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Anemia - What is Anemia?

How common is anemia?

Anemia is very common: It affects about 1/3 of the global population


types of anemia

A number of types of Anemia exist:

  • Microcytic (MCV <80 fL): e.g. iron deficiency, thalassemia, chronic disease
  • Normocytic (MCV 80 to 100 fL) e.g. chronic renal insufficiency, hemolysis, bone marrow suppression (cancer, aplastic anemia, infection)
  • Macrocytic (MCV >100 fL) e.g. vitamin B12 or folate deficiency, excess alcohol, myelodysplastic syndrome, liver disease, hypothyroidism, HIV infection

 aplastic anemia

Is a rare disorder (incidence in Western countries approximately 2/ million per year life-threatening form of bone marrow failure which, if untreated, is associated with very high mortality. AA refers to pancytopenia in association with bone marrow hypoplasia/aplasia.


What are the symptoms of aplastic anemia?

Recurrent infections due to neutropenia, mucosal hemorrhage or menorrhagia due to thrombocytopenia, or fatigue and cardiopulmonary findings associated with progressive anemia.


Why does aplastic anemia occur 

  • Cytotoxic drugs and radiation 
  • Cancer treatment (anticipated effect) 
  • Drug reaction (anti-seizure agents, antibiotics, nonsteroidal anti-inflammatory drugs, anti-thyroid medications, gold, arsenicals, 
  • Toxic chemicals (benzene, solvents, glue vapors )
  • Viral infections (Epstein-Barr virus, hepatitis, HIV, herpes viruses )
  • Immune disorders (eosinophilic fasciitis, systemic lupus erythematosus)
  • Paroxysmal nocturnal hemoglobinuria 
  • Thymoma 
  • Pregnancy 
  • Anorexia nervosa


Who is more prone to develop aplastic anemia? 

The sex ratio of AA is close to 1:1. Half of cases of AA occur in the first three decades of life.


What about hemolytic anemia?

Defined as anemia due to a shortened survival of circulating red blood cells (RBCs) due to their premature destruction. 

Diagnosis: increase in the reticulocyte count that is not explained by recent bleeding or recent correction of iron deficiency or other nutrient deficiency. Patients may also have evidence of RBC destruction including increased lactate dehydrogenase and bilirubin, decreased haptoglobin, and RBC shape changes on the peripheral blood smear.


  • Autoimmune (cold agglutinin disease, warm autoimmune hemolytic anemia)
  • Congenital hemolytic anemias (e.g., thalassemia, pyruvate kinase deficiency, sickle cell disease, glucose-6-phosphate dehydrogenase deficiency)
  • Disseminated intravascular coagulation (DIC)
  • Drug-induced hemolytic anemias
  • Transfusion-related hemolysis
  • Clostridial sepsis
  • Mechanical hemolysis from aortic stenosis or prosthetic heart valve
  • Mechanical hemolysis from marching or bongo drumming
  • Osmotic lysis from hypotonic infusion
  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • RBC parasite (eg, malaria, Babesia)
  • Snake bite
  • Thrombotic microangiopathy (TMA) 


What are the consequences of hemolytic anemia?

Consequences  and symptoms include fatigue, cardiopulmonary findings, jaundice, dark urine.


What tests are needed to find out the type of anemia and its causes?

A “complete” blood count: hemoglobin, hematocrit, red blood cell (RBC) count, RBC indices (mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH)), and white blood cell (WBC) count, a WBC differential, platelet count, and reticulocyte count.

Additional evaluation for iron deficiency: plasma levels of iron, iron binding capacity (transferrin), transferrin saturation, and ferritin.

Additional evaluation for hemolysis: serum lactate dehydrogenase, haptoglobin, Vitamin B12, folic acid levels.

Bone marrow examination in case of pancytopenia or the presence of abnormal cells in the circulation, such as blast forms.


How is anemia treated according to age?

Treatment depends on the type of anemia but is not different between age groups (except for aplastic anemia where stem cell transplantation is usually not performed above a certain age). 


What type of diet is recommended for people with anemia? 

There is no specific diet. One should generally stick to a healthy diet with vegetables and pulses for folic acid and vitamin B12, and occasional meat for iron and vitamin B12.

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