CHEARS

Hematopoiesis is the process of production of blood cells in the bone marrow. The hormone erythropoietin which is synthesized in the kidneys is a major stimulator of RBC production in bone marrow. However, there can be conditions in which there is a reduction in the proportion of RBCs in blood causing anemia. Predominantly, it is a nutritional deficiency disorder caused by deficiency of RBC or hemoglobin or both. But there are other causes for anemia that also exists. This results in insufficiency of oxygen levels to meet the body’s demands.

It is one of the most common disease affecting 1/3rd of global population. It is usually prevalent in elderly, women of reproductive age & pregnant women. Infants can also be anemic due to less iron in milk from anemic lactating mothers or high consumption of cow’s milk. Majority of the cases are mild and asymptomatic. One is said to be seriously anemic if the hemoglobin levels drop below 7.0g/dL (Normal levels- 12-17 g/dL).

The different types of anemia are:

1. Iron-deficiency anemia: Occurs due to less iron in bloodstream. Iron is an essential component for Hemoglobin synthesis.

2. Pernicious anemia: Occurs due to Vitamin B12 deficiency. Vit. B12 is essential for making new RBCs. This usually develops after 50 years of age.

3. Folate-deficiency anemia: occurs due to inadequate folate (vitamin B9) in diet. Folate is necessary for synthesis of DNA and cell division to produce reticulocytes (immature RBCs). Most common in deprived, pregnant women and chronic alcoholics.

4. Hemolytic anemia: The RBCs are destroyed and removed from bloodstream before they reach their normal lifespan (120 days). This can occur due to stress such as toxins from liver/ kidney disease, venom from snake, other insects, certain foods, etc.

5. Sickle cell anemia: Occurs due to Sickle- shaped RBCs (abnormal Hemoglobin). They die after 10-20 days. It is an inherited and a lifelong disease. Due to this shape, they can’t move easily through blood vessels and clumping can occur which blocks blood flow to limbs & organs.

6. Thalassemia: It is an inherited genetic blood disorder where fewer RBC production occurs. This is due to a defect in RBC production since alpha and beta chains are not made enough. Hence less oxygen is transported in the body.

7. Aplastic anemia: Occurs due to damage to bone marrow stem cells. Hence there is decreased hematopoiesis.

8. Hemorrhagic anemia: Occurs due to loss of blood due to trauma, ulcers, excessive menstrual bleeding.

How to identify the various signs and symptoms of anemia?

• Fatigue

• Headache

• Yellowish skin

• Irregular heart beats

• Dizziness

• Cold hands

• Chest pain

• Leg cramps

• Spooning of nails

• Mucus membranes and nails look pale

What makes you anemic?

• Dietary history- diets with insufficient amounts of iron, vit B12, folic acid and in general lacking nutritional diet.

• Fatty stools causes less absorption of nutrients such as iron, vit B12.

• Obvious bleeding via rectum, heavy menstruation or hemorrhoids

• Surgery history of gastric and abdominal surgery. It might be due to internal bleeding.

• Family history of hereditary forms of anemia such as Sickle cell anemia and thalassemia.

Diagnostic tests to detect if you are anemic-

• Complete Blood Count (CBC) to measure RBC count in body. Normal range is 4.0 to 6.0 million cells per microlitre of blood.

• Corrected reticulocyte count to determine the number of reticulocytes in hematocrit.

• Mean corpuscular volume (MCV) to determine any aberrations in the size of RBC. The size can be classified as normal, macrocyte (larger RBCs), microcyte (smaller RBCs).

• Blood smear to determine the morphology of RBC and if any irregularities are present such as sickle shape.

• Colonoscopy to determine GI internal bleeding.

• Ultrasonography, MRI to determine presence of fibroids in pelvis.

What are the treatment options?

• Nutritional diet: Consume foods with good sources of iron, folic acid and Vit. B12 & Vit C (for absorption of iron) such as Green leafy vegetables, red meat, dates, tofu, soy, poultry, foods fortified with folic acid and Vit. B12 etc.

• Oral supplementation of iron: Dosage depending on age, severity of condition.

• Treatment with cross-matched RBCs for excessive blood loss.

• Bone marrow transplantation & synthetic erythropoietin if suffering from aplastic anemia

Do not miss out on any symptoms or diagnosis! If treatment not taken on time, it could lead to complications such as multi organ failure, premature labor, risk of anemia in fetus, cardiovascular disorders, impaired neurological development in children, etc.

References:

• VanPutte, C., Regan, J., & Russo, A. (2016). Seeley's Essentials of Anatomy and Physiology (9th ed., p. 313). New York: McGraw-Hill Education.

• N., Soundarya. (2015). A review on anaemia – types, causes, symptoms and their treatments.

• Turner J, Parsi M, Badireddy M. Anemia. [Updated 2020 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499994/