Anemia: Causes and Symptoms

Anemia is a prevalent medical condition characterized by a decrease in the total red blood cell volume or blood hemoglobin concentration, leading to an insufficient supply of oxygen to the body tissues. Red blood cells, vital for oxygen transport, circulate in the peripheral blood for about 100 to 120 days, with approximately 1% of the body’s red cells being lost and replaced daily. However, when there is a disproportionate loss of red blood cells from circulation compared to their production, anemia ensues.

The classic symptoms of anemia are indicative of oxygen deprivation in tissues, including fatigue, paleness, general breathlessness, difficulty breathing during activity, and heart palpitations. These symptoms can significantly impact an individual's quality of life, affecting their ability to perform daily tasks and engage in physical activities.

Anemia can arise from various factors. It may develop when red blood cells are inadequately produced, excessively destroyed, or lost due to bleeding. Nutritional deficiencies, particularly of iron, folic acid, and vitamin B12, are common causes of anemia. Iron deficiency anemia, resulting from insufficient iron intake or absorption, is notably prevalent globally and is often linked to poor dietary habits.

Elderly individuals are particularly susceptible to anemia due to factors such as poor nutrition and decreased absorption efficiency. This demographic may have difficulty obtaining essential nutrients from their diets, leading to deficiencies that contribute to anemia. Additionally, absorption issues related to aging can exacerbate the problem.

Furthermore, modern dietary trends characterized by reliance on fast food and junk food contribute to the prevalence of anemia. These diets are often lacking in essential nutrients, such as iron, folic acid, and vitamin B12, necessary for red blood cell production. Consequently, individuals who primarily consume such diets are at heightened risk of developing anemia.

Addressing anemia requires a multifaceted approach that encompasses nutritional interventions, supplementation, and management of underlying health conditions. Increasing awareness about the importance of a balanced diet rich in essential nutrients is crucial in preventing and managing anemia. Moreover, healthcare professionals play a vital role in diagnosing and treating anemia, ensuring that individuals receive appropriate interventions tailored to their specific needs.

In conclusion, anemia is a widespread condition characterized by reduced red blood cell mass or hemoglobin concentration, leading to tissue oxygen deprivation. Nutritional deficiencies, particularly of iron, folic acid, and vitamin B12, contribute significantly to its prevalence. Addressing anemia requires comprehensive strategies aimed at improving dietary habits, supplementing essential nutrients, and managing underlying health conditions to enhance overall well-being and quality of life.
Anemia: Causes and Symptoms

Folate: Deficiency, Symptoms, Prevention

Folate, the natural form of vitamin B9, is a crucial water-soluble vitamin necessary for various bodily functions. Found abundantly in citrus fruits, leafy greens, legumes, and fortified carbohydrates, folate plays a key role in preventing megaloblastic anemia, a condition characterized by unusually large, oval-shaped red blood cells with DNA synthesis defects.

To address the risk of folate deficiency, folic acid, the synthetic form of vitamin B9, is often added to food products and supplements. This proactive approach helps ensure that individuals receive adequate levels of this essential nutrient. Folate deficiency, though rare due to its prevalence in diverse foods, can manifest through symptoms such as weakness, fatigue, irregular heartbeat, shortness of breath, difficulty concentrating, hair loss, pale skin, and mouth sores.

Folate-deficiency anemia is a specific condition indicating a lack of folic acid in the bloodstream. Folic acid is instrumental in the production of red blood cells, which are responsible for carrying oxygen through hemoglobin. When there are insufficient levels of folic acid, megaloblastic anemia may occur, leading to the production of abnormal red blood cells.

Several factors can contribute to folate deficiency, including dietary insufficiency, malabsorption issues, pregnancy, malignancy, blood disorders, inflammation, or the use of specific medications. It's important to recognize common symptoms of anemia, such as fatigue, shortness of breath, palpitations, headaches, tinnitus, or a diminished appetite, as these may indicate a potential deficiency.

Pregnant women, in particular, are advised to ensure adequate folate intake, as it plays a critical role in fetal development, especially in preventing neural tube defects. Folate supplementation is often recommended during pregnancy to support the increased demands for this vitamin.

In conclusion, while folate deficiency is uncommon, maintaining awareness of its symptoms and understanding the diverse sources of folate, including both natural and fortified options, is essential for overall health. Adequate folate intake is especially critical during certain life stages, such as pregnancy, to support optimal well-being.
Folate: Deficiency, Symptoms, Prevention

Thalassemia

Thalassemia is an inherited blood disorder caused when the body doesn’t make enough of a protein called haemoglobin, an important part of red blood cells. This causes a shortage of red blood cells and low levels of oxygen in the bloodstream, leading to a variety of health problems.

Thalassemia is caused by mutations in the DNA of cells that make haemoglobin. Haemoglobin is the protein molecule in red blood cells that carries oxygen throughout human body. The mutations associated with thalassemia are passed from parents to children.

In general, thalassemia is inherited in an autosomal recessive manner; however, the inheritance can be quite complex as multiple genes can influence the production of haemoglobin.

Haemoglobin molecules are made of chains called α-and β- chains that can be affected by mutations. In thalassemia, the production of either the α or β chains are reduced, resulting in either α-thalassemia or β-thalassemia.

α-thalassemias occur most often in people from Southeast Asia, the Middle East, China, and in those of African descent.

β-thalassemias occur most often in people of Mediterranean origin. To a lesser extent, Chinese, other Asians, and African Americans can be affected.

The symptoms of thalassemia can vary. Thalassemia signs and symptoms can include:
*Fatigue
*Weakness
*Pale or yellowish skin
*Bone deformities, especially in the face
*Delayed growth and development
*Abdominal swelling
*Dark urine

The disorder results in excessive destruction of red blood cells, which leads to anaemia. People with thalassemia may have mild or severe anaemia. Severe anaemia can damage organs and lead to death.

Bone marrow and stem cell transplant from a compatible related donor is the only treatment that can cure thalassemia. It is the most effective treatment.
Thalassemia

Vitamin-deficiency anemia

Vitamin-deficiency anemia is a condition in which human body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B12 and folate. When body doesn’t have enough red blood cells, it does not get the amount of oxygen it needs.

Low levels of vitamin B-12 can be caused by:

*Diet. A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who do not regularly eat these foods can become deficient.

*Pernicious anemia. This condition occurs when the body's immune system attacks cells in the stomach that produce a substance called intrinsic factor. Intrinsic factor is a protein made in the stomach. It is needed to absorb vitamin B12.

*Gastric surgeries. This part of the small intestine is where vitamin B12 is absorbed. It also can reduce the amount of intrinsic factor produced.

*Intestinal problems. Crohn's disease and celiac disease can interfere with absorption of vitamin B-12.

The risk of developing vitamin deficiency anemia gets higher as the people grow older. Pregnant women are at a higher risk for developing the condition because their bodies need more vitamins during pregnancy.

The deficiency causes the body to produce abnormally large red blood cells (megaloblastic anemia) that cannot function properly. With these types of anemia, the red blood cells don’t develop normally. They are very large.

Other types of megaloblastic anemia may be associated with type 1 diabetes, thyroid disease, and a family history of the disease.

B12 deficiency can cause a variety of symptoms, including fatigue, headaches, depression, pale or yellow skin, mental impairment, and pain and inflammation in the mouth and tongue.
Vitamin-deficiency anemia

Hemolytic anemia

Hemolytic anemia is defined as the destruction of red blood cells (RBCs) before their normal 120-day life span. While hemolysis can be a lifelong asymptomatic condition, it most often presents as anemia when erythrocytosis cannot match the pace of red cell destruction.

Premature destruction of RBCs can occur intravascularly or extravascularly in the reticuloendothelial system, although the latter is more common. Intravascular hemolysis is the destruction of red blood cells in the circulation with the release of cell contents into the plasma. The intravascular mechanisms include direct cellular destruction, fragmentation, and oxidation. Direct cellular destruction is caused by toxins, trauma, or lysis.

The more common extravascular hemolysis is the removal and destruction of red blood cells with membrane alterations by the macrophages of the spleen and liver.

Classification of Hemolytic anemias
1. Red cell abnormality

* Hereditary
* Acquired

2. Extracorpuscular factors

*Immune hemolytic anemias
*Nonimmune hemolytic anemias

Hemolytic anemias can also be classified according to whether the cause of hemolysis is intrinsic or extrinsic to the RBC— damage from within or without.
*Intrinsic causes of hemolysis include abnormalities of hemoglobin, the RBC membrane, or RBC enzymes.
*Extrinsic causes include RBC-directed antibodies, a disordered vasculature, infections, or toxins.

Hemolysis should be considered when a patient experiences acute jaundice or hematuria in the presence of anemia. Symptoms of chronic hemolysis include lymphadenopathy, hepatosplenomegaly, cholestasis, and choledocholithiasis. Other nonspecific symptoms include fatigue, dyspnea, hypotension, and tachycardia.
Hemolytic anemia

Aplastic anemia

In aplastic anemia, there occurs a failure of hematopoiesis; the bone marrow appears empty, and the blood cells count falls to a great degree. Aplastic anemia is generally categorized as severe or mild. Aplastic anemia can be acquired, inherited or congenital.

In the mild form of aplastic anemia, the blood cells are less drastically reduced in number. Sometimes, a deficiency of some type of blood cell precedes the full-blown development of aplastic anemia.

In severe cases a patient may suffer from heavy or prolonged bleeding, frequently or severe infections and severe anemia.

Lymphocyte

The mechanism working behind aplastic anemia is regarded as being immune mediated, in which there is active destruction of stem cells by lymphocytes. Because of this destruction, a reduction in all blood cells types occurs; this reduction is called pancytopenia.

The major causes for acquired aplastic anemia include exposure to radiation, drugs and other chemicals, viruses, immune diseases and other disease processes.

Genetic syndromes associated with aplastic anemia include Fanconi’s anemia, Familiar aplastic anemia, Schwachman-Diamond syndrome and other nonhematologic syndromes.
Aplastic anemia

Pernicious anemia

Pernicious anemia is a rare blood disorder characterized by inability of the body to properly utilize B12 or cobalamin, which is essential for development of red blood cells. It is a megaloblastic anemia and also known as Addison’s anemia.

Research studies have recently documented that 1.9% of person older than 60 years have undiagnosed pernicious anemia. Approximately 20% of the relatives of patients with pernicious anemia have pernicious anemia.

The three forms of pernicious anemia are congenital pernicious anemia, juvenile pernicious anemia and adult-onset pernicious anemia.

Pernicious anemia results when the body lacks intrinsic factor - a glycoprotein produced by the parietal cells of the stomach lining and that is necessary for absorption of vitamin B12 . Without it, vitamin B12 cannot be properly absorbed in the ileum.

Intrinsic factor deficiency in the adult form of pernicious anemia is caused by atrophic gastritis.

Pernicious anemia also may be associated with autoimmune endocrinopathies and antireceptor autoimmune disease.
Pernicious anemia

Protein deficiency anemia

Anemia is a reduction of hemoglobin in red blood cells below normal levels.

Patients with protein deficiency anemia also show signs of multiple nutritional deficiencies, especially of folic acid, vitamin B12, and iron.

Protein is essential for the proper production of hemoglobin and red blood cells. Due to deficiency of proteins, the synthesis of hemoglobin is reduced. The RBCs are macrocytic and hypochromic.

The deficiency protein results in decreased formation of all hematopoietic cells. Hematopoietic cells are lodged within the bone marrow that give rise to all the other blood cells and are derived from mesoderm.

A mild normocytic anemia develops after 6 months of semi-starvation and after 3 months of complete starvation.

In chronic protein deficiency, the decreased RBC production is proportionate to the reduced by decreased secretion of erythroproietin.
Protein deficiency anemia

Megaloblastic anemia

Megaloblastic anemia, megaloblastosis, refers to a pathogenic process characterized by delay in maturation of the nucleus of blood cell precursors and continuing development of the cytoplasm.

The result of this nuclear-cytoplasmic dissociation is production of cells that are larger than normal due to the defective DNA and RNA synthesis. Megaloblastic changes affect all dividing cells, (e.g. blood, intestine, skin) and the hematopoietic effects involve all blood cell lines.

Megaloblastic anemias can be classified into two major categories based on etiology. The major divisions are vitamin B12 (cobalamin) deficiency and folic acid deficiency. Vitamin B12 and folic acid are both essential for the synthesis of DNA and RNA.

One of the major causes of vitamin B12 deficiency is pernicious anemia, and autoimmune condition that is characterized by the inability of the gastric mucosa to produce intrinsic factor (IF). Intrinsic factor is necessary of the transportation of vitamin B12 across the intestinal mucosa.

In severe megaloblastic anemia, many developing red blood cells are destroyed in the bone marrow before they are released into the circulation.
Megaloblastic anemia

Iron deficiency anemia

Iron is found in the body in two forms, as functional iron and as storage iron. Iron containing compounds play key roles in oxygen and energy metabolism. When people have depleted their stores of iron, they are said to be ‘iron deficient’.

Iron deficiency, as defined by specific biochemical tests, is the most common cause of anemia in most parts of the world.

The term iron deficiency anemia implies that anemia is due to a less than normal quantity of iron in the body.

As iron deficiency progresses to anemia, further consequences become more evident, including changes in behavior and intellectual performance, reduced resistance to infection, increase susceptibility to lead poisoning, loss of appetite, tachycardia and cardiomegaly.

Iron plays an important role in brain development and many studies have indicated that iron deficiency is associated with cognitive impairment, poor motor development, and behavioral problems.

Infectious diseases, especially in developing countries, are frequent causes of anemia. Iron deficiency anemia can readily occur in cases of infection with blood loss.

According to UNICEF severe anemia from iron deficiency is believed to claim lives of 22,000 women during pregnancy and childbirth each year.

The prevalence of iron deficiency anemia among children is much higher than among adult women and may partly attributable to the high prevalence of hookworm among children.

The three pediatric age groups most at risk for this type of anemia are infants, toddlers, and adolescents.
Iron deficiency anemia

Sickle Cell Anemia

Anemia is a condition in which a person’s blood does not contain enough red blood cells. Sickle cell disease prevents the normal flow of oxygen to the body. The disease can be in a constant state of anemia and therefore a lack of hemoglobin to move vital oxygen around the body.

Sickle shaped blood cells can cause and even block blood flow throughout the body, causing severe pain and damaging the lungs, kidneys and other organ.

The abnormal sickle cells are destroyed faster than normal shaped red bloods cells, and this causes anemia. In contrasts to a normal red blood cell life of 120 days, sickle cells live only 10 to 12 days.

Due to abnormal shape, these blood cells are fragile and tend to break apart. Sickle cell anemia is caused by an abnormal gene that alters the shape of red blood cells.

It is cause by a very small change in the structure of one protein, Even though the change is very small, the altered protein severely affects how the body functions.

More than 70,000 people in the United States have sickle cell anemia. Health care organizations consider sickle cell anemia to be an international health problem.

Some of the symptoms of sickle cell anemia are: 
*Pain in the arms, legs, stomach and back
*Swollen hands and feet
*Sores on the legs that heal very slowly
*Growing more slowly than other kids
*Getting sick more often than other kids
Sickle Cell Anemia

Anemia

Red blood cells circulate in the peripheral blood for 100 to 120 days, and approximately 1% of the body’s red cells are lost and replaced each day.

A reduced red blood cells mass results from loss of red blood cells from the circulation at a rate greater than their production.

Anemia is generally defined as a reduction in red cell mass or blood hemoglobin concentration and therefore an insufficient supply of oxygen to the tissues.

The oxygen carrying capacity of blood is a function of the total volume of circulating red blood cells, so anemia can be defined as a decrease in the total red cell volume.

The classic symptoms include fatigue paleness, general breathlessness, difficulty breathing during activity and heart palpitations.

Anemia can come about from a variety of causes. Anemia develops when red blood cells are not produce in sufficient numbers, when they are too quickly destroyed or when they are lost due to bleeding.

Because oxygen is transported in the blood by means of molecules of hemoglobin, a red pigment found in red blood cells, their absence can result in fatigue and reduced stamina.

While nutritional anemia is directly caused by a lack of sufficient quantities of all the nutrients - iron, folic acid and vitamin B12. Nutritional anemia was considered to be large component of global anemia prevalence, and iron deficiency anemia was considered the most common cause of nutritional anemia.

This condition is common in older people, who often eat poorly and also may have absorption problems, and in people whose diet consists primarily of fast food and junk food.
Anemia