Anemia, Causes and Treatment Types

Anemia

Anemia, that is, “anemia” as it is popularly known, is a disease caused by a decrease in the total number of red blood cells/ red blood cells/Erythrocytes, or a decrease in the amount of hemoglobin in erythrocytes, or both Decombustible. Anemia can cause hypoxia (lack of oxygen) in cells, tissues and organs due to the fact that hemoglobin contained in erythrocytes transports oxygen from the lungs to the capillary arteries (capillaries). Due to the fact that oxygen is essential for cell viability, its deficiency causes many clinical consequences.

Anemia is the most common disease among blood diseases. The types and causes of anemia are quite a lot. Classification is mostly done in the form of erythrocyte morphology or etiology. MCV (average erythrocyte volume) is used in morphological classification.

Iron, folic acid and vitamin B12 are very important for erythrocytes. Iron deficiency anemia can occur with iron deficiency. In this case, the erythrocytes become smaller than usual and are unable to perform their tasks fully and successfully. In case of folic acid and vitamin B12 deficiency, erythrocytes become larger than normal and cannot perform their duties, this condition is called megaloblastic anemia. Erythrocytes seen in iron deficiency have a hypochrome microcytic appearance. Since folic acid and vitamin B12 participate in the production of DNA, erythrocyte sizes become larger when they are deficient.

Signs and Symptoms

Many patients are not aware that they are anemic. The symptoms can also be quite vague.

Anemia patients usually describe weakness, fatigue, weakness. This may also be accompanied by dyspnea (shortness of breath) and palpitations.

On physical examination, pallor is observed on the skin. This paleness can also be observed on the lips or nail beds.

In addition, different symptoms are observed in different subtypes of anemia. For example, in iron deficiency anemia, pica(soil, ice eating), sickle cell anemia, ulcers on the legs may be observed.

Causes of Anemia

Anemia can be classified roughly as etiological, that is, depending on the causes, disorders in erythrocyte production, conditions associated with increased erythrocyte destruction(hemolytic anemia), blood loss and fluid loading (hypervolemia).

Iron deficiency anemia is the most common cause of anemia in the world.

Erythrocyte production disorders

** Stem cell proliferation and differentiation disorders

Pure erythrocyte aplasia.
Aplastic anemia affects all blood cells. Fanconi anemia is a hereditary disease that causes aplastic anemia and many other abnormalities.
Renal insufficiency anemia due to insufficiency in the production of nitropoietin
Endocrine disease anemia

** Erythroblast proliferation and maturation disorders

Pernicious anemia is a deficiency of megaloblastic anemia that occurs due to insufficient absorption of vitamin B12. Deficiency of dietary B12 causes non-pernicious megaloblastic anemia.
Anemia due to folic acid deficiency causes megaloblastic anemia, such as vitamin B12 deficiency.
Premature anemia, usually between 2-6 weeks in premature infants due to blood samples taken for laboratory tests and a Decelerated erythropoietin response.
Iron deficiency anemia is caused by a lack of synthesis of hemoglobin in hemoglobin
Thalassemias are caused by a lack of synthesis in the globin section of hemoglobin
Anemia of renal insufficiency (in addition to stem cell dysfunction)

** Those with unknown or multiple mechanisms

Lack of production in the bone marrow due to causes such as myelophytic anemia or myelophysis, malignant tumor, granulomatous diseases
Myelodysplastic syndrome
Anemia seen in chronic infections

Increased erythrocyte destruction

Intrinsic (intracorpuscular) abnormalities are inherited, genetic diseases, except for cleft palate nocturnal hemoglobinuria.
Due to hereditary spherocytosis erythrocyte membrane defect, red blood cells are destroyed in the spleen.
Hereditary elliptocytosis, due to a membrane skeletal defect.
Abetalipoproteinemia, by causing a disorder in membrane lipids.
Enzyme deficiencies
Pyruvate kinase and hexokinase deficiencies due to glycolysis defect
Glucose-6-phosphate dehydrogenase and glutathione synthetase deficiency due to increased oxidative stress
Hemoglobinopathies
Sickle cell anemia
Hemoglobinopathies that cause anstable hemoglobin
Paroxysmal nocturnal hemoglobinuria due to acquired membrane defect
Extrinsic (extracorporeal) abnormalities
Antibody mediated

Hot autoimmune hemolytic anemia;

Through IgG. It is the most common form of autoimmune hemolytic anemia. Idiopathic, as it may be, medication may be due to diseases such as systemic lupus erythematosus, or chronic lymphocytic leukemia.

Cold agglutinin hemolytic anemia;

Through IgM.
Erythroblastosis fetalis, Rh disease, in newborns

Transfusion reactions:

Due to a blood transfusion.
Mechanical trauma to erythrocytes

Microangiopathic hemolytic anemias:

Thrombotic thrombocytopenic purpura and disseminated intravascular coagulation

Infections:

Malaria
Heart surgeries
Hemodialysis

Blood loss

Premature anemia as a result of excessive blood intake due to laboratory tests
Due to physical trauma or surgery, acute blood loss
Acute and chronic blood loss due to causes such as gastrointestinal tract lesions, ulcers, angiodysplasia, tumors
Acute and chronic blood loss due to gynecological diseases, endometrial polyps, miscarriage
Menstruation, due to excessive or prolonged bleeding in menstruating women

Liquid loading

Hypervolemia causes a decrease in hemoglobin concentration.

Excessive water and sodium intake.
Anemia seen during pregnancy.

Diagnosis

Diagnosis is made by laboratory examination of blood values. In the first step, values such as Hb/hemoglobin, erythrocyte count/RBC, hematocrit/HCT, reticulocyte count, average erythrocyte volume/MCV, erythrocyte distribution width/RDW are taken into consideration. After anemia is detected with a decrease in Hb, HCT and RBC, the cause of anemia should be determined. Differential diagnosis is made by using the erythrocyte morphology made using MCV. Differences in erythrocyte shape and size in blood smears give clues about etiology. Electrophoresis is performed when hemoglobinopathies are suspected, Coombs test is performed when immunological reasons are suspected, folic acid and vitamin B12 values are checked if megaloblastic anemias are suspected. When a chronic blood loss is suspected, the gastrointestinal tract can be examined by examinations such as endoscopy, colonoscopy. In the differential diagnosis of iron deficiency anemia, serum iron level, serum iron binding capacity, serum ferritin level, transferrin saturation are examined.