What is …?
The word anemia is of Greek origin and in literary translation means the absence of blood, which is incompatible with life. Anemia is defined as an absolute reduction in the total mass of erythrocytes, secondary to hemorrhage, hemolysis, or reduction in red blood cell production. One of the most common illnesses in medicine. Anemia is a blood disorder that occurs due to defects in red blood cells. This disease can have a very serious impact on the lives of affected people. A condition that represents a decrease in the number of erythrocytes in the blood, followed by a decrease in hemoglobin and hematocrit below normal values. These conditions are accompanied by a disturbed balance between the formation of erythrocytes and hemoglobin in the bone marrow of their eruption from the blood. In doing so, the reduction of hemoglobin and erythrocytes is not always parallel. A small number of erythrocytes contain less hemoglobin, which is why oxygen delivery to organs such as the brain, heart, and muscles is reduced, and thus the cells receive fewer nutrients. Anemic people feel mental and physical weakness; the heart works faster in an attempt to increase blood flow by compensating for the lack of oxygen in the blood of poor red blood cells.
Statistics say almost a third of the world’s population suffers from anemia, of which 500 million of sideropenic anemia. Anemia may arise as an isolated disorder in matured erythroid lineage, either innate or acquired. According to the WHO criteria, anemia is defined as a hemoglobin concentration (Hb) in the blood lower than 130 g / l or hematocrit (Hct) of less than 39% in adult males, or Hb of less than 120 g / l or Hct lower than 37% in adult women.
Is based on the present clinical anemic syndrome and the basic parameters of blood count: reduced number of erythrocytes reduced hemoglobin concentrations and reduced hematocrit values. As well as determining the proliferative potential of erythroid vascular in vitro (bone marrow cell culture). The indication for a hospital examination is the repeated need for blood transfusions, often found in these patients.
The next step in the diagnosis of anemia type is the determination of anemia according to the erythrocyte form, which is determined by the parameters MCV, MCH, MCHC. The bone marrow response to anemia is estimated based on the number of reticulocytes. An increased number of reticulocytes corresponds to an increased response to the bone marrow, and a reduced number, a weak bone marrow response to anemia. Peripheral blood smear allows an optical analysis of the erythrocyte form, as well as an insight into the present forms of white vines where possible disorders.
A large number of other organ system diseases (malabsorption syndromes, renal failure, malignant diseases), as well as systemic autoimmune diseases (rheumatoid arthritis, systemic lupus), lead to anemia, which is often one of the first laboratory findings, which, with anamnestic data and results other tests, to point to the cause of anemia.
Etiology and Metabolism
Erythrocytes are bone marrow-containing cells that contain hemoglobin that supplies the body with oxygen and participate in the elimination of carbon dioxide from the body. Iron, vitamins, amino acids are needed for proper erythrocyte formation. The normal erythrocyte era is 90 to 100 days. One ml of erythrocyte contains one mg of iron. Iron is essential for the synthesis of hemoglobin, myoglobin, and tissue enzymes. It is absorbed in the intestines and binds to protein transferrin and transports through the blood to the tissue. The excess of iron is deposited in the form of ferritin and hemosiderin in the liver, bone marrow, and spleen. The diet contains 10-20 mg of iron, and it absorbs 0.6-2 mg per day. Daily men need about 1 mg of iron, women in the generative age 2 mg, and in pregnancy 3 mg per day.
Among the three main causes of anemia include high blood loss (hemorrhage), increased erythrocyte decomposition (hemolysis), insufficient erythrocyte production (reduced erythropoiesis). Chronic kidney, endocrine, and hepatitis diseases, inflammation and carcinomas, as well as bleeding from GIT, abundant menstruation, pregnancy, lactation, bleeding from other organ systems, and the use of drugs can lead to anemia.
- Anemia is sometimes difficult to detect because early symptoms (symptoms) are very mild.
- It is therefore easy to replace problems that are seen in other diseases or after using some medicines.
- Anemia can reduce life energy to the extent that it makes it difficult for people to perform the most basic living activities.
- It aggravates the problems that create other diseases as well if they interact with one another, and drowsiness, weakness, paleosalinity and other indicators become very pronounced.
- Fatigue – drowsiness
- Weakness – fast fatigue
- Dizziness and insecurity
- Faded skin and mucous membranes of lips, gums, conjunctiva, nails, and palms
- Accelerated cardiac work – tachycardia
- Feelings of cold, especially limbs – arms and legs
- Sorrow and depression
- Reduction of sexual function
- Sleep disorders and appetite suppression
Anemia can be classified in three ways:
- Division of anemia by size of erythrocyte (MCV)
-Microcrete – MCV less than 80fl – the result of reduced production of hemoglobin in erythroblasts.
-Normocytes – MCV from 80 to 95fl – is the result of disturbances in the differentiation of erythrocytes in the bone marrow.
-Macrocyte or megaloblastic – MCV is greater than 95fl – the consequence of delays in the synthesis of DNA. The maturation of the erythroblast nucleus lasts longer, so in the cytoplasm
Purchases more hemoglobin than usual.
- Division by hemoglobin concentration in erythrocyte to:
- Pathogenetic division of anemia to:
-Hemolytic anemia – due to increased red blood cell degradation due to loss blood
– Hyperproliferation anemia – the consequence of disturbed stimulation of erythropoiesis or weakness of the bone marrow
– Anemia due to mood disorders
The consequence of reduced hemoglobin formation in erythroblasts. As the incorporation of all three components of the hemoglobin is synchronized, reduced availability of deep chains, hematomas or iron causes microcytic anemia. Sideropenia anemia is the most common form of anemia and is due to the lack of iron.
From the onset of the deficit to the manifestation of anemia, the organism passes through three phases:
- Iron depression due to reduced or absent iron stores in the body, while serum iron is of normal value,
- Iron deficiency – iron depreciation with reduced serum iron values, as well as reduction of transferrin saturation,
- Manifested sideropenic anemia where the values of iron, hemoglobin, and hematocrit are reduced.
Normocytic anemia arises as a result of interference in the erythrocyte differentiation in the bone marrow.
They can be divided into:
- Corpuscular (internal – membrane defects, lack of enzyme, hemoglobinopathy),
- Extracorpuscular (autoimmune, all immunologic, non-immunological – infection, splenomegaly, physical trauma).
- Acute blood loss,
- Aplastic anemia,
- Anemia chronic illness,
- Anemia in chronic renal failure,
- Anemia in endocrine disorders,
- Myelophytic anemia.
Megaloblastic anemia is a consequence of delays in the synthesis of deoxyribonucleic acid (DNA). The erythroblast core ripening lasts longer, and more hemoglobin is consumed in the cytoplasm than is common.
Anemia therapy depends on the cause of anemia and should primarily be detected and treated by the cause (bleeding – gynecologist, gastroenterologist).
Selection of therapies Sideropenia anemia is in the peroral administration of bivalent iron irrespective of whether it is sulfate, fumarate, or any other salt, which is normally absorbed in the upper parts of the digestive tract. The optimal dose is 100-200 mg of elemental iron daily, before meals for 3-6 months after correction of anemia. In older than 65 years, the iron dose is reduced to 200 mg/day because it is harder to tolerate iron preparations. Along with iron therapy, Vit C 500 mg is given, as it increases the absorption of Fe.
The assessment of therapy is done after 3-4 weeks and based on the hemoglobin value, and if it is increased by 10g / l, the therapy is successful. Causes of failure of therapy should be sought in the wrong diagnosis, irregular, and miscarriage, continuous bleeding, or iron malaise. The recommendations on the minimum duration of therapy vary and range from 2-12 months and curtains from the clinical picture of the patient.
TREATMENT OF PERNICIOUS ANEMIA
The illness is chronic and leads to death if it is not treated. Treatment is performed using vitamin B12. The daily requirement for vitamin B12 is 2.5 μg. In the initial stage of treatment, parenterally 100 μg of vitamin B12 is given per day. If there are pronounced neurological symptoms, the dose is 1000 μg daily for one week, then at the same dose once a week for four weeks, or until the normalization of the blood count. The maintenance phase is once a month for the rest of life in the same dose. A day after the beginning of therapy with vitamin B12, the preparation of iron is added.
The effect of treatment is very rapid. The best indicator of recovery is the increase in the number of reticulocytes in the peripheral blood, reticulocyte crisis. After the reticulocyte crisis, hematocrit, hemoglobin, and the number of erythrocytes increase. After 1-2 months, the erythrocyte and hemoglobin values are normalized. Already 6-8 hours after the first dose of vitamin B12, the number of megaloblasts is reduced. After 24-48 hours, the appearance of bone marrow is normal. Symptoms of anemia and symptoms associated with the digestive tract are generally normalized, while neurological symptoms only improve and stop worsening.
Anemia is the most common disorder of blood vessels and one of the most common pathological conditions, because it occurs in some form almost in every human illness.
Therefore, in most cases, anemia should not be considered as a specific diagnosis, but rather as a clinical sign, a guideline leading to the diagnosis of the underlying disease.
- If anemia is not treated in time, a severe condition of the organism can lead to the need for blood transfusions.
- Also, low levels of erythrocytes can lead to additional health problems. Anemia can lead to heart overruns and heart problems.
- Anemia can also hamper mental processes. If it lasts long or the symptoms get worse, this can seriously and permanently damage the health.
- Approaches to treatment are different and depend on the causes of anemia.
- Prevention, early recognition, and examination of anemia are essential, as the only path for diagnosis and timely treatment, resulting in a better quality of life.