Anemia

Also read:

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• Anemia symptoms
• Causes of anemia
• Iron deficiency anemia

Synonyms

Anemia, anemia, bleaching
English: anemia

definition

The Anemia is a common symptom. Anemia is understood to mean a reduction in the number red blood cells (Erythrocytes), the red blood pigment (hemoglobin) and / or the cellular component of the blood (hematocrit). Of the Hematocrit describes the percentage of blood cells in the total blood volume.
The erythrocytes are in the Bone marrow and have a lifespan of around 120 days. Their diameter is approx. 7.5 µm, they are round, indented on both sides and can be deformed. The formation of blood in the red blood cells (erythropoiesis) takes about 5 - 7 days. The dismantling takes place regularly in the spleen.

Classification of anemia

The anemia is classified according to:

• the volume of red blood cells: macrocytic, normocytic, microcytic
• the Hemoglobin content (proteinwhich transports the oxygen and iron contains): hypochromic, normochromic, hyperchromic
• of the root cause: Blood loss, synthesis disturbance, increased breakdown (hemolysis)
• the Bone marrow findings

Forms of anemia

Anemia can be divided into different forms:

• Iron deficiency anemia
• megaloblastic anemia
• pernicious anemia
• hemolytic anemia
• aplastic anemia

In the respective topic you can find out more about diagnosis, cause and specific therapy.

General introduction and causes

Anemia is a reduction in hemoglobin. This is an oxygen-carrying protein in the body.
It is found in the entire body in the red blood cells (erythrocytes) and thus serves to supply the organs with oxygen.
A drop in hemoglobin can be congenital or acquired.
Due to the anemia, the body reacts with an increased heart rate and a lower resilience. This gives rise to various symptoms. Depending on the cause of the anemia, there are different therapy options.

Anemia is divided into different forms, depending on the blood values ​​mentioned above.
This is also a classification of the cause of the various forms of anemia.
Normochromic, normocytic anemia describes anemia with normal sized red blood cells and a normal hemoglobin content (red blood pigment). The total number of red blood cells is decreased.
Often the cause of such anemia is an insufficient effect of the hormone erythropoietin or cytokine.

Erythropoietin is made in the kidney and stimulates the production of red blood cells in the bone marrow. An erythropoietin deficiency can be caused by kidney disease or a low metabolic state.
For example, as a result of an underactive thyroid (hypothyroidism), pituitary insufficiency (hypophyseal hypofunction) or a protein deficiency.
Likewise, aplastic anemia can lead to normochromic, normocytic anemia. The erythropoietin content is usually normal here. In contrast, the progenitor cells in the bone marrow are reduced, so that not enough red blood cells can be produced.
The exact cause is unclear; a genetic form is described which is known as Fanconi anemia.
Also

• radiation
• Chemicals
• Infections
• Medication
  or
• chemotherapy

can influence the formation in the bone marrow. However, this damage is unspecific and also affects the other progenitor cells in the bone marrow.
The blood-forming bone marrow can also:

• Malignancies (malignant tumors)
• Metastases
• malignant lymphoma (cancer of the lymph gland)
  or
• Leukemias

to be damaged.
However, this then not only leads to a disruption of the red blood cells, but also of the other blood cell rows.
Hyperchromic, macrocytic anemia describes a form of anemia with particularly large red blood cells that are rich in hemoglobin.
However, the number of red blood cells is decreased.
The reasons for this are:

• a lack of vitamin B12
• Thiamine
  or
• Folic acid.

Vitamin B12 is required in the body for DNA synthesis (genetic material). If there is insufficient DNA to synthesize it, the red blood cells become too large for comparison.

A vitamin B12 deficiency can result from insufficient intake with food or malabsorption (absorption disorder).
In order for vitamin B12 to be absorbed in the intestine, the intestinal mucosa needs the intrinsic factor (IF).
If this is absent or if it is not available in sufficient quantities, vitamin B12 cannot be absorbed. This can be due to acquired or congenital causes.
Chronic inflammatory bowel disease, tapeworm infestation or other intestinal diseases can also lead to a deficiency in vitamin B12.
There is an increased need for vitamin B12 during pregnancy, childhood and malignant tumor diseases.

Read more on the topic: Vitamin requirements during pregnancy

If this is not covered by sufficient intake, anemia also occurs.
Folic acid serves as a coenzyme in the synthesis of purines, thymine and methionine. A deficiency also leads to a disruption in DNA synthesis. The causes largely correspond to the reasons for a vitamin B12 deficiency.
Insufficient intake, intestinal diseases or an increased need in pregnancy and childhood without corresponding increased intake cause a deficiency.

The third form is hypochromic, microcytic anemia. Here the red blood cells are too small and contain too little hemoglobin. This form of anemia usually occurs as a result of an iron deficiency.
At around 80%, it is the most common form of anemia. One speaks of iron deficiency anemia.
An increased iron loss through bleeding, for example in the digestive tract, is often the cause of iron deficiency.

Read more here Iron deficiency anemia

Insufficient absorption due to diarrhea or a lack of gastric acid can also cause the body to have too little iron.
Iron deficiency anemia can also occur due to defects in the iron transport proteins (transferrin) or due to kidney disease and the resulting high iron loss.
Inadequate use of iron occurs, for example, in thalassemia or sickle cell anemia and also leads to anemia.
Likewise:

• Cancers
• Autoimmune diseases
  and
• acute or chronic infections

trigger iron deficiency anemia and thus anemia.
You can find out more about this anemia under our topic: Iron Deficiency Anemia.

Symptoms of anemia

The various symptoms of anemia are either a direct result of the insufficient oxygen supply (hypoxia) or the compensatory mechanisms of the body. Often the first symptoms that patients feel are tiredness and exhaustion. Due to the lack of oxygen, the skin and mucous membranes are often pale.
Since the brain can no longer receive enough oxygen either:

• a headache
• nausea
• Fainting (syncope)
• Difficulty concentrating
  or
• Ringing in the ears (tinnitus)

occur.
If the heart muscle receives too little oxygen, this can lead to angina pectoris, which takes the form of a heart attack.
The kidneys need a lot of oxygen for their work. If this is no longer sufficient, small amounts of blood (hematuria) and protein (proteinuria) can appear in the urine.
Brittle fingernails and hair loss can also be symptoms of anemia. In a compensatory way, the body tries to supply the organs with enough oxygen. This speeds up breathing and heart rate.
The above symptoms are general symptoms of anemia. Furthermore, specific symptoms can occur depending on the underlying disease. Basically, anemia itself is always a symptom of the actual disease.

You can also find more information under our topic: Symptoms of anemia such as Symptoms of iron deficiency anemia

diagnosis

Already from the Medical history (anamnesis) can provide a first indication of anemia.
This is followed by the Search for the cause at the most important point. Doing this is the main diagnostic tool Blood count.
This shows by means of the various parameters which causes can come into question.
The most important thing is the distinction between:

• an increased Blood loss or Blood degradation
  or
• one Hematopoietic disorder.

First of all, the blood count provides the answer as to whether there is anemia at all. This can be seen on Hemoglobin level read off (men <13 g / dl, women <12 g / dl).
The medium volume (MCV) of the Erythrocytes (red blood cells) gives an indication of the size of the cells. The middle one Hemoglobin content of an erythrocyte (MCH) and the concentration of the Hemoglobins (MCHC) indicate possible disturbances in the formation of the red blood pigment.

General therapy

The therapy depends on the various causes of anemia.

• Substitution of iron, vitamins, intrinsic factor, etc.
• Eliminate source of bleeding (e.g. treatment of tumors and ulcers)
• Treat infections
• Abstinence from triggering factors such as chemicals, pesticides, certain drugs, etc.
• Giving foreign blood (transfusion)

However, the therapy depends crucially on the form of the anemia, so you will find specific therapies directly under the forms of anemia.

Therapy for anemia consists primarily of eliminating the cause. In all patients with anemia, a precise diagnosis of the type of anemia must first be carried out.
An iron deficiency can be treated with iron tablets or, in the case of more severe forms, initially with repeated iron infusions.
Basically, the iron tablets should be taken about 30 minutes before a meal and with orange juice. The vitamin C it contains means that iron can be better absorbed.
If chronic bleeding in the gastrointestinal tract is suspected, the source of the bleeding must first be found.
Ulcer bleeding (bleeding from a stomach ulcer) in the stomach can be stopped by clipping (clamping off the bleeding) or injecting substances that promote coagulation.
Furthermore, patients should then regularly take proton pump inhibitors to reduce stomach acid.
If there is a deficiency of cobalamin (intrinsic factor) or thiamine, the substances can be administered intravenously. Hydroycobalamin is preferred to cyanocobalamin because it is excreted more slowly.
Already on the second day there is a significantly increased number of progenitor cells. So that enough red blood cells can be formed, iron and potassium must be given in this phase in order to be able to compensate for the massive increase in demand.
In the case of folic acid deficiency, this can be administered orally at a dose of 5 mg per day. In both cases, causal therapy (the cause must be eliminated) must take place if the cause of the deficiency is a chronic inflammatory bowel disease, tapeworm disease or tumor disease. In these cases, a simple substitution of the missing substance is not enough.
In the case of congenital diseases such as thalassemia or sickle cell anemia, only a stem cell transplant will help. Otherwise, erythrocyte concentrates must be administered regularly about every 3 weeks.
Another possibility is the regular administration of erythropoietin to stimulate production. This is mainly used in dialysis patients or after aggressive chemotherapy cycles to compensate for the erythropoietin deficiency.

Also read the article: The consequences of anemia.

Forecast of anemia

The prognosis of anemia also depends on the cause and cooperation (Compliance) of the patient. The range extends from temporary substitution (from e.g. iron) up to a lifelong gift of Vitamins. Certain forms can even be fatal if left untreated.

Summary

The Anemia is a common illness which can have various causes.
These range from comparatively harmless deficiencies (Iron deficiency) due to inadequate nutrition up to severe tumor diseases as the cause.
To find the cause, a simple blood count first helps, which provides information on the type of anemia and thus the cause. The individual forms of anemia (normochromic, normocytic / hyperchromic, macrocytic / hypochromic, microcytic) lead to different therapy options due to the numerous causes.
Simple deficiency states (e.g. iron deficiency) can be treated relatively easily by compensating them (e.g. iron administration).
Congenital causes of anemia, however, must through Administration of erythrocyte concentrate (Blood) or a bone marrow transplant.
Chronic diseases like Crohn's disease or Ulcerative colitis, as well as others Autoimmune diseases must be checked by inhibiting the Immune system be treated.
Anemia due to tumor diseases is often particularly difficult to treat, since the anemia arises not only from the tumor itself, but also from its therapy using radiation and chemotherapy.