Do You Have Anemia?
What is Anemia?
Anemia is a blood disease due to deficiency of oxygen carrying erythrocytes either due to decrease number of RBC’s itself or decrease in Hemoglobin content in erythrocytes.
It is considered as anemia when the male patient’s RBC count less than 4.5 million/micron L and Hb content is less than 13.5gm/dL. Meanwhile for the female’s patient, the RBC’s count 3.9million/micron L and Hemoglobin content is 11.5gm/dL/
What are the types of anemia?
They are classified according to the size and Hb content of each RBC into:
1. Normocytic normochromic
2. Microcytic hypochromic ( Iron deficiency anemia)
3. Macrocytic anemia (Megaloblastic anemia)
We’re gonna stress more on Iron deficiency anemia and Megaloblastic anemia and Pernicious anemia.
Iron deficiency anemia
This type of anemia due to lower intake of iron rather than the amount needed. It is more common in growing children and during pregnancy. It is also caused by deficient in iron absorption due to partial gasterectomy,vitamin C deficiency,much intake of phytic acid,oxalates,phosphates and bowel diseases. As we know,iron homeostasis is closely regulated via intestinal absorption. Once iron is absorbed,there’s no physiologic mechanism for excretion of excess iron from the body other than blood loss. So, in case of gasterectomy, there’s no mechanism that take part in reducing the ferric iron to absorbable form as all the dietary iron taken daily in ferric state.
What is the role of stomach in absoprtion of iron?
The iron is mainly absorbed in the duodenum and upper jejunum (Vitamin B12 is absorbed in terminal ileum). The stomach plays a role in iron absorption through dissolving iron by HCL and forming soluble complex together with Vitamin C(reducing agent) to aid its reduction into ferrous absorbable form.
What are the treatment of iron deficiency anemia?
1. Oral iron therapy.
– ferrous sulphate
– ferrous fumarate
Common side effects include : which is dose-related and can often be overcome by lowering dose of iron or by taking the tablets immediately after or with meals)
– nausea,epigastric pain,abdominal cramps,constipation,diarrhea,black stool (often misdiagnose with GIT blood loss)
2. Parenteral iron therapy.
Iron dextran intramuscular (IM) or intravenous infusion(IV)
but,it has dangerous IV side effect,these are :
– headache,light-headedness,fever,arthralgia,nausea,vomiting,back pain,flushing,urticaria,bronchospasm,anaphylaxis and death. So,owing for the risk of hypersensitivity reaction,a small test dose of iron dextran should always be given before full IM or IV doses are given. We should ask the patient about the history of allergy and patients who have previously received parenteral iron dextran.
Iron sorbitol citric acid IM
How to manage the patient who is already in iron toxic state?
1. Acute iron toxicity
-most probably occur in children who acidently ingest iron tablets. They experienced necrotizing gastroenteritis,vomiting,abdominal pain,bloody diarrhea followed by shock,lethargy and dyspnea.
– treatment by gastric lavage with NaHCO3, iron chelating agent (Desferrioxamine injection), and treatment of causes.
2. Chronic iron toxicity ( Hemachromatosis/Bronzed diabetes)
it is due to excess iron is deposited in the heart.liver,pancreas and lead to organ failure and death.
it is commonly occur in patients with inherited hemochromatosis and in patients who received frequent blood transfusion over long period of time (patients with thalasemia major)
it cause pancreatic damage and leading to diabetes.
treatment : chronic iron overloade without anemia can be treated by intermittent phlebotomy. One unit of blood can be removed every week so untill all the excess iron are removed but in patient with thalasemia major, we use cletion agent to treat this disease (Desferrioxamine).
This is due to folic acid deficiency and Vitamin B12 deficiency
Folic acid deficiency is due to less intake in diet, increased need in pregnancy, failure of absorption and treatment with antifolate cytotoxic drugs as methotrexate.
Vitamin B12 deficiency is due to defective absorption as after gastrectomy , absence of intrinsic factor (pernicious anemia) and terminal ileum disease (malabsorption syndrome,inflammatory bowel diseases and small bowel resection)
Neurologic syndrome cause by Vit B12 deficiency.
it usually started with paresthesias and weakness in peripheral nerves and progress to spasticity,ataxia,and other CNS disturbances. Correction of Vit B12 deficiency arrest the progression of neurologic diseases but it may not fully reverse neurologic symptoms that have present for several months.
this is a familial disease of an elderly women caused by immune reactions againts parietal cell of the stomach leading to destruction of parietal cell so,there is absence of HCL and intrinsic factor. So,it leads to defective absorption of Vit B12 resulting in macrocytic anemia accompanied by nervous manifestations.
What are the treatment of pernicious anemia?
Cyanocobalamin 1 mg IM for long life treatment
Hydroxocobalamin IM : in cyanide poisoning
What are the treatment of megaloblastic anemia?
Phenobarbitone , Phenytoin ,Primidone