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Anemia

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Anemia
Other namesAnaemia, erythrocytopenia
Blood smearshowingiron-deficiency anemia,with small, palered blood cells.
Pronunciation
SpecialtyHematology
SymptomsFeeling tired,pale skin,weakness,shortness of breath,feeling faint[1]
CausesBlood loss,decreased red blood cell production, increased red blood cell breakdown[1]
Diagnostic methodBlood hemoglobin measurement[1]
Frequency2.36 billion / 33% (2015)[2]

Anemiaoranaemia(British English) is ablood disorderin which thebloodhas a reduced ability to carryoxygen.This can be due to a lower than normal number ofred blood cells,a reduction in the amount ofhemoglobinavailable for oxygen transport, or abnormalities in hemoglobin that impair its function.[3][4]

The name is derived fromAncient Greekἀν- (an-)'not', andαἷμα(haima)'blood'.[5] When anemia comes on slowly, the symptoms are often vague, such astiredness,weakness,shortness of breath,headaches,and areduced ability to exercise.[1]When anemia is acute, symptoms may includeconfusion,feeling like one is going to pass out,loss of consciousness,andincreased thirst.[1]Anemia must be significant before a person becomes noticeablypale.[1]Additional symptoms may occur depending on the underlying cause.[1]Anemia can be temporary or long term and can range from mild to severe.[6]

Anemia can be caused byblood loss,decreased red blood cell production, and increasedred blood cell breakdown.[1]Causes of blood loss includebleeding due to inflammation of the stomach or intestines,bleeding fromsurgery,seriousinjury,orblood donation.[1]Causes of decreased production includeiron deficiency,folate deficiency,vitamin B12deficiency,thalassemiaand a number ofbone marrow tumors.[1]Causes of increased breakdown includegenetic disorderssuch assickle cell anemia,infections such asmalaria,and certainautoimmune diseases.[1]

Anemia can also be classified based on thesize of the red blood cellsandamount of hemoglobin in each cell.[1]If the cells are small, it is calledmicrocytic anemia;if they are large, it is calledmacrocytic anemia;and if they are normal sized, it is callednormocytic anemia.[1]The diagnosis of anemia in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dL); in women, it is less than 120 to 130 g/L (12 to 13 g/dL).[1][7]Further testing is then required to determine the cause.[1][8]

Treatment depends on the specific cause. Certain groups of individuals, such as pregnant women, can benefit from the use ofiron pillsfor prevention.[1][9]Dietary supplementation,without determining the specific cause, is not recommended.[1]The use ofblood transfusionsis typically based on a person's signs and symptoms.[1]In those without symptoms, they are not recommended unless hemoglobin levels are less than 60 to 80 g/L (6 to 8 g/dL).[1][10]These recommendations may also apply to some people with acute bleeding.[1]Erythropoiesis-stimulating agentsare only recommended in those with severe anemia.[10]

Anemia is the most common blood disorder, affecting about a fifth to a third of the global population.[1][2][11][12]Iron-deficiency anemiais the most common cause of anemia worldwide, and affects nearly one billion people.[13]

In 2013, anemia due to iron deficiency resulted in about 183,000 deaths – down from 213,000 deaths in 1990.[14]This condition is most prevalent in children[15]with also an above average prevalence in elderly[1]and women of reproductive age (especially during pregnancy).[13]Anemia is one of the sixWHOglobal nutrition targets for 2025 and for diet-related global targets endorsed byWorld Health Assemblyin 2012 and 2013. Efforts to reach global targets contribute to reachingSustainable Development Goals(SDGs),[16]with anemia as one of the targets inSDG 2for achieving zero world hunger.[17]

Signs and symptoms

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Main symptoms that may appear in anemia[18]
The hand of a person with severe anemia (on the left, with ring) compared to one without (on the right)

A person with anemia may not have any symptoms, depending on the underlying cause, and no symptoms may be noticed, as the anemia is initially mild, and then the symptoms become worse as the anemia worsens. A patient with anemia may reportfeeling tired,weak, decreased ability to concentrate, and sometimesshortness of breathonexertion.[19]These symptoms are unspecific and none of the symptoms alone or in combination show a good predictive value for the presence of anemia in non-clinical patients.[20]

Symptoms of anemia are written inBengali,Hindi and English language on a board atAIIMS Kalyani,West Bengal.

Symptoms of anemia can come on quickly or slowly.[21]Early on there may be few or no symptoms.[21]If the anemia continues slowly (chronic), the body may adapt and compensate for this change. In this case, no symptoms may appear until the anemia becomes more severe.[18][22]Symptoms can include feeling tired, weak,dizziness,headaches,intolerance to physical exertion,shortness of breath, difficulty concentrating,irregularorrapidheartbeat, cold hands and feet,cold intolerance,paleoryellowskin,poor appetite,easy bruising and bleeding, andmuscle weakness.[21]

Anemia that develops quickly, often, has more severe symptoms, including,feeling faint,chest pain,sweating, increased thirst, and confusion.[21][23][24][25]There may be also additional symptoms depending on the underlying cause.[1]

In more severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasingcardiac output.The person may have symptoms related to this, such aspalpitations,angina(if pre-existingheart diseaseis present), intermittentclaudicationof the legs, and symptoms ofheart failure.[26]

On examination, the signs exhibited may includepallor(pale skin,mucosa,conjunctivaandnail beds), but this is not a reliable sign. A blue coloration of thescleramay be noticed in some cases of iron-deficiency anemia.[27]There may be signs of specific causes of anemia,e.g.koilonychia(in iron deficiency),jaundice(when anemia results from abnormal break down ofred blood cells– inhemolytic anemia),nerve celldamage (vitamin B12deficiency), bone deformities (found inthalassemiamajor) or legulcers(seen insickle-cell disease). In severe anemia, there may be signs of ahyperdynamic circulation:tachycardia(a fast heart rate),bounding pulse,flow murmurs,andcardiacventricular hypertrophy(enlargement). There may be signs ofheart failure. Pica,the consumption of non-food items such as ice, paper, wax, grass, hair or dirt, may be a symptom of iron deficiency;[28]although it occurs often in those who have normal levels ofhemoglobin. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced academic performance in children of school age.Restless legs syndromeis more common in people withiron-deficiency anemiathan in the general population.[29]

Causes

[edit]
Figure shows normal red blood cells flowing freely in a blood vessel. The inset image shows a cross-section of a normal red blood cell with normal hemoglobin.[30]

The causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (hemolytic anemia), blood loss and fluid overload (hypervolemia). Several of these may interplay to cause anemia. The most common cause of anemia is blood loss, but this usually does not cause any lasting symptoms unless a relatively impaired RBC production develops, in turn, most commonly byiron deficiency.[4]

Impaired production

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Increased destruction

[edit]
Further information:Hemolytic anemia

Anemias of increasedred blood cell destructionare generally classified ashemolytic anemias.These types generally featurejaundice,and elevated levels oflactate dehydrogenase.[34][35]

Blood loss

[edit]

The roots of the wordsanemiaandischemiaboth refer to the basic idea of "lack of blood", but anemia andischemiaare not the same thing in modern medical terminology. The wordanemiaused alone implieswidespreadeffectsfrom blood that either is too scarce (e.g., blood loss) or is dysfunctional in its oxygen-supplying ability (due to whatever type of hemoglobin or erythrocyte problem). In contrast, the wordischemiarefers solely to the lack of blood (poorperfusion). Thus ischemia in a body part can cause localized anemic effects within those tissues.[46]

Fluid overload

[edit]

Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia:[47]

  • General causes of hypervolemia include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space.[48]
  • From the 6th week of pregnancy, hormonal changes cause an increase in the mother's blood volume due to an increase in plasma.[49]

Intestinal inflammation

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Certain gastrointestinal disorders can cause anemia. The mechanisms involved are multifactorial and not limited to malabsorption but mainly related to chronic intestinal inflammation, which causes dysregulation ofhepcidinthat leads to decreased access of iron to the circulation.[50][51][52]

Diagnosis

[edit]
Peripheral blood smear microscopy of a patient withiron-deficiency anemia
A Giemsa-stained blood film from a person with iron-deficiency anemia. This person also had hemoglobin Kenya.

Definitions

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There are a number of definitions of anemia;reviewsprovide comparison and contrast of them.[58]A strict but broad definition is an absolute decrease in red blood cell mass,[59]however, a broader definition is a lowered ability of the blood to carryoxygen.[60]Anoperational definitionis a decrease in whole-bloodhemoglobinconcentration of more than 2standard deviationsbelow themeanof an age- and sex-matchedreference range.[61]

It is difficult to directly measure RBC mass,[62]so thehematocrit(amount of RBCs) or thehemoglobin(Hb) in thebloodare often used instead to indirectly estimate the value.[63]Hematocrit; however, is concentration dependent and is therefore not completely accurate. For example, during pregnancy a woman's RBC mass is normal but because of an increase in blood volume the hemoglobin and hematocrit are diluted and thus decreased. Another example would be bleeding where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit initially remains normal until fluids shift from other areas of the body to the intravascular space.[citation needed]

The anemia is also classified by severity into mild (110 g/L to normal), moderate (80 g/L to 110 g/L), and severe anemia (less than 80 g/L) in adults.[64]Different values are used in pregnancy and children.[64]

Testing

[edit]

Anemia is typically diagnosed on acomplete blood count.Apart from reporting the number ofred blood cellsand thehemoglobinlevel, theautomatic countersalso measure the size of the red blood cells byflow cytometry,which is an important tool in distinguishing between the causes of anemia. Examination of a stainedblood smearusing amicroscopecan also be helpful, and it is sometimes a necessity in regions of the world where automated analysis is less accessible.[citation needed]

WHO's Hemoglobin thresholds used to define anemia[65] (1 g/dL = 0.6206 mmol/L)
Age or gender group Hb threshold (g/dL) Hb threshold (mmol/L)
Children (0.5–5.0 yrs) 11.0 6.8
Children (5–12 yrs) 11.5 7.1
Teens (12–15 yrs) 12.0 7.4
Women, non-pregnant (>15yrs) 12.0 7.4
Women, pregnant 11.0 6.8
Men (>15yrs) 13.0 8.1

A blood test will provide counts of white blood cells, red blood cells and platelets. If anemia appears, further tests may determine what type it is, and whether it has a serious cause. although of that, it is possible to refer to the genetic history and physical diagnosis.[66]These tests may also includeserum ferritin,iron studies,vitamin B12,genetic testing, and abone marrow sample,if needed.[67][68]

Reticulocyte counts, and the "kinetic" approach to anemia, have become more common than in the past in the large medical centers of the United States and some other wealthy nations, in part because some automatic counters now have the capacity to include reticulocyte counts. Areticulocytecount is a quantitative measure of thebone marrow's production of new red blood cells. Thereticulocyte production indexis a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a "normal" reticulocyte count actually may reflect an inadequate response. If an automated count is not available, a reticulocyte count can be done manually following special staining of the blood film. In manual examination, activity of the bone marrow can also be gauged qualitatively by subtle changes in the numbers and the morphology of young RBCs by examination under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation oferythropoiesiscan help assess whether the bone marrow will be able to compensate for the loss and at what rate.

When the cause is not obvious, clinicians use other tests, such as:ESR,serum iron,transferrin,RBC folate level,hemoglobin electrophoresis,renal functiontests (e.g.serum creatinine) although the tests will depend on the clinical hypothesis that is being investigated.

When the diagnosis remains difficult, abone marrow examinationallows direct examination of the precursors to red cells, although is rarely used as is painful, invasive and is hence reserved for cases where severe pathology needs to be determined or excluded.[medical citation needed]

Red blood cell size

[edit]

In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in themean corpuscular volume(MCV). If the cells are smaller than normal (under 80fl), the anemia is said to bemicrocytic;if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified asmacrocytic.This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result ofiron deficiency.In clinical workup, the MCV will be one of the first pieces of information available, so even among clinicians who consider the "kinetic" approach more useful philosophically, morphology will remain an important element of classification and diagnosis. Limitations of MCV include cases where the underlying cause is due to a combination of factors – such as iron deficiency (a cause of microcytosis) and vitaminB12 deficiency(a cause of macrocytosis) where the net result can be normocytic cells.[medical citation needed]

Production vs. destruction or loss

[edit]

The "kinetic" approach to anemia yields arguably the most clinically relevant classification of anemia. This classification depends on evaluation of several hematological parameters, particularly the bloodreticulocyte(precursor of mature RBCs) count. This then yields the classification of defects by decreased RBC production versus increased RBC destruction or loss. Clinical signs of loss or destruction include abnormalperipheral blood smearwith signs of hemolysis; elevatedLDHsuggesting cell destruction; or clinical signs of bleeding, such as guaiac-positive stool, radiographic findings, or frank bleeding.[medical citation needed] The following is a simplified schematic of this approach:[medical citation needed]

Anemia
Reticulocyte production indexshows inadequate production response to anemia.Reticulocyte production indexshows appropriate response to anemia = ongoing hemolysis or blood loss without RBC production problem.
No clinical findings consistent with hemolysis or blood loss: pure disorder of production.Clinical findings and abnormal MCV: hemolysis or loss and chronic disorder of production*.Clinical findings and normal MCV= acute hemolysis or loss without adequate time forbone marrowproduction to compensate**.
Macrocytic anemia(MCV>100)Normocytic anemia(80<MCV<100)Microcytic anemia(MCV<80)

*For instance, sickle cell anemia with superimposed iron deficiency; chronic gastric bleeding with B12and folate deficiency; and other instances of anemia with more than one cause.
**Confirm by repeating reticulocyte count: ongoing combination of low reticulocyte production index, normal MCV and hemolysis or loss may be seen in bone marrow failure or anemia of chronic disease, with superimposed or related hemolysis or blood loss. Here is a schematic representation of how to consider anemia with MCV as the starting point:

Anemia
Macrocytic anemia(MCV>100)Normocytic anemia(MCV 80–100)Microcytic anemia(MCV<80)
HighreticulocytecountLowreticulocytecount

Other characteristics visible on the peripheral smear may provide valuable clues about a more specific diagnosis; for example, abnormalwhite blood cellsmay point to a cause in thebone marrow.

Microcytic

[edit]
Main article:Microcytic anemia

Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies:

Iron-deficiency anemia is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope.

  • Iron-deficiency anemia is due to insufficient dietary intake or absorption ofironto meet the body's needs. Infants, toddlers, and pregnant women have higher than average needs. Increased iron intake is also needed to offset blood losses due to digestive tract issues, frequent blood donations, orheavy menstrual periods.[70]Iron is an essential part of hemoglobin, and low iron levels result in decreased incorporation of hemoglobin into red blood cells. In the United States, 12% of all women of childbearing age have iron deficiency, compared with only 2% of adult men. The incidence is as high as 20% among African American and Mexican American women.[71]In India it is even more than 50%.[72]Studies have linked iron deficiency without anemia to poor school performance and lowerIQin teenage girls, although this may be due to socioeconomic factors.[73][74]Iron deficiency is the most prevalent deficiency state on a worldwide basis. It is sometimes the cause of abnormal fissuring of the angular (corner) sections of the lips (angular stomatitis).
  • In the United States, the most common cause of iron deficiency is bleeding or blood loss, usually from thegastrointestinal tract.Fecal occult blood testing,upper endoscopyandlower endoscopyshould be performed to identify bleeding lesions. In older men and women, the chances are higher that bleeding from the gastrointestinal tract could be due tocolon polypsorcolorectal cancer.
  • Worldwide, the most common cause of iron-deficiency anemia is parasitic infestation (hookworms,amebiasis,schistosomiasisandwhipworms).[75]

TheMentzer index(mean cell volume divided by the RBC count) predicts whether microcytic anemia may be due to iron deficiency or thalassemia, although it requires confirmation.[76][citation needed]

Macrocytic

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Main article:Macrocytic anemia

Macrocytic anemia can be further divided into "megaloblastic anemia" or "nonmegaloblastic macrocytic anemia". The cause of megaloblastic anemia is primarily a failure of DNA synthesis with preserved RNA synthesis, which results in restricted cell division of the progenitor cells. The megaloblastic anemias often present with neutrophil hypersegmentation (six to 10 lobes). The nonmegaloblastic macrocytic anemias have different etiologies (i.e. unimpaired DNA globin synthesis,) which occur, for example, in alcoholism. In addition to the nonspecific symptoms of anemia, specific features of vitamin B12deficiency includeperipheral neuropathyandsubacute combined degeneration of the cordwith resulting balance difficulties from posterior column spinal cord pathology.[78]Other features may include a smooth, red tongue andglossitis. The treatment for vitamin B12-deficient anemia was first devised byWilliam Murphy,who bled dogs to make them anemic, and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure the disease.George MinotandGeorge Whipplethen set about to isolate the curative substance chemically and ultimately were able to isolate thevitamin B12from the liver. All three shared the 1934Nobel Prize in Medicine.[79]

Normocytic

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Main article:Normocytic anemia

Normocytic anemia occurs when the overall hemoglobin levels are decreased, but the red blood cell size (mean corpuscular volume) remains normal. Causes include:

Dimorphic

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A dimorphic appearance on a peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content (this last feature affecting the color of the red blood cell on a stained peripheral blood smear). For example, a person recently transfused for iron deficiency would have small, pale, iron deficient red blood cells (RBCs) and the donor RBCs of normal size and color. Similarly, a person transfused for severe folate or vitamin B12 deficiency would have two cell populations, but, in this case, the patient's RBCs would be larger and paler than the donor's RBCs.

A person with sideroblastic anemia (a defect in heme synthesis, commonly caused byalcoholism,but also drugs/toxins, nutritional deficiencies, a few acquired and rare congenital diseases) can have a dimorphic smear from the sideroblastic anemia alone. Evidence for multiple causes appears with an elevated RBC distribution width (RDW), indicating a wider-than-normal range of red cell sizes, also seen in common nutritional anemia.[citation needed]

Heinz body anemia

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Heinz bodiesform in the cytoplasm of RBCs and appear as small dark dots under the microscope. In animals, Heinz body anemia has many causes. It may be drug-induced, for example in cats and dogs byacetaminophen(paracetamol),[80]or may be caused by eating various plants or other substances:

Hyperanemia

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Hyperanemia is a severe form of anemia, in which thehematocritis below 10%.[83]

Refractory anemia

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Refractory anemia, an anemia which does not respond totreatment,[84]is often seen secondary tomyelodysplastic syndromes.[85]Iron-deficiency anemiamay also be refractory as a manifestation of gastrointestinal problems which disruptiron absorptionor causeoccult bleeding. [86]

Transfusion dependent

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Transfusion dependent anemia is a form of anemia where ongoing blood transfusion are required.[87]Most people withmyelodysplastic syndromedevelop this state at some point in time.[88]Beta thalassemiamay also result in transfusion dependence.[89][90]Concerns from repeated blood transfusions includeiron overload.[88]This iron overload may requirechelation therapy.[91]

Treatment

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The global market for anemia treatments is estimated at more than USD 23 billion per year and is fast growing because of the rising prevalence and awareness of anemia. The types of anemia treated with drugs areiron-deficiency anemia,thalassemia,aplastic anemia,hemolytic anemia,sickle cell anemia,andpernicious anemia,the most important of them being deficiency and sickle cell anemia with together 60% of market share because of highest prevalence as well as higher treatment costs compared with other types.[12]Treatment for anemia depends on cause and severity. Vitamin supplements given orally (folic acidor vitamin B12) or intramuscularly (vitamin B12) will replace specific deficiencies.[1]

Apart from that, iron supplements, antibiotics, immunosuppressant, bone marrow stimulants, corticosteroids, gene therapy and iron chelating agents are forms of anemia treatment drugs, with immunosuppressants and corticosteroids accounting for 58% of the market share. A paradigm shift towards gene therapy and monoclonal antibody therapies is observed.[12]

Oral iron

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Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to have iron deficiency without anemia with one-third of them having an iron deficiency with anemia.[92]Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.[citation needed]

Mild to moderate iron-deficiency anemia is treated by oral iron supplementation withferrous sulfate,ferrous fumarate,orferrous gluconate.Daily iron supplements have been shown to be effective in reducing anemia in women of childbearing age.[93]When taking iron supplements, stomach upset or darkening of the feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed.Vitamin Caids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit.[94]

In the anemia of chronic kidney disease,recombinanterythropoietinorepoetin alfais recommended to stimulate RBC production, and if iron deficiency and inflammation are also present, concurrentparenteral ironis also recommended.[95]

Injectable iron

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In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively), or where absorption is impeded (for example in cases of inflammation),parenteral ironpreparations can be used. Parenteral iron can improve iron stores rapidly and is also effective for treating people with postpartum haemorrhage, inflammatory bowel disease, and chronic heart failure.[96]The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases, the patient has a deficit of over 1,000 mg of iron which would require several months to replace. This can be given concurrently witherythropoietinto ensure sufficient iron for increased rates oferythropoiesis.[97]

Blood transfusions

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Blood transfusions in those without symptoms is not recommended until the hemoglobin is below 60 to 80 g/L (6 to 8 g/dL).[1]In those withcoronary artery diseasewho are not actively bleeding transfusions are only recommended when the hemoglobin is below 70 to 80g/L (7 to 8 g/dL).[10]Transfusing earlier does not improve survival.[98]Transfusions otherwise should only be undertaken in cases of cardiovascular instability.[99]

A 2012 review concluded that when considering blood transfusions for anaemia in people with advanced cancer who have fatigue and breathlessness (not related to cancer treatment or haemorrhage), consideration should be given to whether there are alternative strategies can be tried before a blood transfusion.[100]

Vitamin B12intramuscular injections

[edit]

In many cases, vitamin B12is used byintramuscular injectionin severe cases or cases of malabsorption of dietary-B12.Pernicious anemiacaused by loss ofintrinsic factorcannot be prevented.[101]If there are other, reversible causes of low vitamin B12levels, the cause must be treated.[102]

Vitamin B12deficiency anemia is usually easily treated by providing the necessary level of vitamin B12supplementation.[103]The injections are quick-acting, and symptoms usually go away within one to two weeks.[103]As the condition improves, doses are reduced to weeks and then can be given monthly. Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severeneurologicsymptoms.[103]Treatment should begin rapidly for severe neurological symptoms, as some changes can become permanent.[104]In some individuals lifelong treatment may be needed.[104]

Erythropoiesis-stimulating agents

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The objective for the administration of anerythropoiesis-stimulating agent(ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual person's needs.[105]They should not be used for mild or moderate anemia.[98]They are not recommended in people withchronic kidney diseaseunless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along withparenteral iron.[105][106]The 2020 Cochrane Anaesthesia Review Group review of erythropoietin (EPO) plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non‐cardiac surgery[107]demonstrated that patients were much less likely to require red cell transfusion and in those transfused, the volumes were unchanged (mean difference -0.09, 95% CI -0.23 to 0.05). Pre-operative hemoglobin concentration was increased in those receiving 'high dose' EPO, but not 'low dose'.[citation needed]

Hyperbaric oxygen

[edit]

Treatment of exceptional blood loss (anemia) is recognized as an indication forhyperbaric oxygen(HBO) by theUndersea and Hyperbaric Medical Society.[108][109]The use of HBO is indicated whenoxygendelivery to tissue is not sufficient in patients who cannot be givenblood transfusionsformedicalorreligiousreasons. HBO may be used for medical reasons when threat ofblood productincompatibility or concern fortransmissible diseaseare factors.[108]The beliefs of some religions (ex:Jehovah's Witnesses) may require they use the HBO method.[108]A 2005 review of the use of HBO in severe anemia found all publications reported positive results.[110]

Preoperative anemia

[edit]

An estimated 30% of adults who require non-cardiac surgery have anemia.[111]In order to determine an appropriate preoperative treatment, it is suggested that the cause of anemia be first determined.[112]There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have preoperative anemia.[111]

Epidemiology

[edit]

Anemia affects 27% of the world's population with iron-deficiency anemia accounting for more than 60% of it.[113]A moderate degree ofiron-deficiency anemiaaffected approximately 610 million people worldwide or 8.8% of the population.[13]It is somewhat more common in females (9.9%) than males (7.8%).[13]Mild iron-deficiency anemia affects another 375 million.[13]Severe anaemia is prevalent globally, and especially in sub-Saharan Africa[114]where it is associated with infections including malaria and invasive bacterial infections.[115]

History

[edit]

Signs of severe anemia in human bones from 4000 years ago have been uncovered in Thailand.[116]

References

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  10. ^abcQaseem A, Humphrey LL, Fitterman N, Starkey M, Shekelle P (December 2013). "Treatment of anemia in patients with heart disease: a clinical practice guideline from the American College of Physicians".Annals of Internal Medicine.159(11): 770–779.doi:10.7326/0003-4819-159-11-201312030-00009.PMID24297193.S2CID4712203.
  11. ^Peyrin-Biroulet L, Williet N, Cacoub P (December 1, 2015)."Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review".The American Journal of Clinical Nutrition.102(6): 1585–1594.doi:10.3945/ajcn.114.103366.PMID26561626.
  12. ^abc"Anemia Treatment Drugs: 2019 Global Market Study; Analyzed by Type of Anemia, Type of Drug, and Geography".GlobeNewswire(Press release). April 26, 2019.RetrievedAugust 2,2023.
  13. ^abcdeVos T, et al. (December 2012)."Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010".Lancet.380(9859): 2163–2196.doi:10.1016/S0140-6736(12)61729-2.PMC6350784.PMID23245607.
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  15. ^"WHO Global Anaemia estimates, 2021 Edition".Wolrd Health Organization.RetrievedFebruary 27,2022.
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