Anemia is a condition which arises when level of hemoglobin in blood falls below the normal range.

Hemoglobin level varies according to age, sex and other factors. However, in case of females, it should be 11.5-15g/dL and in males it should be between 13-16g/dL.

Symptoms:-

When a person is suffering from anemia, his symptoms initially are not very clear but later become very clear and can be easily diagnosed. Person suffering from anemia becomes very weak. His weakness stops him from doing prolonged duration tasks especially the ones requiring physical stamina. He often remains in a state of extreme mental tiredness as well as physical tiredness which is very commonly known as fatigue as well as becomes lazy. He experiences frequent headache. His concentration becomes weak. He faces disturbed sleep or lack of sleep. Nausea and vomiting are very common in his case accompanied with indigestion. He often experiences irritation along with dizziness. Fingers and toes often become numb due to decreased blood flow to these areas. Indigestion and disturbances of bowel are other common symptoms. Some patients experience strange sensation like throbbing in head and ears. They are scared of heights and fall sick and there by become unsteady quickly above ground level developing vertigo.                                                                                                                                         Some of the other symptoms are:-

• Amenorrhoea, 
• Polymenorrhoea,
• Angina,
• Palpitation,
• Cerebral ischemia,
• Tinnitus etc.....

Causes:-

Anemia can be a result of various causes. It may be due to sudden blood loss or gradual blood loss. It may be due to decreased number of red blood cells or may be due to extensive destruction of these cells. Some of the causes of anemia are:-

• Deficiency of iron and folate,
• Deficiency of vitamin B12,
• Blood loss due to an accident,
• Blood loss during surgical operation,
• Kidney failure,
• Liver failure,
• Blood loss due to peptic ulcers,
• Excessive blood loss during menstruation,
• Hypothyroidism,
• Hypopituitarism,
• In case of marrow failure,
• Chronic inflammatory diseases,
• Chronic infection,
• In case of enzyme abnormalities,
• Secondary carcinoma etc.....

Types:-

Anemia depending on the causative factors is classified into three types:-

• Blood loss anemia

           -Acute blood loss anemia,

           - Chronic blood loss anemia

• Anemia due to red blood cells destruction
• Anemia due to red blood cells inadequate production

 Anemia can also be classified into:-

• Normocytic anemia,
• Macrocytic anemia,
• Microcytic anemia

 Signs:-

• Patients shows swelling of limbs,
• Skin, mucous membrane of oral cavity as well as palms become pale,
• Pallor of palpebral conjuctivae,
• Nail beds show pale color,
• Angular cheilitis,
• Frontal bossing,
• Tachycardia,
• Ataxia,
• Cardiac dilation

 Treatment:-

The most important and foremost treatment essential to treat anemia is transfusion of blood with proper care and by following all the necessary precautions with utmost care. In case of old age patients, special care is required as there is risk of overloading which can be dangerous to life.

Second important treatment is to eliminate or get rid of causative factors responsible for causing anemia. In certain cases, infection may be an underlying cause for anemia and in other cases, certain underlying disease may cause anemia. Thus, whether it is an infection, inflammation or a disease, it has to be cured early to bring back the blood hemoglobin level to normal range.

ACUTE BLOOD LOSS ANEMIA:-

Acute blood loss anemia is a condition in which hemoglobin level of blood decreases due to excessive loss of large volume of blood within short period of time.

In case of acute blood loss, initially heart beat increases and body temperature of person decreases. Patient experiences excessive sweating and shivering. However, his blood pressure remains the same. He turns pale. When blood is lost beyond normal range blood flows towards skin. Main aim is to continue the blood supply to important organs of the body like brain, heart and kidney. Thus, skeletal muscle starts getting reduced. If blood flow stops, production of plasma restarts which will compensate for the lost blood volume. But, if blood loss continues there may be danger to important body organs like heart, brain and kidney which may even result in death.

This kind of acute blood loss anemia is usually seen in case of accidents causing severe internal bleeding or may be due to trauma. Also seen in hemophilic patients. Treatment is simple and that is to replenish the blood loss that can be done either by packed cells or can be done by whole blood transfusion.

CHRONIC BLOOD LOSS ANEMIA:-

Chronic blood loss anemia is a condition in which hemoglobin of blood decreases due to loss of small volume of blood over a long period of time. In case of small volume of blood lost over a longer duration, iron stores of body get depleted and as a result iron deficiency anemia develops.

IRON DEFICIENCY ANEMIA:-

Daily iron requirement of body is 10-15 mg. In case of its deficiency, its level in hemoglobin decreases and as a result iron deficiency anemia occurs.

Most of the signs and symptoms of iron deficiency anemia are same as general anemia. Apart from them, iron deficiency anemic patient shows finger nails which are quite brittle. He very easily develops glossitis and angular stomatitis. He develops pica which is defined as a feeling of fondness of eating strange things like mud, coal , ice, tomatoes etc.....

In case of iron deficiency anemia, hemoglobin is reduced along with iron storage present in bone marrow. Iron present in plasma gets decreased and thus it results in increase in total iron binding capacity.

Investigations:-

• Upper gastrointestinal scopy,
• Malabsorption investigation,
• Occult blood stool investigation,
• Schistosomiasis urine investigation,
• Colonoscopy

Treatment:-

• Treatment is done by giving oral iron tablets.
• Iron is also given intramuscularly or intravenously in extreme cases.

PLUMMER-VINSON SYNDROME:-

It is a syndrome which develops when a patient displays iron deficiency anemia for a long duration. In order to treat it or correct it, iron transfusion is done. It is also known as Patterson-Kelly syndrome as well as Sideropenic dysphagia. Signs and symptoms are same as iron deficiency anemia but most important clinical feature which leads to its diagnosis is the display of postcricoid web. However, it is not continuos. Patient experiences difficulty in swallowing only solid foods and not liquid beverages. Glossitis is also a very common feature.

VITAMIN B12 DEFICIENCY ANEMIA:-

1-2mcg of vitamin B12 is the normal range required daily. In case of its deficiency, a person becomes anemic and develops signs of anemia. His skin and mucous membrane become pale. On investigation, megaloblastic macrocytic anemia is diagnosed. Schilling test is important to determine its deficiency. Cyanocobalamin is given intramusculary along with oral iron therapy.

FOLIC ACID DEFICIENCY ANEMIA:-

100-200 mcg of folic acid is required daily. However, its demand increases in case of infants, pregnant and lactating mothers. Also in case of certain infections, inflammations and tumors, its demand increases. If a person is alcoholic or if he is suffering from intestinal disorders, folate is not adequately absorbed in his body. In such cases megaloblastic macrocytic anemia develops.

Treatment:-

Oral folic acid dose can be given daily followed by maintenance dose once a week. Pregnant women should be regularly given supplements of folic acid as demand of folate increases during pregnancy. Always, folic acid dose should be given with vitamin B12.

NORMOCYTIC ANEMIA:-

Normocytic anemia is a condition in which size of the red blood cells do not change.

Investigations:-

• Peripheral blood smear,
• Count of platelets,
• Count of reticulocyte.

Causes:-

• Anemia due to illness,
• Renal failure,
• Liver diseases,
• Acute blood loss,
• Sickle cell disease,
• Pregnancy,
• Adrenal insufficiency,
• Pituitary insufficiency

Treatment:-

Treatment of normocytic anemia is simple. It is caused due to underlying disease and thus treatment of underlying cause will prove effective to treat it.

SIDEROBLASTIC ANEMIA:-

Sideroblastic anemia is a refractory anemia. It is characterized by large amount of iron in marrow along with ring sideroblasts. On investigation of peripheral smear, it shows red cells which are hypochromic. Sideroblastic anemia may be hereditary or acquired. It can be acquired from drugs like isoniazid, excess of alcohol consumption, rheumatoid arthritis, lead toxicity, carcinoma etc..... There is iron overload in this condition. Thus, there will be increase in iron level in serum as well as transferrin saturation. Treatment of sideroblastic anemia is done with transfusions. Supportive care is done. However, in case of certain patients when alcohol, drugs or toxins are withdrawn it is seen that these patients do respond.

MEGALOBLASTIC MACROCYTIC ANEMIA:-

It is seen in patients suffering from either vitamin B12 deficiency or folate deficiency as well as in case of both. In this condition, cells of both peripheral blood and bone marrow show increased cell size.

Investigations:-

• There is decrease in hemoglobin level, red blood cell count, platelet count, along with reticulocyte count and total leucocyte count. There is increase in iron in serum and serum ferritin level.
• Peripheral smear study.
• Study of bone marrow.

Treatment:-

Blood transfusions with special and extensive care need to be done. Underlying infections should be treated. If the patient is suffering from cardiac failure, its immediate treatment has to be done. Folic acid supplements along with vitamin B12 proves to be beneficial.

ADDISONIAN PERNICIOUS ANEMIA:-

This is a condition arises when stomach fails to secrete an intrinsic factor. Vitamin B12 in absence of such a factor does not gets absorbed and as a result its deficiency develops. Patient shows decreased level of serum vitamin B12 and increased level of serum gastrin. Megaloblastic bone marrow and macrocytic picture of blood will give clear picture of this condition. Vitamin B12 therapy along with iron therapy is essential to cure this condition. Treatment of underlying infection and cause is essential. Blood transfusion is also very beneficial.

ANEMIA OF CHRONIC DISEASE:-

Many chronic diseases, inflammations, cancers and conditions like hepatitis, rhematoid arthritis can lead to the formation of anemia which is mainly normocytic anemia. Such patients show decrease in level of serum iron, transferrin level as well as iron binding capacity. Red blood cells in these kind of patients do not last long and gets destroyed. Erythropoietin production is also very less. When the underlying chronic disease or inflammation is treated, anemia gets cured by itself.

HEMOLYTIC ANEMIA:-

For the maintenance of normal level of hemoglobin in blood, adequate number of red blood cells are required. In case of hemolytic anemia, red blood cell destruction occurs at a very rapid rate. This can occur due to certain drugs like dapsone. It also occurs due to certain underlying inflammation or when a person is suffering from cancer. Patients suffering from malaria also develops this kind of anemia.

Patient excretes urine which is normal in color but after sometime it turns black. He is prone to infections and displays all signs of anemia. He often experiences pain in spleen which is due to its rapid growth in size. He is very prone to jaundice. Peripheral blood smear test and Coomb's test can be done to identify hemolytic anemia. Treatment of underlying cause which may be an infection or disease should be done. Leg ulcers have to be treated well to avoid further worsening of the situation. Blood transfusions can correct the anemia to a large extent.

APLASTIC ANEMIA:-

This kind of anemia can be either acquired or it may be hereditary. Certain drugs essential in the treatment of diabetes along with antibacterial drugs and tranquilliers are known to induce aplastic anemia. Patients suffering from HIV and viral hepatitis also develops it. Radiations are known for inducing it.

Patient experiences weakness and pallor. He becomes fatigue. On examination, he displays jaundice, enlargement of spleen as well as lymph nodes. His hemoglobin level is reduced whereas serum iron and transferrin level is increased. Also, bone marrow shows increase in iron stores along with presence of large number of fat cells.

Aplastic anemia can be treated by removal of underlying cause which may be an infection or an underlying disease along with blood transfusion. Bone marrow transplantation is also very beneficial in most of the cases.