General Overview Regarding AnemiaIntroduction
Anemia in a simplified translation means a “lack of blood cells”, but
it involves a catalogue of complex symptoms. Just giving it a label without looking
for the cause is a serious medical blunder. Anemia is like a warning flag that
points to an underlying medical problem that needs to be investigated. Symptoms
The patient may not notice mild forms, and only laboratory tests will show
abnormalities. Severe forms of anemia can produce a host of signs and symptoms.
Weakness, dizziness, headache, ringing in the ears (tinnitus), lack of energy,
irritability and loss of libido may be part of the symptoms that send the patient
to the doctor. Sometimes there are gastro-intestinal complaints, jaundice or an
enlarged spleen. Diagnosis It is necessary to investigate
the mechanisms that led to anemia. Acute blood loss is the most obvious reason.
Chronic blood loss-even if the amounts are small- can lead to anemia. A deficiency
in the production of red blood cells (erythopoiesis) may be the culprit or destruction
of red blood cells (know as excessive hemolysis) could be responsible. Blood loss
in its acute or chronic form have to be considered first. Any source of unrecognized
internal bleeding (ulcers and gastro-intestinal bleeding) can be at the source
of anemia. Too frequent periods or heavy periods will lead to anemia in females.
Iron deficiency anemia shows a similar laboratory pattern as anemia due to chronic
blood loss. If blood loss has been excluded as a reason for anemia, only the other
two mechanisms (deficient production of red blood cells and destruction of red
blood cells) have to be considered. Forms of Anemia The
changes in laboratory patterns, also known as morphological changes, and the special
features make the condition of anemia a very complex one. For instance, the microcytic
form of anemia caused by chronic blood loss and iron deficiency leads to a production
problem of the bone marrow. The macrocytic form of vitamin B12 deficiency anemia
and folate deficiency anemia comes from impaired DNA synthesis in the bone marrow
leading to blown up appearing red blood cells (“macrocytic”), but overall
there are insufficient numbers of them circulating in the blood because of a reduced
production in the bone marrow. The latter one (folate deficiency) is often associated
with celiac desease, pregnancy, malabsorption of nutrients and alcoholism. Other
forms of anemia can have their origin in bone marrow failure, can stem from chronic
infection or inflammation, or can be the result of a paroxysmal cold hemoglobinuria
after exposure to a cold or an infection with syphilis. Hereditary forms include
hereditary sphero-cytosis or there could be inborn or acquired defects (sideroblastic
anemia.) Some specific anemias are more common in certain population groups. As
an example, sickle cell anemia is almost exclusively found in blacks, and thalssemia
is frequently found in patients of Mediterranean descent. Due to the complexity
of this disease, it is imperative to seek a referral to a hematologist, who assesses
and treats disorders of the blood. Tests for Anemia Blood
tests give information about the severity of the condition and are the data source,
which are needed for the proper diagnosis. In most cases the blood is collected
in the laboratory by venipuncture. The so-called CBC, which stands for “complete
blood count” is the basic test, which includes information about the composition
of the blood. It includes a count of the white blood cells, the red blood cells,
the white blood cell differential count, hemoglobin and hematocrit, as well as
information about platelet spread. This test is valuable, as it may detect anemia,
infection, bone marrow failure and adverse drug reactions. Blood smear examinations
can help with the detection of other abnormalities. This test is important to
check the appearance of red blood cells. Some abnormalities (thrombocytopenia
and others) can be detected, even if the CBC showed normal counts. Automated technology
makes test results available in about 30 seconds. Red blood count and reticulocyte
count give more details about the red blood cells, the latter being the young
cell population. An increased count in the young cells (reticulocutosis) is especially
noticeable in hemolytic anemias and in acute and severe bleeding. Electronic and
automated technologies have opened up new diagnostic possibilities. Variation
in the shape of cells, portions of disrupted cells, membrane alterations and fragments
of red blood cells can be found. Tests for red blood cell fragility (osmotic fragility)
are another tool, and hemostasis (bleeding time, prothrombin time and others can
provide further insight. Bone Marrow Studies The
techniques of bone marrow aspiration and biopsy allow a direct observation of
activity and maturation of the red blood cell precursors. The amount of distribution,
the cellular pattern of iron content or abnormal maturity of the cells are all
helpful tests in anemias. Bone marrow aspiration and biopsy are neither difficult
nor invasive, can be done as a single procedure and for this reason should be
part of the early diagnostic tools in suspected hematological diseases. These
procedures typically are ordered by a hematologist.
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