Anaemia is termed as the reduced RBC and haemoglobulin levels.
An iron deficiency anemia affects 8.8% of the population world wide.It is slighltly more common among females than males.
Anaemia due to increased blood loss
Post haemorshagic anemia and chronic blood loss
B.Anaemia due to impaired red cell production:
Iron deficient anaemia-it is caused due to defect in haem synthesis
Thalaessaemia-it is caused dur to defect in globin synthesis.
Vitamin B12 deficiency(Pernicious anaemia) and megaloblastic aneamia
Congenital anaemia-sideroblastic anaemia(erythrocytes and normoblast which contains iron in their cytoplasm ,congenital dyserythropoietic anaemia.
Bleeding-it may occur due to injury to the vessel wall,coagulation factor deficiency
Reduced intake of iron supplements in food
Chronic kidney diseases and enlaged spleen
Post operative to major or minor surgeries
Subnormal levels of haemoglobin causes lower oxygen carrying capacity of the blood.this,in turn initiates compensatory physiologic adaptation as follows.
Increased release of oxygen from blood
Increased blood flow to the tissues
Mainteanance of the volume of blood
Redistribution of blood flow to maintain the cerebral supply
Tissue hypoxia leads to the impaired function of the organs.
COMMON CLINICAL SIGNS AND SYMPTOMS :
Complete blood count (CBC)
A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in your blood (hematocrit) and the hemoglobin in your blood.
Normal adult hematocrit values vary among medical practices but are generally between 40% and 52% for men and 35% and 47% for women. Normal adult hemoglobin values are generally 14 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women.
A test to determine the size and shape of your red blood cells(Peripheral blood smear)Some of your red blood cells might also be examined for unusual size, shape and color.
Serum iron and ferritin test-to check the amount of iron in blood and body
Reticulocyte test:to check that the bone marrow is functioning in an accelerated level
Haemoglobin electrophoresis:to check the abnormality of haemoglobin as seen in the sickle cell anaemia and thalassemia.
Osmotic fragility test: to check if the red blood cells are more fragile than usual
Endoscopy:to check for internal bleeding
Colonoscopy:to check for bleeding from tumour in the intestine
Ultrasound:to check for enlarged spleen
Doppler ultrasound:it detect the circulatory anomalies that is suggestive of anaemia in new borns
Body Magnetic resonance imaging:It is used to reveal the functions of bone marrow and also it is used to find the deposition of iron in heart,liver and other vital organs.
TREATMENT AND PROGNOSIS :
Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to have iron deficiency without anemia; one-third of them have iron deficiency with anemia. Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.
Mild to moderate iron-deficiency anemia is treated can be treated by intake of oral supplements with ferrous sulphate,ferrous fumarate,ferrous glutamate. Routine intake of Iron supplement is indicated in women with child bearing age and also in pregnant women.Large amount of intake of iron might results in darkening of the faecal matter. Vitamin C promotes the absorption of an iron hence while taking the iron supplements one can take vitamin c as an adjuvant.If the anaemia occurs in chronic kidney disease recombinant erythropoietin is recommended.
Anaemia due to bone marrow dysfunction is treated by:Medication,chemotherapy and bone marrow transplant.
Parenteral Iron is given when iron is not taken by the oral route and the patient feel difficulty in taking iron supplemets orally.It is very much useful in patients with postpartum haemorrhage,longtime kidney diseases and inflammamtory bowel syndrome. The body is capable of absorbing 6mg of iron daily from the gastrointestinal tract. In chroic cases erythropeitin can be used as the supplements to restore the Iron.
Blood transfusion is mainly indicated in the patients who are symptomatic and the haemoglobin level is below 6-8gm/dl.In cardiac patients who are actively bleeding and the Hb level is below 8 should undrgo blood transfusion.
In cancer patients before the transfusion of the blood other strategies should be checked in them.if anyoter alternatives is possible it can be opted in them.
The main aim of Erythropoiesis stimulating agents is to minimize the transfusion reactions and it is not recommended in peoples with mild to moderate symptoms.It is contraindicated in people with chronic kidney disease unless their Hb level is maintained at less than 10. They should be used in adjunct to the oral iron.
Treatment of exceptional blood loss (anemia) is recognized as an indication for hyperbaric oxygen(HBO) The use of HBO is indicated when oxygen delivery to tissue is not sufficient in patients who cannot be given blood transfusion. HBO may be used for medical reasons when threat of blood product incompatibility or concern for transmission disease are factors.The beliefs of some religions may require they use the HBO method.A 2005 review of the use of HBO in severe anemia found all publications reported positive results.
An estimated 30% of adults who require non-cardiac surgery have anemia. In order to determine an appropriate pre-operative treatment, it is suggested that the cause of anemia be first determined.There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have pre-operative anemia.
The prognosis of the anaemia depends on the indivduals status and response to the iron therapy .
Dietary intake of Iron
Arrest bleeding when ever it is necessary
Medicines used in the Treatment :
Oral iron supplements such as ferritin,ferrous sulphate can be given.