Treatment of anemia

Anemia represents a reduction in the body's red blood cell mass, which can be caused by many types of diseases. The goal of the clinician is to determine the etiology of anemia and treat it appropriately. The intention of this classes it to teach an understanding of the approach to the differential diagnosis of anemia using history and simple laboratory tests. Further detail on each clinical entity will build on this foundation.

Physiologic Mechanisms of Anemia

Anemia occurs whenever there is an upset in the balance between red blood cell production and red blood cell destruction or loss.

From a physiologic standpoint, the causes of anemia may be broken down into the following categories:

1. Absence or deficiency of "building blocks" to make red blood cells:

Iron: An essential nutrient require by every human cell. It is a part of the heme group which carries oxygen. Iron is stored, mostly in the liver and bone marrow in the form of ferritin. Vitamin B12: Vitamin essential for DNA synthesis Folate: Vitamin essential for DNA synthesis

2. Congenital abnormalities of the content of red blood cells, hemoglobin

Sickle cell anemia Thalassemia Other abnormal hemoglobin

3. Abnormality of the micro environment, where red blood cell precursors are produced, the bone marrow.

	Empty bone marrow:    ex. Aplastic anemia
	Marrow space filled with other elements: ex. Leukemia/lymphoma/myeloma
		Cancer

4. Loss of red blood cells: bleeding

Gastro-intestinal/Menstrual/Urinary/Epistaxis

5. Decreased lifespan of red blood cells within the circulation: hemolysis
    
6. Chronic illness, particularly renal, which inhibits erythropoietin or other steps in red blood cell production.

	Renal failure/acute or chronic
	ANY serious medical disorder
	Investigation Of Anemia  Keeping the physiologic mechanisms of anemia in mind, there are tools which may be used to reach a correct diagnosis History: The patient may be from an ethnic group that would make them likely to carry a congenital abnormality of hemoglobin or red blood cell enzyme.  The patient may be vegetarian which might lead to a deficiency of iron or Vit B12. Hospitalized patients may be fasting and on an antibiotic which may lead to folate deficiency. History of blood loss through gastrointestinal bleeding or epistaxis, or chronic such as heavy menstrual periods or undetected gastrointestinal bleeding The patient may have a history of much more serious systemic      complaints such as weight loss, bruising, or pain suggesting an underlying disorder of the bone marrow such as leukemia. The patient may have serious medical problems such as renal failure or rheumatoid arthritis, which affect the bone marrow's ability to respond to anemia either by reducing the production of erythropoietin from a failing kidney or bone marrow suppression from inflammatory cytokines. Physical exam:  If the bone marrow is failing due to an underlying disorder, the white blood cells and the platelets may also be affected and the patient may have evidence of bruising or infection. When red blood cells are destroyed in the circulation, hemoglobin is released from the red cells. The heme portion is broken down into bilirubin. If the rate of red cell destruction is too rapid, bilirubin may build up in the blood leading to jaundice. If the site of destruction of the red blood cells is the spleen, there may be splenomegaly. There may be obvious chronic disease such as rheumatoid arthritis or renal failure Laboratory Testing After the history and physical exam are complete, simple laboratory tests can help classify the type of anemia. The reticulocyte count and complete CBC, including the mean red cell volume (MCV), are particularly helpful. Each of these tests limits the diagnostic possibilities for a particular case of anemia, allowing the physician to narrow the likely causes of anemia to a few. Treatments Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss  Dietary Changes and Supplements  To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron Sometimes, your doctor may suggest eating iron containing food especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish needed to make hemoglobin. Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow's milk, and infants who are fed breast milk only or formula that isn't fortified with iron. Medication Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia such as: Antibiotics to treat infections. Hormones to treat heavy menstrual bleeding in teenaged and adult women. A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks. Medicines to prevent the body's immune system from destroying its own red blood cells. Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning. Blood Transfusion. A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient's blood. Blood and Marrow Stem Cell Transplant. A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets. Surgery. If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.