vitamin B12 (cobalamin) or vitamin B9 (folate).
Your body needs these vitamins to make red blood cells.
 Some people with megaloblastic anemia might not have symptoms for many years. But once
symptoms do appear, they’re similar to other types of anemia, and include:
 Dizziness and fatigue
 Diarrhea, nausea
 Fast or irregular heartbeat (tachycardia)
 Muscle pain or weakness
 Pale skin
 Trouble breathing
 Doctors treat megaloblastic anemia with vitamin B9 and vitamin B12 supplements to
replace what your body is missing. You'll also need treatment for any disease -- such
as Crohn's -- that caused your body to lack these vitamins.

Fanconi Anemia
 Fanconi anemia makes your blood marrow produce too few blood cells. It's hereditary,
meaning it’s passed down from one of your parents through a gene mutation.
 Symptoms of Fanconi anemia include:
  Abnormal thumbs
 Heart, kidney, and bone problems
 Skin color changes
 Small body, head, and eyes
 If you have Fanconi anemia, you’re more likely to get a type of cancer called acute myeloid
leukemia, or AML. Your odds of getting cancers of the head, neck, skin, GI tract, or genitals
also go up.
 Treatment depends on several factors, including what stage it’s in and the severity of
physical complications. Treatments include hormone therapy and growth factors to boost
blood cell growth.
 If symptoms become severe, your doctor might recommend a bone marrow stem cell
transplant. Oftentimes a bone marrow transplant can cure the problems altogether.

Prevention

Many types of anemia can't be prevented. But you can avoid iron
deficiency anemia and vitamin deficiency anemias by eating a diet that
includes a variety of vitamins and minerals, including:

 Iron. Iron-rich foods include beef and other meats, beans, lentils,

iron-fortified cereals, dark green leafy vegetables, and dried fruit.

 Folate. This nutrient, and its synthetic form folic acid, can be found
in fruits and fruit juices, dark green leafy vegetables, green peas,
kidney beans, peanuts, and enriched grain products, such as bread,
cereal, pasta and rice.

 Vitamin B-12. Foods rich in vitamin B-12 include meat, dairy

products, and fortified cereal and soy products.

 Vitamin C. Foods rich in vitamin C include citrus fruits and juices,

peppers, broccoli, tomatoes, melons and strawberries. These also
help increase iron absorption.

Treatment

Daily iron and folic acid supplementation during pregnancy

WHO recommendations
Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron* and
400 µg (0.4 mg) folic acid** is recommended for pregnant women to prevent maternal
anaemia, puerperal sepsis, low birth weight, and preterm birth.***
*The equivalent of 60 mg of elemental iron is 300 mg ferrous sulfate heptahydrate, 180 mg
ferrous fumarate or 500 mg of ferrous gluconate.
** Folic acid should be commenced as early as possible (ideally before conception) to
prevent neural tube defects.

Treatment

Anemia treatment depends on the cause.

 Iron deficiency anemia. Treatment for this form of anemia usually

involves taking iron supplements and changing your diet.

If the cause of iron deficiency is loss of blood — other than from

menstruation — the source of the bleeding must be located and the
bleeding stopped. This might involve surgery.

 Vitamin deficiency anemias. Treatment for folic acid and vitamin C

deficiency involves dietary supplements and increasing these
nutrients in your diet.

If your digestive system has trouble absorbing vitamin B-12 from the
food you eat, you might need vitamin B-12 shots. At first, you might
have the shots every other day. Eventually, you'll need shots just once
a month, possibly for life, depending on your situation.

 Anemia of chronic disease. There's no specific treatment for this

type of anemia. Doctors focus on treating the underlying disease. If
symptoms become severe, a blood transfusion or injections of a
synthetic hormone normally produced by your kidneys (erythropoietin)
might help stimulate red blood cell production and ease fatigue.

 Aplastic anemia. Treatment for this anemia can include blood

transfusions to boost levels of red blood cells. You might need a bone
marrow transplant if your bone marrow can't make healthy blood cells.

 Anemias associated with bone marrow disease. Treatment of these

various diseases can include medication, chemotherapy or bone
marrow transplantation.

 Hemolytic anemias. Managing hemolytic anemias includes avoiding

suspect medications, treating infections and taking drugs that
suppress your immune system, which could be attacking your red
blood cells.
 Depending on the cause or your hemolytic anemia, you might be
referred to a heart or vascular specialist.

 Sickle cell anemia. Treatment might include oxygen, pain relievers,

and oral and intravenous fluids to reduce pain and prevent
complications. Doctors might also recommend blood transfusions,
folic acid supplements and antibiotics.

A cancer drug called hydroxyurea (Droxia, Hydrea, Siklos) also is used

to treat sickle cell anemia.

 Thalassemia. Most forms of thalassemia are mild and require no

treatment. More severe forms of thalassemia generally require blood
transfusions, folic acid supplements, medication, removal of the
spleen, or a blood and bone marrow stem cell transplant.