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Weakness, lack of willingness to perform everyday activities, dizziness and headaches, pale skin? These are the most common symptoms of anemia, but they are not the only ones. Anemia has many faces and the choice of treatment method depends on its cause.
Understand anemia
Anemia is a pathological condition in which the number of red blood cells and the amount of circulating hemoglobin are insufficient for the proper oxygenation of peripheral tissues. Anemia is defined when the hemoglobin concentration or total red blood cell volume (hematocrit) is below the lower limit defined by the 95% range of the reference values established for age, sex, and latitude.
According to the definition of the World Health Organization (WHO), anemia is defined as a drop in hemoglobin below 13 g / dl in men and below 12 g / dl in women. It is estimated that up to a third of our population suffers from anemia – most often it affects children, pregnant women and the elderly. It is associated with increased morbidity and mortality.
Depending on the severity of symptoms resulting from disorders in the red cell system, we can distinguish: mild, moderate, severe and life-threatening anemia. However, depending on the cause of anemia, we can talk about its different types, determining the method of treatment. Let’s take a closer look at the most common ones …
Haemorrhagic anemia
It arises as a result of acute or chronic blood loss. The most common acute cause of haemorrhagic anemia is injuries. While the loss of about 500 ml of blood may not cause any symptoms, the loss of 1-2 liters of blood in a short time (several or several dozen minutes) causes hemorrhagic shock, characterized by a drop in body temperature, cold sweats, anxiety, urinary retention, cooling of the limbs and drop in blood pressure, and often loss of consciousness.
In the case of chronic blood loss, gastrointestinal bleeding is the most common cause. They accompany diseases such as gastric ulcer or duodenal ulcer, damage to the gastric mucosa by e.g. drugs, alcohol, bile, toxins, stress, esophageal varices or its ulceration (as a consequence of reflux disease), infectious enteritis (e.g. Salmonella, Shigella infections) , Campylobacter), colorectal polyps, tumors of the gastrointestinal tract, thrombocytopenia or bleeding disorders. Chronic blood loss most often leads to the development of iron deficiency anemia.
Deficiency anemia
As the name suggests, it is caused by an insufficient amount of substances involved in the production of erythrocytes, i.e. iron, folate, vitamin B12 or copper.
Iron deficiency anemia, the basic building block of hemoglobin, is the most common type of anemia. It is estimated that about 10% of the European population is affected. women and 4 percent. men. In addition to symptoms common to other types of anemia, i.e. weakness, dizziness and headaches, impaired concentration and attention, pale skin, in this case, weakened hair quality and changes in nails are observed. The most common causes of iron deficiency anemia include: an improperly balanced diet, impaired absorption of iron from the gastrointestinal tract (conditions after removal of the stomach or part of the intestine, inflammatory bowel disease, celiac disease), chronic blood loss, increased need for iron (pregnancy and breastfeeding, ripening).
Anemia in chronic diseases
It develops as a result of long-lasting diseases related to inflammation: malignant tumors, autoimmune diseases (rheumatoid arthritis, lupus erythematosus, inflammatory bowel disease), chronic, recurrent bacterial, parasitic and fungal infections.
A special type of anemia of chronic diseases is anemia in the course of chronic kidney disease (CKD), the so-called renal anemia. Its primary and primary cause is the deficiency of erythropoietin (EPO), a hormone responsible for stimulating the processes aimed at producing erythrocytes. The pathogenetic mechanisms of anemia in patients with CKD include, in addition, functional and absolute iron deficiency, latent or overt blood loss, chronic inflammation, the presence of uremic inhibitors, shortened erythrocyte survival time, folate and vitamin B12 deficiency, and increased bone marrow resistance to erythropoietin.
Nephrogenic anemia occurs in the majority of patients with advanced stages of CKD and in almost all chronic dialysis patients. Untreated, it leads to many complications, especially damage to the cardiovascular system (left ventricular hypertrophy, coronary heart disease and subsequent development of heart failure). Experts emphasize that patients in the early stages of the disease may not experience symptoms of anemia (reduced tolerance to exercise, shortness of breath, constant fatigue, reduced cognitive abilities). Additionally, they often adapt to a gradual decrease in hemoglobin levels. Therefore, it is extremely important to identify anemic patients early and initiate treatment promptly.
Aplastic anemia
It results from damage to the bone marrow, which is responsible for the production of blood cells. Factors that destroy bone marrow can be both radiation and viral diseases (HIV, hepatitis, parvovirus B19 infection), poisoning with drugs or toxins, and even pregnancy. In aplastic anemia, typical symptoms of anemia resulting from insufficient red blood cells include symptoms caused by the deficiency of other types of blood cells: leukocytes and thrombocytes, including susceptibility to infections, nosebleeds and haemorrhages, ecchymoses and bruises.
Sideroblastic anemia
This is a very rare type of anemia caused by the abnormal production of heme, a component of hemoglobin. The result is the production in the bone marrow of the so-called ring sideroblasts, i.e. immature red blood cells with iron deposits inside, which is visible under the microscope. The causes of sideroblastic anemia can be congenital or acquired. The first are genetic mutations that result in errors in the production of red blood cells. There are also genetic syndromes in which sideroblastic anemia is one of the symptoms.
Some of these diseases are related to disorders of vitamin B1 (thiamine) metabolism. Acquired causes of sideroblastic anemia include the so-called Acquired clonal forms, classified as neoplasms of the haematopoietic system, characterized by disorders of blood cell formation. There are also reversible acquired causes, such as side effects of some drugs, copper deficiency, lead poisoning, alcoholism, and hypothermia. In the case of sideroblastic anemia, the symptoms typical of anemia also overlap with symptoms resulting from excess iron in the body: enlargement of the spleen, diabetes or glucose intolerance, joint pain, dark skin, heart rhythm disturbances or heart failure, impotence.
Hemolytic anemia
This is a type of anemia caused by the shortening of the erythrocytes’ lifetime, which causes them to be depleted in the blood. A normal red blood cell lives for 100–120 days, in a hemolytic state – only about 50. There can be many reasons for an abnormal, increased breakdown of erythrocytes. In congenital forms, there is an abnormal structure of blood cells or a deficiency of substances necessary for their proper functioning (congenital spherocytosis, thalassemia or sickle cell anemia).
However, acquired forms may have various causes: certain drugs, infectious agents (viruses, bacteria, parasites), toxins, stimulants. In addition to the typical symptoms of anemia, in the case of haemolytic anemia there are symptoms resulting from the increased breakdown of blood cells: jaundice, enlargement of the spleen, and gallstone disease. In acute form (the so-called acute hemolytic crisis), poisoning with the breakdown products of blood cells may result in high fever, chills and loss of consciousness.