Chaparro, C. M., & Suchdev, P. S. (2019).

Anemia epidemiology, pathophysiology, and

etiology in low‐and middle‐income countries. Annals of the New York Academy of

Sciences, 1450(1), 15-31. https://doi.org/10.1111/nyas.14092

This article states that anemia affects one-third of the world's population and

contributes to increased morbidity, mortality, decreased work productivity, and

impaired neurological development. It is estimated that a lack of red blood cells causes

anemia. It is essential to have a comprehensive understanding of the many and varied

factors that contribute to the development of anemia to design and implement effective

interventions that take into account the specific environmental factors that contribute to

anemia and to monitor existing anemia control programs effectively. We will look at

the various situations that lead to the development of anemia. We emphasize the risk

factors that are most common in low- and middle-income nations, such as inadequacies

in nutrition, infections and inflammations, and hereditary hemoglobin abnormalities.

Recent research has helped us understand the multifaceted causes of anemia, including

the proportion of the condition that can be attributed to iron deficiency (ID), as well as

the impact that inflammation and infection play. There is mounting evidence to suggest

that the proportion of anemia attributable to ID varies not just by population type but

also by the geographical environment, infectious disease burden, and the presence of

other factors that can cause anemia. Additional research is required to investigate the

role that other nutritional deficiencies play, the contribution that infectious and chronic

diseases make, and the significance of hereditary hemoglobin problems in some

populations. This article aims to show Anemia worldwide health problem, especially in

LMICs, where improvement has been slow and unequal. Recent research reveals that

anemia etiology is complicated and context-specific. Understanding how ID and other

poor nutrition, illness, and Hb problems contribute to anemia is needed to apply

 suitable therapies in specific circumstances. Evaluating anemia medically and in

populations will involve biochemical indicators of micronutrient status (iron and VA

mainly) and markers of inflammation.

Weiss, G., Ganz, T., & Goodnough, L. T. (2019). Anemia of inflammation. Blood, 133(1),

40–50. https://doi.org/10.1182/blood-2018-06-856500

This article describes anemia of inflammation (AI), also called anemia of chronic

disease (ACD), and is a severe kind of anemia in the hospitalized and chronically ill

population. Infection, autoimmune illnesses, and cancer all produce persistent

immunological activation, and their patients have a higher risk of developing this

condition. Obesity, chronic respiratory disorders, chronic kidney disease, and

congestive heart failure are relatively new additions. Disease-specific factors

contributing to AI include a decreased antidiuretic hormone response to anemia, a

shorter erythrocyte half-life, and the suppression of erythroid cell development by

inflammatory mediators. This article states that Diagnosing AI patients with

simultaneous iron insufficiency are trickier, even though AI is a diagnosis of exclusion

supported by typical abnormalities in hypothermia, iron homeostasis, and

hyperferritinemia. Many people with anemia can benefit from iron therapy in

conjunction with erythropoiesis-stimulating medications and treating the underlying

condition causing the AI. New therapies that block hepcidin's effects and redirect the

body's endogenous iron supply toward erythropoiesis are being developed as a potential

future treatment option. This article aims to understand better the role of anemia in each

patient's morbidity and the effect of anemia treatment on the patient's diagnosis in

various disease settings. It is necessary to determine the appropriate indications again

for specific treatment of AI, based on knowledge of anemia treatment in chronic renal

disease, critical illness, and cancer.

Tao, Z., Xu, J., Chen, W., Yang, Z., Xu, X., Liu, L., ... & Liu, J. (2021). Anemia is

associated with severe illness in COVID‐19: a retrospective cohort study. Journal of

medical virology, 93(3), 1478-1488. https://doi.org/10.1002/jmv.26444

According to Tao et al., anemia commonly aggravates the severity of respiratory

diseases, whereas thus far, few studies have elucidated the impact of anemia on

coronavirus disease 2019 (COVID-19). This study aimed to evaluate the clinical

characteristics of patients with anemia and to further explore the relationship between

anemia and the severity of COVID-19. In this single-center, retrospective,

observational study, 222 confirmed patients admitted to Wuhan Ninth Hospital from 1

December 2019 to 20 March 2020 were recruited, including 79 patients with anemia

and 143 without anemia. Clinical characteristics, laboratory findings, disease

progression, and prognosis were collected and analyzed. Univariable and multivariable

logistic regression models established risk factors associated with severe illness in

COVID-19. In our cohort, compared to patients without anemia, patients with anemia

were more likely to have one or more comorbidities and severe COVID-19 illness.

More patients demonstrated elevated levels of C-reactive protein (CRP), procalcitonin

(PCT), and creatinine in the anemia group. Levels of erythrocyte sedimentation rate, D-

dimer, myoglobin, T-pro brain natriuretic peptide (T-pro-BNP), and urea nitrogen in

patients with anemia were significantly higher than in those without. In addition, the

proportion of patients with dyspnea with elevated CRP and PCT was positively

associated with the severity of anemia. The odd ratio of anemia related to the severe

condition of COVID-19 was 3.47 (95% confidence interval [CI]: 1.02-11.75; P = .046)
and 3.77 (95% CI: 1.33-10.71; P = .013) after adjustment for baseline date and

laboratory indices, respectively. Anemia is an independent risk factor associated with

the severe illness of COVID-19, and healthcare professionals should be more sensitive

to the hemoglobin levels of COVID-19 patients on admission. Awareness of anemia as

a risk factor for COVID-19 was of great significance. Anemic COVID-19 patients had

more comorbidities, severe inflammatory responses, and organ damage than nonanemic

controls. In COVID-19 individuals, inflammation was linked to anemia. Anemia was

linked to severe disease in COVID-19.

Smith, C., Teng, F., Branch, E., Chu, S., & Joseph, K. S. (2019). Maternal and perinatal

morbidity and mortality associated with anemia in pregnancy. Obstetrics and

Gynecology, 134(6), 1234.

https://doi.org/10.1097%2FAOG.0000000000003557

This article analyzed data from a population-based retrospective cohort study of all

women who gave birth in British Columbia between 2004 and 2016 and were at least

20 weeks in their pregnancies. At birth, anemia was diagnosed if a woman had a

hemoglobin value below the third-trimester threshold or if she had a third-trimester

hemoglobin value below the threshold (made before delivery). Patients were classified

as having no anemia (hemoglobin 11 g/dL or more), mild anemia (9-10.9 g/dL),

moderate anemia (7-8.9 g/dL), severe anemia (less than seven g/dL), or anemia of

undefined severity (with the diagnosis made before delivery). Adjusted odds ratios

(AOR) and 95% confidence intervals (CIs) were calculated using logistic regression to

quantify the connection between anemia and maternal and perinatal outcomes. 65,906

(12.8%) of 515,270 study women had anemia: 11.8%, 0.43%, and 0.02% had mild,

moderate, and severe anemia, respectively, and 0.58% had unspecified anemia. Anemic
women experienced longer hospitalizations, more prenatal admissions, and a greater

incidence of preeclampsia, placenta previa, and cesarean birth. Intrapartum–postpartum

blood transfusion rate was 5.1 per 1,000 among women without anemia and higher

among women with anemia (aOR 2.45, 95% CI 1.74–3.45 for mild anemia; 21.3, 95%

CI 12.2–37.3 for moderate anemia; not analyzable for severe anemia; and 48.3, 95% CI

6.60–353.9 for unspecified anemia). Anemia was linked to preterm birth (aOR 1.09,

95% CI 1.05–1.12), small-for-gestational-age live birth, low 5-minute Apgar score,

neonatal death, and perinatal death. Anemia in pregnancy is a prevalent and potentially

reversible risk factor for antepartum, intrapartum, and postpartum maternal morbidity

and mortality. This article aims to show the effects of anemia among pregnant women.

Anemia affects 40% of pregnant women worldwide and 33% in the US. Anemia in

pregnancy is linked to maternal death, perinatal death, preterm birth, hypertension, low

birth weight, small-for-gestational-age live birth, and cesarean delivery. 3–9 Preterm

birth and low birth weight are more common in women with hemoglobin below seven

g/dL.

Chen, N., Hao, C., Liu, B. C., Lin, H., Wang, C., Xing, C., ... & Yu, K. H. P. (2019).

Roxadustat treatment for anemia in patients undergoing long-term dialysis. New

England Journal of Medicine, 381(11), 1011-1022.

This article's primary emphasis is Roxadustat. Roxadustat promotes erythropoiesis

and controls iron metabolism. More data are needed to compare the efficacy and

security of Roxadustat with epoetin alfa in treating anemia in dialysis patients. In a

Chinese trial, patients on dialysis and epoetin alfa medication for at least six weeks

were randomly assigned to receive roxadustat or epoetin alfa three times each week

for 26 weeks. Iron was only given as rescue therapy. The primary endpoint was a
 change in hemoglobin concentration from baseline to weeks 23-27. Noninferiority of

roxadustat would be demonstrated if the difference between the roxadustat and

epoetin alfa groups was higher than or equal to 1.0 g per deciliter. Each group's doses

were modified to obtain 10.0 to 12.0 g per deciliter of hemoglobin. Adverse reactions

and clinical laboratory results were used to assess safety. 305 individuals were

randomized (204 to roxadustat and 101 to epoetin alfa), and 256 completed the 26-

week therapy period. Mean hemoglobin was 10.4 g/dL. Compared to epoetin alfa,

roxadustat enhanced transferrin (0.43 g per liter; 95% CI, 0.32 to 0.53), maintained

serum iron (25 g per deciliter; 95% CI, 17 to 33), and reduced transferrin saturation

(4.2 percentage points; 95% CI, 1.5 to 6.9) . Total cholesterol decreased more with

roxadustat than with epoetin alfa at week 27 (22 mg per deciliter; 95% CI, 29 to 16),

as did low-density lipoprotein cholesterol (18 mg per deciliter; 95% CI, 23 to 13).

Roxadustat reduced hepcidin by 30.2 ng per milliliter (95% CI, 64.8 to 13.6)

compared to 2.3 ng per milliliter (51.6 to 6.2) in the epoetin alfa group.

Hyperkalemia, upper respiratory infection, and hypertension were more common in

the roxadustat group. The oral application was non-inferior to injectable epoetin alfa

for anemia in Chinese dialysis patients.

Joosten, E. (2017). Iron deficiency anemia in older adults: A Review. Geriatrics &

Gerontology International, 18(3), 373–379. https://doi.org/10.1111/ggi.13194

This article states that higher mortality and morbidity rates have been linked to anemia

in older people. Anemia diagnostic threshold levels shift with age, gender, and race.

Often, laboratory tests will reveal that you have anemia, even though you have no

symptoms. Patients may appear with signs related to coexisting illnesses, such as blood

loss, or signs due to impaired oxygen-carrying capacity, like weakness, exhaustion, and
 shortness of breath. Many people with anemia have no apparent cause, although some

of the most common are malnutrition, chronic kidney illness, chronic inflammation,

and occult blood loss from gastrointestinal cancer. The evaluation consists of a

thorough medical history and physical examination, a review of potential contributing

factors, and an estimation of the patient's mean corpuscular volume. Endoscopy is

necessary to evaluate gastrointestinal cancer in elderly patients with probable iron

deficient anemia.

To treat the problem effectively, we must first identify and treat its root. Patients

experiencing symptoms whose hemoglobin levels are eight g/dL or lower may benefit

from a transfusion of whole blood. It is recommended to try oral iron replacement in

patients with suspected iron deficiency anemia. Medications with a lesser dose may be

just as effective with fewer side effects. Most patients' hemoglobin levels return to

normal by the eighth week after treatment. Doctors turn to parenteral iron infusion

when oral iron therapy has failed or is intolerable. This article aims to show the effects

of anemia in older people. Older people, especially those above 60, often suffer from

anemia. There is a growing older population, and primary care doctors need to know

how to evaluate and treat anemia in this population to reduce the related morbidity and

death.

Wiciński, Michał, et al. "Anemia Of Chronic Diseases: Wider Diagnostics—Better

Treatment?". Nutrients, vol 12, no. 6, 2020, p. 1784. MDPI AG,

https://doi.org/10.3390/nu12061784.

This article states that anemia of chronic diseases is a condition that occurs alongside a

specific underlying disease and is characterized by a decrease in hemoglobin,

hematocrit, and erythrocyte counts as a result of a complex process, typically

introduced by cellular innate immune mechanisms and cytokines and pro-inflammatory

cytokines and hepcidin. This anemia is second only to iron deficiency anemia in terms

of prevalence worldwide. Its intensity is usually proportional to the degree of the

underlying sickness. Constant inflammation, autoimmune disorders, cancer, and kidney

failure are often companions to this illness. Complete blood count and biochemical

parameter evaluations, as well as evaluation of the severity of the underlying disease,

should precede any treatment. Excluding other causes of anemia, such as iron

deficiency anemia, is crucial to making a differential diagnosis of anemia of chronic

conditions. A moderate decrease in hemoglobin level, a decrease in the reticulocyte

percentage, a decrease in iron and transferrin concentration, and an increase in ferritin

are the major hallmarks of anemia in chronic illnesses. This anemia has a growing list

of biochemical indicators for diagnosis as we learn more about the patterns and

structures of chronic illnesses and the biology of cancer. Other hematopoietic

determinants include folic acid and vitamin B12 levels and hepcidin, creatinine, and

erythropoietin concentrations. Chronic illness anemia can be treated with iron, folic

acid, and vitamin B12 supplements or by eating a diet high in these hematopoietic

components. Whether a patient should receive an oral, intramuscular, or intravenous

dose, doctors must weigh the potential advantages against the risks before making this

decision. The new approaches to treating the underlying disease and the anemia are

encouraging. There are new approaches to treating anemia caused by chronic

conditions, and they entail more than just making up for nutritional shortfalls; they also

involve the use of medications that are molecularly targeted to specific proteins or

receptors.
Anand, Inder S., and Pankaj Gupta. "Anemia And Iron Deficiency In Heart

Failure ."Circulation, vol 138, no. 1, 2018, pp. 80-98. Ovid Technologies (Wolters

Kluwer Health), https://doi.org/10.1161/circulationaha.118.030099.

According to Anand et al., anemia and iron shortage are frequent in heart failure

patients. Both disorders are linked to poor clinical state and outcomes. Anemia and iron

deficiency may be indications of heart failure severity, or they may affect progression

and outcomes and should be treated. In recent years, erythropoiesis-stimulating drugs

have been studied for treating anemia in heart failure patients. These medicines did not

enhance outcomes and increase adverse effects. Iron insufficiency in heart failure

patients can be absolute when total body iron is low, or functional when total body iron

is normal or high but insufficient to meet tissue needs due to sequestration in the

storage pool. Absolute iron deficiency anemia is treated with iron replacement.

However, it's uncertain how to address the functional iron deficit in nonanemic heart

failure patients. Small trials found that intravenous iron improves symptoms and

exercise capacity in heart failure patients with absolute or functional iron shortage with

or without anemia. Long-term results and safety data are not yet available. This review

addresses anemia, iron deficiency, and heart failure etiology, pathophysiology, and

therapy options. Understanding the pathogenesis of heart failure has led to rational

medicines that enhance patient outcomes.

1 HF's prognosis is still bleak. 2 Anemia and iron shortage are typical HF comorbidities

associated with poor clinical state and worse prognosis. If anemia and ID are mediators

of poor outcomes in HF patients, treating them could improve results. Several small

studies found that using erythropoiesis-stimulating agents (ESAs) to increase

hemoglobin in patients with HFrEF improved clinical outcomes3,4. However, the

neutral results of the large pivotal RED-HF trial5 suggest that anemia is probably not a

mediator of poor outcomes but rather a marker of HF severity. Recent trial data suggest

that treating ID may be beneficial, but we don't know when, how, or for how long

anemia or ID should be treated in HF or the processes underlying treatment effects. In

this review, we characterize the extent of anemia and ID in HF patients, evaluate their

impact on long-term outcomes, and examine how they should be addressed based on

recent clinical trial findings.