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What is anemia?
Anemia in general is one of many conditions in which the circulating red blood cells are either deficient in number or in total hemoglobin content, relative to the normal ranges.
For the red blood cells to remain constant, the ones that die off must be replaced by new red blood cells that are released from the bone marrow. The average lifespan of a red blood cell is about 120 days - roughly 4 months - with about 1/120th being replaced on a daily basis, and a correspondingly equal count of new red blood cells being released into the bloodstream on a daily basis. In acute (24-48 hours after the acute blood loss) or long-term chronic cases, there may also be "reticulocytes" in the blood, these are immature blood cells the body is releasing ahead of schedule in order to speed up production.
What causes anemia?
Anemias typically can be broken down into two basic types - regenerative (the body can keep up with demand) and non-regenerative (the body is unable to make new red blood cells fast enough for whatever reason). These can then be broken down into the various separate sub-types (only ONE of which is due to iron deficiency!) as follows:
- Anemia via genetic cause (you're born with it)
- Anemia due to malnutrition (dieting or medication-caused)
- Anemia due to hypovolemia and traumatic causes
- Anemia via acquired issues (drugs and other chemicals)
- Anemia due to autoimmune conditions (body destroying it's own cells)
- Anemia due to chronic ailments (cancer, kidney problems, etc.)
Each type can then be further broken down into types that are due to blood destruction vs. simple blood loss, decreased blood formation (assembly problems), and bone marrow (production) problems, and so on. Each type can have a variety of causes - anemias of blood cell destruction (hemolytic anemias) alone can have any one of hundreds of causes.
Remember that anemia is NOT a diagnosis (except for genetic cases) - it is just one symptom of an underlying problem. Thus, any signs of anemia need to be investigated so that the primary cause may be dealt with. The symptoms are neither sensitive nor specific, and do not help differentiate the different types of anemias - what the symptoms do indicate is the body's attempt to compensate for the lack of oxygen in the blood.
Here a list of known types of anemias, according to the eMedicine website (source link below). Note that there are a LOT - close to 40 types - in this list, which highlight the importance of getting bloodwork done and further testing if required to determine the true cause of anemia:
- Congenital dyserythropoietic anemia
- Defects of the RBC cytoskeleton
- Diamond-Blackfan Anemia
- Enzyme abnormalities of the glycolytic pathways
- Fanconi anemia
- Hereditary xerocytosis
- Rh null disease
- Shwachman-Diamond Syndrome
- Sickle Cell Anemia Thalassemias
- Iron deficiency
- Vitamin B-12 deficiency
- Folate deficiency
- Starvation and general malnutrition
Hemorrhage / Physical effects
- Prosthetic valves and surfaces
Drugs and chemicals (Acquired causes)
- Aplastic anemia
- Megaloblastic anemia
Chronic diseases and malignancies
- Cancer / Neoplasia
- Chronic infections
- Collagen (connective tissues) and vascular (blood vessels) diseases
- Hepatic / liver disease
- Renal / kidney disease
- Bacterial - Clostridia, gram-negative sepsis
- Protozoal - Malaria, leishmaniasis, toxoplasmosis
- Viral - Hepatitis, infectious mononucleosis, cytomegalovirus
What are the symptoms of anemia?
General symptoms such as weakness, seeing spots, fatigue, drowsiness, difficulty with concentration, lack of appetite, continually thirsty, chest pain, fainting, and shortness of breath on exertion are common.
Sometimes additional symptoms such as vertigo/dizziness, headache, a pulsating "ringing" in the ears, irregular monthly cycles (for women), loss of libido, and stomach/gut complaints may also occur.
In severe anemia, anxiety, irritability, heart failure or shock can develop with severely oxygen-starved tissues and signs of hypovolemia.
How is it diagnosed?
Certain other symptoms (in addition to the above) may suggest the originating source of the anemia, which can help medical staff determine the actual cause. Signs of other underlying problems - in addition to the anemia signs - are often more diagnostically accurate, especially in acute cases, such as:
- Jaundice - yellowing of the skin and eyes - and dark urine in the absence of liver disease suggest a destructive process.
- Weight loss suggests cancer (or other chronic disease process that will cause weight loss).
- Severe and widespread bone or chest pain may suggest sickle cell disease (or a cancer in the bones)
- Pain in a stockings-and-gloves pattern may suggest vitamin B12 or folate deficiency.
- Blood in the fecal matter identifies GI bleeding.
- Hypovolemia coming from acute bleeding, whether external (accident/trauma) or internal (blunt trauma causing organ damage).
There are, obviously, many other other diagnostic symptoms not covered here. It's important to get anemia symptoms evaluated so that once the source of the bleeding is known, medical staff can make appropriate decisions and recommendations as to treatment and management.
General bloodwork testing will include:
- CBC with WBC and platelets
- RBC indices and morphology
- Peripheral smear
- Reticulocyte count (high when regenerative, few or none when non-regenerative or early post-hemmorrhage)
- Sometimes bone marrow aspiration and biopsy
How is it treated?
Remember that anemia is not a diagnosis by itself (except in genetic cases), so usually the anemia is cured by fixing the underlying cause. In some cases, for example where the cause is genetic, there may only be treatment options available.
If you've been diagnosed with one of the many anemias, talk to your medical professional(s) about the underlying cause(s) and it's treatment options.
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