Anemia: Causes, Symptoms, and Treatment

Introduction 

Anemia is a condition whereby there is a reduction of the red blood cells in the blood. Due to the reduced number of red blood cells, the blood’s ability to carry oxygen is lowered (Kassebaum et al., 2013). Signs and symptoms of the early stages of anemia range from general sickness symptoms such as exhaustion, weakness, and breathing difficulties to acute symptoms such as unconsciousness, confusion and increased thirstiness. Anemic conditions are generally caused by loss of blood, reduced production of red blood cells, and enhanced breakdown of red blood cells. Blood can be lost through gastrointestinal bleeding, extreme injury, and trauma.

Signs and symptoms 

Signs and symptoms of anemia include fatigue and general weakness, decreased concentration, chest pain, increased cardiac output as a result of oxygen deficiency in the blood, palpitations, seasonal claudication of patient’s legs, and sometimes pallor. In addition, specific causes of anemia show particular symptoms such as leg ulcers in patients suffering from sickle-cell disease, jaundice and borne deformities in hemolytic anemia, and koilonychia and restless leg syndrome in iron-deficiency anemia ( Mayoclinic, 2017). Symptoms such as hyper-dynamic circulation, increased cardiac output, cardiac enlargement, bounding pulse, and occasional heart failure signs may occur in severe anemia. Chronic anemia in children may lead to impaired neurological development and decreased academic ability in school-aged children.

Causes 

Anemic conditions are generally caused by loss of blood. However, there are other factors which may contribute to the development of anemia and they include reduced production of red blood cells, fluid overload, intestinal inflammation, iron deficiency, and enhanced breakdown of red blood cells (World Health Organization, 2014).

Decreased production of red blood cells may be triggered by disorders in production and differentiation of pluripotent cells. Red blood cell aplasia is one of the disorders that affect the bone marrow leading to the lowered production of red blood cells. This disorder generates aplastic anemia which damages the bone marrow and hematopoietic stem cells thus affecting the production of all the three types of blood cells. Also, renal failure anemia is another disorder that affects the kidney’s secretion of erythropoietin cytokine which stimulates the bone marrow-production of the red blood cells. Endocrinal disorders can also cause a reduction in the production of the red blood cells. Vitamin B12 deficiency causes insufficiency of red blood cells thus causing a megaloblastic type of anemia called pernicious anemia. Other anemic disorders that are as a result of impaired red blood cell production include anemia of prematurity, thalassemias, myelodysplastic syndrome, chronic inflammation anemia, myelophthisic anemia, and folic acid deficiency anemia ("Anemia - Symptoms and causes," 2017).

Increased breakdown of red blood cells cause hemolytic anemia and is caused by factors such as intra-corpuscular and extra-corpuscular disorders (Burke, Leon & Suchdev, 2014). Mechanical trauma to red blood cells is also another cause of the reduced production of red blood cells. Mechanical trauma can result from hemodialysis, microangiopathic hemolytic anemia, heart surgery, and infections such as malaria. Factors that cause blood loss include surgery, frequent blood sampling, gastrointestinal tract wounds or injuries, intestinal roundworm infections, fibroid-related menstruation, and other gynecologic disorders. Fluid overload in the blood system leads to lowered hemoglobin concentration, hence causing anemia. Excessive sodium and fluid intake is the main cause of fluid overload in the blood.

Risk Factors 

The risk factors for anemia include age, family history and genetics, chronic conditions such as cancer, unhealthy environments, lifestyle behaviors, and sex. Children aged between 6 months and two years are at a higher risk for iron deficiency, especially if the milk they are fed on is not fortified with iron (Gupta et al., 2016). Teenagers at adolescent stage require higher levels of iron and thus at a risk of developing anemia. Aged people are also at a higher risk for anemia because of the lowered production of red blood cells and other complications that are associated with old age. Environments with lead contaminations pose a risk for anemic prevalence because the presence of lead in the blood inhibits hemoglobin functioning. Children who live in such unhealthy environments are at risk of anemia infection, given their susceptibility in taking untreated water. There are bleeding disorders which hereditary such as Von Willebrand disease which lowers the blood’s clotting ability, thus leading to loss of blood as a result of trauma, heavy menstruation, and surgery (National Heart, Lung, and Blood Institute, n.d.). People with a family history with hemophilia are more exposed to anemia. Lifestyle behaviors of people such as vegetarian patterns, endurance athletes and frequent blood donors, put them at a higher risk for anemia given the decreased iron levels in their bodies. The female gender is at a higher risk for anemia especially those under such situations as menstruation, pregnancy and breastfeeding.

Diagnosis 

In the examination of causal factors of anemia in a patient, the physician may review how blood loss occurred, unhealthy environments, lifestyles, family history, as well as review screening tests. Anemia is diagnosed through physical examination, blood tests, and gastrointestinal tests. A physician can diagnose anemia by checking the medical history and symptoms such as bleeding, heartbeat rate, uneven breathing, and paleness of tongue, fingernails, and eyelids among other signs. Also, anemia diagnosis can be done through blood tests to check the complete blood count, blood iron level, ferritin level, and reticulocyte count (Burke, Leon & Suchdev, 2014). To diagnose if gastrointestinal bleeding is the cause of anemia, a physician may carry out tests such as fecal occult blood test, colonoscopy, and upper endoscopy.

Prevention and/or Treatment 

People who are at a higher risk of suffering from anemia such as vegetarians and women with hemophilia histories must adopt lifestyles, which promote vitamin B12, C and iron-rich food intakes as preventive mechanisms (Burke, Leon & Suchdev, 2014). Iron-rich sources include dried fruits, salmon, eggs, red meat, iron-fortified cereals and bread, and dark-green leafy vegetables among others. Vitamin C sources that boost iron absorption include tomatoes, strawberries, and oranges. Pregnant and lactating women must always seek pre- and post-natal counseling to ensure that the infants and they are protected against anemia. Other preventive measures include seeking genetic counseling, getting a multivitamin prescription, and preventing malaria.

Anemia can be treated depending on the cause and severity of the disease. Iron and vitamin deficiency anemias can be treated by use of iron supplements and increased intake of foods rich in iron and vitamin B12. Intake of vitamin B12 shots is also recommended. Procedures are adopted where iron supplements cannot restore the lost iron to the required levels. Iron therapy interventions can be complemented by the erythropoiesis-stimulating agent in order to aid in the stimulation of production of the red blood cells in the bone marrow (Kassebaum et al., 2013).

In severe anemia of chronic disease, blood transfusion and other procedures that help stimulate the production of red blood cells such as erythropoietin injections can be utilized for treatment. Aplastic anemia is treated through blood transfusions and bone marrow transplant in cases where it is damaged by other disease infections. Hemolytic anemia is managed by treating related complications, shunning the use of suspect medications and in severe conditions, blood transfusion and plasmapheresis can be adopted (National Heart, Lung, and Blood Institute, n.d.). Sickle-cell anemia can be treated through oxygen administration and intravenous fluid therapies that relieve pain and inhibit complications. Folic acid supplements, antibiotic use, blood transfusions and bone marrow transplant are other effective treatment interventions.

Statistics 

There has been an increased prevalence of anemia in the United States population. The high-risk population groups for anemia are the elderly, pregnant and non-pregnant reproductive-aged women, preschool children, and Hispanics and Americans of African origin. On average, 5.6% of the American population is affected by anemia (Le, 2016).

According to the world health organization, 1.62 billion people worldwide are affected by anemia with preschool-age children having the highest prevalence whereas men have the least prevalence. The prevalence of anemia among different populations are as follows; preschool-age children 47.4%, pregnant women 41.8%, non-pregnant women 30.2%, men have, 12.7%, and elderly have 23.9% (McLean et al., 2008). The indicated figures represent a period between 1993 and 2005, thus may not be up-to-date but picture the high-risk population groups.

Conclusion 

Anemia is globally attributed to poor health outcomes and its prevalence is a major concern for populations and public health stakeholders worldwide. Iron deficiency is the primary cause of anemia. However, predisposing conditions such as chronic diseases that lead to a decreased oxygen-carrying capacity of the blood are potential causal factors of anemia (Kassebaum et al., 2013). An understanding of the risk factors and causes of anemia is crucial in the prevention of this deadly disease. High-risk groups such as preschool-age children and infants, women and the elderly must be examined frequently to ensure that treatment measures are adequately administered so as to prevent any fatalities. Treatment interventions are available for all types of anemia and for various severity levels. Treatment interventions range from the use of iron supplements, procedures, surgery, blood transfusions to bone marrow transplants. The consumption of foods rich in iron and vitamin B12 and C must be embraced by high-risk population groups to prevent and treat anemia.

References 

Mayoclinic (2017, August 8). Anemia - symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360 

Burke, R., Leon, J., & Suchdev, P. (2014). Identification, prevention and treatment of iron deficiency during the first 1000 days.  Nutrients ,  6 (10), 4093-4114. doi:10.3390/nu6104093 

Gupta, P., Perrine, C., Mei, Z., & Scanlon, K. (2016). Iron, Anemia, and Iron Deficiency Anemia among Young Children in the United States.  Nutrients ,  8 (6), 330-334. doi:10.3390/nu8060330 

National Heart, Lung, and Blood Institute (n.d). Iron-Deficiency Anemia. Retrieved from https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia 

Kassebaum, N. J., Jasrasaria, R., Naghavi, M., Wulf, S. K., Johns, N., Lozano, R., … Murray, C. J. (2013). A systematic analysis of global anemia burden from 1990 to 2010.  Blood ,  123 (5), 615-624. doi:10.1182/blood-2013-06-508325 

Le, C. H. (2016). The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012).  Plos One ,  11 (11), 1-14. doi:10.1371/journal.pone.0166635 

McLean, E., Cogswell, M., Egli, I., Wojdyla, D., & De Benoist, B. (2008). Worldwide prevalence of Anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005.  Public Health Nutrition ,  12 (04), 444. doi:10.1017/s1368980008002401 

World Health Organization. (2014). Global nutrition targets 2025: Anaemia policy brief.  World Health Organization , 1-8. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/148556/WHO_NMH_NHD_14.4_eng.pdf?sequence=1