Anemia is a condition characterized by a reduction in the number of erythrocytes per unit of blood volume or a decrease in hemoglobin to below the level of normal/usual psychological need. Anemia is defined as the hemoglobin level below the 95th percentile for healthy reference population of men, women and children.
Anemia however, is not a disease it is a symptom of a number conditions which may include:
- Extensive blood loss
- Excessive destruction of blood cells
- Decreased blood formation
It is observed mainly in hospital patients.
Classification of Anemias:
Nutritional deficits are a major cause of decreased hemoglobin and erythrocyte production. Anemias associated with a mean RBC volume of less than 80 fl are considered to be microcytic, those with value 80 fl to 90 fl are normocytic and those with a value of 100 fl or more are considered to be macrocytic.
- Microcytic anemia is mostly caused by or is associated with iron deficiency
- Macrocytic anemia is generally caused by either folate or vitamin B12 deficiency. However, because of the low specificity of these indexes, additional data are needed to distinguish between various nutritional causes such as thalassemia trait and chronic renal insufficiency
- Normocytic anemia is associated with the anemia of chronic and inflammatory diseases. This type of anemia is associated with rheumatic diseases, chronic heart failure, chronic infection, cancer, severe tissue injury, multiple fractures and Hodgkin disease
Other Information from the CBC that helps to differentiate the non-nutritional causes of anemia includes leukocyte, reticulocyte and platelet count. When those levels are low, marrow failure is indicated. High counts are associated with anemia caused by leukemia or infection. Reticulocytes are large nucleated, immature red blood cells that are released in small numbers with mature cells. When red blood cell production rate increases reticulocyte number also increases. Other causes of high number of reticulocyte number includes intravascular hemolysis syndrome and an erythropoietin response to therapy for iron, vitamin B12 or folic acid deficiency.
Normocytic anemia may be caused by chronic or acute blood loss such as from recent surgery, injury or positive occult stool test.
Symptoms of Anemia:
The side effects of iron deficiency differ as per the kind of frailty, the hidden reason, the seriousness and any basic medical issues, for example, discharging, ulcers, menstrual issues, or disease. Explicit indications of those issues might be seen first.
The body likewise has an astounding capacity to adjust for early iron deficiency. In the event that your frailty is gentle or has created over an extensive stretch of time, you may not see any side effects.
Following are the symptoms that are commonly seen with people who are being diagnosed with anemia:
- Simple weakness and loss of vitality
- Strangely quick heartbeat, especially with exercise
- Shortness of breath
- Trouble concentrating
- Leg spasms
- A sleeping disorder called Insomnia
Different side effects are related with explicit types of iron deficiency.
Treatment for Anemia:
Converse with your specialist on the off chance that you have chance variables for frailty or notice any signs or indications of sickliness including:
- Relentless weakness
- Fast pulse
- Fair skin
or some other side effects of iron deficiency. Look for crisis care for any inconvenience breathing or change in your heart beat. More symptoms include:
- Terrible eating routine or deficient dietary admission of nutrients and minerals
- Heavy menstrual periods
- Manifestations of an ulcer
- Dawdle stools
- Colorectal malignant growth
- Ecological introduction to lead
You might even get the disease if it runs in the family. Before going to the doctor you might want to check your family history related to anemia.
For ladies thinking about getting pregnant, your specialist will probably prescribe that you start taking enhancements, particularly folate, even before origination. These enhancements advantage both mother and child.
Test for Iron Deficiency Anemias:
Following are the list of tests for iron deficiency anemias:
- Hematocrit or packed cell volume and hemoglobin
- Serum ferritin
- Serum iron
- Total iron binding capacity and transferrin saturation
Hematocrit or packed cell volume and hemoglobin:
Hematocrit and hemoglobin are an important part of a routine CBC and are used together to evaluate iron status. Hematocrit is the measure of percentage of RBCS in total blood volume. Usually the hematocrit volume is three time than the hemoglobin concentration in grams per decimeter. The value is affected by the high number of white blood cells count and hydration status. Individuals living in higher altitudes have higher values of HCT.
The hemoglobin concentration is the measure of the total amount of Hgb in the peripheral blood. It is a more direct measure of iron deficiency than Hct as it quantifies the total Hgb in red blood cells rather than a percentage of total blood.
Ferritin is the storage protein that sequesters the iron normally gathered in the liver, spleen and the marrow. As the iron supply increases, the intracellular level of ferritin increases to accommodate iron storage. A small amount of this ferritin leaks into the circulation. This ferritin can be measured by assays that are available in most crucial laboratories. In individuals with normal iron storage, 1 mg/ml of serum ferritin equals approx. 8 mg of stored iron. Ferritin is a positive acute phase protein, meaning that synthesis of proteins increases in the presence of inflammation. Ferritin is not a reliable indicator of iron stores in patients with acute inflammation, uremia, metastatic cancer and alcohol related liver disease.
Serum iron measures the amount of circulating iron that is bound to transferrin. However, it is relatively a poor index of iron status because of large day to day changes even in healthy individuals. Diurnal variations also occur, with the highest concentrations occurring midmorning and a nadir averaging 30 percent less than the morning level, occurring midafternoon.
Total iron binding capacity and transferrin saturation:
Total iron binding capacity is a direct measure of protein available to bind to mobile iron and depends on the number of free binding sites on the plasma iron transport protein transferrin. Each transferrin molecule binds to ferritin ions at each of the two binding sites and two bicarbonate ions at separate sites. Intracellular iron availability regulates the synthesis and secretion of transferrin. There are exceptions to the general rule that transferrin saturation decreases and TIBC increases in patients with iron deficiency. For example TIBC increases in those with hepatitis and also in people with hypoxia, women who are pregnant and are taking contraceptives or receiving estrogen replacement therapy. While on the other hand TIBC levels decrease in patients with malignant diseases. Nephritis and hemolytic anemias. An additional concern about the use of serum iron, TIBC and transferrin saturation values is that normal values persist until frank deficiency actually develops.
Tests For Macrocytic Anemias From Vitamin Deficiencies
Treatment for macrocytic anemia includes static measurement of folate and vitamin B12 deficiency in blood. They are assayed using tests of the ability of the patients’ blood specimen to support the growth of microbes that require either folate or vitamin B12 radio binding assays. Serum homocysteine, folate and vitamin B12 are required for the synthesis of SAM, the biochemical precursor involved in the transfer of one carbon groups through many biochemical syntheses. SAM is synthesized from the amino acid methionine by a reaction that includes a methyl group and purine base adenine. For example, when SAM releases a methyl group for the synthesis of thymine, choline, creatine and protein and DNA methylation, it is converted into methyl homocysteine.
Vitamin B12 assessment is the process in which vitamin B12 is measured in the serum and all the indications are that the serum level gives as much information about vitamin B12 stats as does the RBC level. If vitamin B12 status is compromised intrinsic factor antibodies and parietal cell antibodies are measured. The presence of antibodies suggests the main cause of pernicious anemias. The Schilling test was used to detect the defects in vitamin B12 absorptions. It is rarely used today because the rest require that the patient be given radioactive vitamin B12. Vitamin B12 and methyl malonic acid. Once a genetic cause is ruled out the most straight forward biochemical method for differentiating between folate and vitamin B12 deficiencies is to monitor the hyper homo cysteinemia by measuring the serum or urinary MMA level. MMA is formed during the degradation of the amino acid valine and odd chain fatty acids. MMA is the side product in this metabolic pathway that increases when conversion of methyl malonic acid coenzyme A to succinyl CoA is blocked by lack of vitamin B12 a coenzyme for this reaction. The urinary MMA test is more sensitive than the serum B12 test because it indicates true tissue B12 deficiency. The serum MMA test may give high false values. Homocysteine and MMA tend to detect impending vitamin deficiencies better than the static assays. This is especially important while assessing the status of certain patients such as vegans or older adults who could have vitamin B12 deficiency associated with central nervous system impairment.
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