Anemia: Causes, Symptoms, Diagnosis, and Treatment

Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin in the blood, leading to a reduced ability to transport oxygen to the tissues in the body. According to the World Health Organization (WHO), anemia is defined as follows:

• Newborn: Hemoglobin < 140 g/l

• Under 6 years old: Hemoglobin < 110 g/l

• From 6 to 14 years old: Hemoglobin < 120 g/l

Causes of anemia:

The causes of anemia can be broadly categorized into three main groups:

1. Decreased red blood cell production:

• Deficiency of hematopoietic factors:

• Iron deficiency: This is the most common cause.

• Folic acid deficiency: Necessary for DNA synthesis, which helps red blood cells to divide and develop.

• Vitamin B12 deficiency: Essential for red blood cell formation.

• Protein deficiency: A key component of red blood cells.

• Impaired utilization of hematopoietic factors:

• Due to the body’s inability to absorb iron: For example, lead poisoning.

• Due to disorders in the metabolism of vitamin B12 and folic acid: Often occurs in diseases related to bone marrow.

• Decreased or absent bone marrow production:

• Pure red blood cell aplasia: Diamond-Blackfan anemia.

• Acquired or congenital aplastic anemia: Fanconi anemia.

• Bone marrow infiltration: Leukemia, metastatic cancer.

• Other causes:

• Chronic kidney disease.

• Malnutrition.

• Hypothyroidism.

• Collagen diseases.

2. Blood loss:

• Acute: Trauma, bleeding disorders (such as hemophilia).

• Chronic: Hookworm infection, peptic ulcer disease, hemorrhoids, polyps.

3. Hemolysis:

• Due to red blood cell abnormalities:

• Red blood cell membrane disorders.

• Hemoglobin disorders.

• Red blood cell enzyme disorders.

• Due to external factors:

• Immune hemolysis: Mother-fetus blood group incompatibility, mismatched blood transfusions, autoimmune hemolysis.

• Infections: Malaria, dengue fever.

• Toxins: Snake venom, burns, bacteria.

• Hypersplenism.

• Medications: Vitamin K, antimalarials.

• Hemolytic uremic syndrome (HUS).

Classification of anemia based on red blood cell size and color:

• Microcytic hypochromic anemia:

• Decreased serum iron: Iron deficiency, chronic blood loss, chronic kidney disease.

• Increased serum iron: Thalassemia, iron-deficient erythropoiesis, lead poisoning, vitamin B6 deficiency.

• Normocytic normochromic anemia:

• Due to disorders in red blood cell production in the bone marrow.

• Blood loss.

• Hypersplenism.

• Macrocytic anemia:

• Folic acid, vitamin B12 deficiency.

• Hypothyroidism.

• Liver disease.

• Diamond-Blackfan anemia.

• DNA synthesis disorders.

Symptoms:

• Hemolytic anemia: Anemia, jaundice, splenomegaly, dark urine.

• Aplastic anemia: Severe anemia, difficult to recover, bleeding.

• Fanconi’s inherited aplastic anemia: Anemia, bleeding, congenital malformations (such as thumb malformations).

• Acute leukemia: Severe anemia, bleeding, bone pain, fever.

• Chronic infections: Anemia, fatigue, prolonged fever.

Diagnosis:

• Blood tests:

• Complete blood count: Evaluates red blood cell count, hemoglobin, hematocrit.

• Reticulocyte count: Evaluates red blood cell production capacity.

• Bilirubin: Evaluates hemolysis.

• Coombs’ test: Evaluates immune hemolysis.

• Iron tests:

• Serum iron.

• Transferrin.

• Ferritin.

• Free erythrocyte protoporphyrin.

Treatment:

• Iron deficiency anemia:

• Iron supplementation: 4-6 mg/kg/day, divided into 2-3 doses, taken between meals.

• High-dose vitamin C supplementation: 50-100 mg/day.

• Blood transfusion: Only when Hemoglobin < 6 g/dl.

• Anemia due to other causes: Treatment based on the underlying cause.

Prevention:

• Iron supplementation for pregnant women from the second trimester of pregnancy.

• Iron supplementation for children at risk of iron deficiency.

• A balanced diet rich in nutrients, especially iron.

Note:

• Anemia is a serious condition that needs to be diagnosed and treated promptly.

• Anemia treatment should be carried out as prescribed by a doctor.

• Do not self-medicate without a doctor’s prescription.

Additional information:

• Iron is most abundant in red blood cells, specifically hemoglobin (65-75%).

• The total amount of iron in the body is about 3-4 g.

• The transferrin saturation index is 30%, iron absorption is easier when this index is low.

• Iron is absorbed in the form of Fe2+.

• Meat, liver, fish, vitamin C, HCl increase iron absorption.

• Milk, egg yolks, cheese, green tea decrease iron absorption.

• Infants need 70% of their iron from the breakdown of old red blood cells and 30% from food.

• Iron deficiency anemia often begins between 6-18 months of age, premature infants may experience it earlier.

• Symptoms of iron deficiency anemia: Pale skin, fatigue, loss of appetite, decreased activity, slow development, susceptibility to infections.

• Tests for diagnosing iron deficiency anemia: Hemoglobin, MCV, MCH, MCHC, RDW>15%.

• Tests indicating iron deficiency: Serum iron < 10 um/l, transferrin < 15%, ferritin < 12 (children under 5 years old) or < 15 (children 5 years old and above), free erythrocyte protoporphyrin > 70 ug/l.

Conclusion:

Anemia is a common condition that can severely impact health. Understanding the causes, symptoms, diagnosis, and treatment of anemia can help you prevent and effectively manage this condition.