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Anaemia symptoms, causes, complications, treatment and preventions

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    ANEMIA

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What Is Anemia?

      Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin.
     

   Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen. 

    Symptoms of anemia -- like fatigue -- occur because organs aren't getting what they need to function properly.

          related content.      Normal blood shape

     Anemia is the most common blood condition worldwide. It affects about 3.5 million Americans. Women, young children, and people with chronic diseases are at increased risk of anemia. Important factors to remember are:

     Certain forms of anemia are hereditary and infants may be affected from the time of birth.Women in the childbearing years are particularly susceptible to iron-deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during  pregnancy.Older adults also may have a greater risk of developing anemia because of poor diet and other medical conditions.

    There are many types of anemia. All are very different in their causes and treatments.

      Irony deficiency anemia, the most common type, is very treatable with diet changes and iron supplements. Some forms of anemia -- like the mild anemia that develops during pregnancy -- are even considered normal. However, some types of anemia may present lifelong health problems.

      What Causes Anemia?

There are more than 400 types of anemia, which are divided into three groups: 

Anemia caused by blood lossAnemia caused by decreased or faulty red blood cell productionAnemia caused by destruction of red blood cells 

   Anemia Caused by Blood Loss 

   Red blood cells can be lost through bleeding, which often can occur slowly over a long period of time, and can go undetected. This kind of chronic bleeding commonly results from the following: 

Foods High in Iron

    Gastrointestinal conditions

 such as        ulcers, hemorrhoids,gastritis (inflammation of the stomach), andcancer Use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which can cause ulcers and gastritis Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies 

Anemia Caused by Decreased or Faulty Red Blood Cell Production 

With this type of anemia, the body may produce too few blood cells or the blood cells may not function correctly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or a lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following: 

         Sickle cell anemia 

        Iron-deficiency anemia

        Vitamin deficiency

        Bone marrow and stem cell problems

       Other health conditions 

    Sickle cell anemia is an inherited disorder that, in the U.S. affects mainly African-Americans and Hispanic Americans. Red blood cells become crescent-shaped because of a genetic defect. They break down rapidly, so oxygen does not get to the body's organs, causing anemia. The crescent-shaped red blood cells can also get stuck in tiny blood vessels, causing pain. 

 Iron-deficiency anemia occurs because of a lack of the mineral iron in the body. Bone marrow in the center of the bone needs iron to make hemoglobin, the part of the red blood cell that transports oxygen to the body's organs. Without adequate iron, the body cannot produce enough hemoglobin for red blood cells. The result is iron-deficiency anemia. This type of anemia can be caused by: 

     An iron-poor diet, especially in infants, children, teens, vegans, and vegetariansThe metabolic demands of pregnancy and breastfeeding that deplete a woman's iron stores.   Menstruation , Frequent blood donation, Endurance training Digestive conditions such as Crohn's disease or surgical removal of part of the stomach or small intestine Certain drugs, foods, and caffeinated drinks 

  Vitamin-deficiency anemia may occur when vitamin B12 and folate are deficient. These two vitamins are needed to make red blood cells. Conditions leading to anemia caused by vitamin deficiency include: 

     Megaloblastic anemia: Vitamin B12 or folate or both are deficient. Pernicious anemia: Poor vitamin B12 absorption caused by conditions such as Crohn's disease, an intestinal parasite infection, surgical removal of part of the stomach or intestine, or infection with HIVDietary deficiency: Eating little or no meat may cause a lack of vitamin B12, while overcooking or eating too few vegetables may cause a folate deficiency.

    Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse, intestinal diseases such as tropical sprue and celiac disease 

 During early pregnancy, sufficient folic acid can help prevent the fetus from developing neural tube defects such as spina bifida. 

     Bone marrow and stem cell problems may prevent the body from producing enough red blood cells. Some of the stem cells found in bone marrow develop into red blood cells. If stem cells are too few, defective, or replaced by other cells such as metastatic  cancer cells, anemia may result. Anemia resulting from bone marrow or stem cell problems include: 

    Aplastic anemia occurs when there's a marked reduction in the number of stem cells or absence of these cells. Aplastic anemia can be inherited, can occur without apparent cause, or can occur when the bone marrow is injured by medications, radiation, chemotherapy, or infection.Thalassemia occurs when the red cells can't mature and grow properly. Thalassemia is an inherited condition that typically affects people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition can range in severity from mild to life-threatening; the most severe form is called Cooley's anemia.Lead exposure is toxic to the bone marrow, leading to fewer red blood cells. Lead poisoning occurs in adults from work-related exposure and in children who eat paint chips, for example. Improperly glazed pottery can also taint food and liquids with lead. 

     Anemia associated with other conditions usually occurs when there are too few hormones necessary for red blood cell production. Conditions causing this type of anemia include the following: 

     Advanced kidney disease   Hypothyroidism  Other chronic diseases, such as cancer, infection, lupus, diabetes, and rheumatoid arthritis Old age 


   Anemia Caused by Destruction of Red Blood Cells 

When red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing hemolytic anemia. Hemolytic anemia can be present at birth or develop later. Sometimes there is no known cause. Known causes of hemolytic anemia may include: 

  Inherited conditions, such as 

    Sickle cell anemia and thalassemia Stressors such as infections, drugs, snake or spider venom, or certain foods

      Toxins from advanced liver or kidney disease Inappropriate attack by the immune system (called hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman)

       Vascular grafts,  prosthetic heart  valves, tumors, severe burns, exposure to certain chemicals, severe hypertension, and clotting disorders

        In rare cases, an enlarged spleen can trap red blood cells and destroy them before their circulating time is up.

How Is Anemia      Treated?

Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss.

Goals of Treatment

The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.)

Another goal is to treat the underlying cause of the anemia.

Dietary Changes and Supplements

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions.

To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron.

Iron

Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meat—especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish.

Nonmeat foods that are good sources of iron include:

  • Spinach and other dark green leafy vegetables
  • Tofu 
  • Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
  • Dried fruits, such as prunes, raisins, and apricots
  • Prune juice
  • Iron-fortified cereals and breads

You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.

Iron also is available as a supplement. It's usually combined with multivitamins and other minerals that help your body absorb iron.

Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow's milk, and infants who are fed breast milk only or formula that isn't fortified with iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with vitamin B12 supplements.

Good food sources of vitamin B12 include:

  • Breakfast cereals with added vitamin B12
  • Meats such as beef, liver, poultry, and fish
  • Eggs and dairy products (such as milk, yogurt, and cheese)
  • Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers

Folic Acid

Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.

Good sources of folic acid include:

  • Bread, pasta, and rice with added folic acid
  • Spinach and other dark green leafy vegetables
  • Black-eyed peas and dried beans
  • Beef liver
  • Eggs
  • Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.

Medicines

Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia. Some of these medicines include:

  • Antibiotics to treat infections.
  • Hormones to treat heavy menstrual bleeding in teenaged and adult women.
  • A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks.
  • Medicines to prevent the body's immune system from destroying its own red blood cells.
  • Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning.

Procedures

If your anemia is severe, your doctor may recommend a medical procedure. Procedures include blood transfusions and blood and marrow stem cell transplants.

Blood Transfusion

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient's blood.

For more information, go to the Health Topics Blood Transfusion article.

Blood and Marrow Stem Cell Transplant

A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets.

During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells.

For more information, go to the Health Topics Blood and Marrow Stem Cell Transplant article.

Surgery

If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.


What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia)  

Some common complications are mentioned below.

    Tiredness

Iron deficiency anaemia can make you feel tired and lacking in energy (lethargic). This may result in you being less productive at work, and you may find it difficult to stay awake or not feel able to exercise regularly.

    Increased risk of infections

Research has shown iron deficiency anaemia can affect your immune system – the body's natural defence system. This increases your vulnerability to infection.

   Heart and lung problems

Adults with severe anaemia may be at risk of developing complications that affect their heart or lungs.

For example, you may develop tachycardia, which is an abnormally fast heartbeat, or heart failure, where the heart fails to pump enough blood around your body at the right pressure.

    Pregnancy complications

Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after birth.

They may also develop  postnatal depression, which some women experience after having a baby.

Research suggests babies born to mothers who have untreated anaemia are more likely to:

  • be born prematurely – before the 37th week of pregnancy
  • have a low birth weight
  • have problems with iron levels themselves
  • do less well in mental ability tests

    Restless legs syndrome

Some cases of restless legs syndromeare thought to be caused by iron deficiency anaemia. Doctors often refer to this as secondary restless legs syndrome.

Restless legs syndrome is a common condition that affects the nervous system, and causes an overwhelming, irresistible urge to move the legs. It also causes an unpleasant feeling in the feet, calves and thighs.

Restless legs syndrome caused by iron deficiency anaemia can usually be treated with iron supplements.

Differential Diagnoses

Includes.
     Alpha Thalassemia


Anaemia prevention and control

  Anaemia is the world’s second leading cause of disability and thus one of the most serious global public health problems. Anaemia affects over half of pre-school children and pregnant women in developing countries and at least 30-40% in industrialized countries. In poorer malaria endemic countries anaemia is one of the commonest preventable causes of death in children under 5 years and in pregnant women.

Reducing the burden of anaemia will make a major contribution to achieving several UN Millennium Development Goals. Since the greatest burden of anaemia falls on the most "hard-to-reach" individuals, any programme that aims to reduce anaemia will need to be accessible by these groups. Primary health care policies and pro¬grammes must be a cornerstone of health care systems. Interventions which have been shown to impact on anaemia include improving nutrition and iron status and treating helminth and malaria infections.

The WHO Anaemia Working Group first met in June 2000 to review the relationship between haemoglobin concentrations and clinically symptomatic anaemia, with particular focus on cut-off levels for blood donation. This is why the Secretariat of the Group has traditionally been housed in the Department of Essential Health Technologies.

The WHO/UNICEF statement on anaemia underlines its multifactorial aetiology; hence the Group is now represented by diverse WHO programmes that need to address the prevention and control of anaemia. Roll Back Malaria is exploring the use of haemoglobin levels as a marker of success of malaria control interventions.

    Early detection of anaemia in pregnant women is reflected in the vision of the Making Pregnancy Safer initiative. HIV/AIDS guid elines state that a haemoglobin estimation and HIV test are the absolute minimum before anti-retroviral therapy, meaning that simple, reliable and affordable screening tools must be widely available if 3 million people are to receive ARVs by 2005.

    One such tool is the Haemoglobin Colour Scale, now commercially available to assist remote settings in the detection and management of anaemia.


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