Chronic Anemia

What is Chronic Anemia?

Anemia, a term that comes from an ancient Greek phrase for “lack of blood,” is a sign of an underlying disease, rather than a diagnosis itself. Various conditions can lead to anemia through different medical pathways. This condition affects a large population around the world, especially in underdeveloped regions, leading to a significant rise in medical costs.

Generally, anemia is identified by the reduction in levels of hemoglobin (under 13.5 g/dL in men and under 12.0 g/dL in women), hematocrit (less than 41.0% in men and less than 36.0% in women), or red blood cell count. However, in daily clinical practices, doctors usually refer to hemoglobin and hematocrit levels rather than the red blood cell count. Standards for what is considered ‘normal’ can vary depending on factors like ethnicity, gender, and age.

The fundamental problem with anemia is that it reduces the blood’s ability to carry oxygen, which can starve body tissues of the oxygen they need.

The National Cancer Institute presents a severity scale for anemia as follows:

1. Mild: Hemoglobin levels between 10.0 g/dL and the lower limit of normal.
2. Moderate: Hemoglobin levels from 8.0 to 10.0 g/dL.
3. Severe: Hemoglobin levels from 6.5 to 7.9 g/dL.
4. Life-threatening: Hemoglobin levels less than 6.5 g/dL.

Lastly, anemia can be categorized into acute anemia and chronic anemia. Acute anemia typically results from sudden blood loss or hemolysis (the destruction of red blood cells), while chronic anemia is more frequently seen and can have many possible causes.

What Causes Chronic Anemia?

Chronic anemia, a condition where you lack enough healthy red blood cells to carry oxygen to your body’s tissues, is generally classified by the average size of your red blood cells, or what’s called mean corpuscular volume (MCV).

When the MCV is less than 80 femtoliters (a measurement of size), it’s called microcytic anemia. This could be due to
– Iron deficiency, which is the most common cause
– Thalassemia, which is a group of inherited blood disorders
– Long-term diseases like cancer or infection
– Sideroblastic anemia, which is a group of blood disorders where your body has enough iron but can’t use it properly

When the MCV is greater than 100 femtoliters, it’s called macrocytic anemia. This could be caused by
– Vitamin B12 or folic acid deficiency
– Alcoholism and liver diseases
– Myelodysplastic syndromes, a group of disorders resulting from poorly formed or dysfunctional blood cells
– Drugs
– Hypothyroidism, a condition in which your thyroid gland doesn’t produce enough hormones

When the MCV is between 80 to 100 femtoliters, it’s labeled as normocytic anemia. This can be due to
– Most long-term illnesses like cancer or infections
– Bone marrow being unable to create enough new cells (technically referred to as bone marrow suppression), which can result in conditions like aplastic anemia and myelophthisic anemia

Hemolytic anemia, where red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over, can be due to various health issues like hemolytic uremic syndrome, sickle cell disease, mechanical heart valves, disseminated intravascular coagulation (a condition that causes blood clots to form throughout the body), cold hemoglobinuria, and cold agglutinin disease.

It’s important to note that some conditions can fit into more than one category. For example, early iron deficiency can result in normocytic anemia, not just microcytic. Anemia due to long-term illnesses can primarily be normocytic, but can sometimes also be microcytic. Hemolytic anemia can lead to either macrocytic or normocytic anemia.

Risk Factors and Frequency for Chronic Anemia

Iron deficiency anemia is the most widespread type of anemia, impacting approximately 8% to 9% of people globally.

• It is more common in developing countries, primarily due to malnutrition and lack of access to good healthcare.
• Women are affected more due to pregnancy and menstrual bleeding.
• African Americans have a higher prevalence due to conditions like sickle cell disease and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• Older adults are also more likely to have anemia because of common health issues such as chronic kidney disease, cancer, and the use of certain medications.

Signs and Symptoms of Chronic Anemia

Chronic anemia is a condition in which the body doesn’t have enough red blood cells to provide oxygen to its tissues. This reduced oxygen flow often leads to symptoms like weakness, fatigue, dizziness, shortness of breath during physical activities, chest pain, heart palpitations, loss of appetite, and cognitive issues, particularly in older people. The severity of these symptoms typically depends on how fast anemia has developed and how low the levels of hemoglobin and hematocrit are in the body. Activities that demand more oxygen, like exercise, can make these symptoms worse.

Typically, when diagnosing chronic anemia, your doctor will consider your medical history, current medications, alcohol usage, and family history. Information about your ethnic background and country of origin is also useful, as some types of anemia are more common in certain ethnic groups.

During a physical examination, your doctor will check for certain signs of anemia such as:

• Pale skin (pallor)
• Yellowing of the skin and eyes (jaundice)
• Fast heart rate (tachycardia)
• Rapid breathing (tachypnea)
• Low blood pressure when standing up from a sitting or lying position (orthostatic hypotension)
• Other symptoms that might point to the cause of the anemia

Testing for Chronic Anemia

The starting point to diagnosing a patient’s condition often involves different types of tests. In the case of diagnosing anemia, here’s what the medical experts may request:

• A complete blood count, which measures several components of your blood, including the hemoglobin and hematocrit levels, the mean corpuscular volume (MCV), and a reticulocyte count.
• A comprehensive metabolic panel which checks your kidney and liver functions.
• Iron studies such as serum iron, total iron-binding capacity (TIBC), and ferritin levels.
• Tests measuring the levels of vitamin B12, folic acid, and thyroid-stimulating hormone (TSH) in your blood.
• A stool test to check for hidden (occult) blood.

The MCV test tells us the average size of your red blood cells. Large cells may suggest a deficiency in vitamin B12 or folate, or alcohol use, while small cells could indicate an iron deficiency.

The mean corpuscular hemoglobin concentration test measures the average amount of hemoglobin in your red blood cells. High values might suggest a condition called spherocytosis, while low values might reveal conditions such as thalassemia, iron deficiency, or macrocytic anemia.

The reticulocyte count indicates the number of young red blood cells in your body. High counts could mean your body is making blood cells too fast due to conditions including anemia, excessive bleeding, pregnancy, or removal of the spleen. Low counts may suggest that your body isn’t producing enough blood cells, which might result from conditions like aplastic anemia, radiation exposure, or chronic infection.

There are different types of anemia which are characterized by different iron study results:

• Iron deficiency anemia: Low serum iron, high TIBC, and low ferritin.
• Anemia of chronic disease: Low serum iron, low TIBC, and high ferritin.
• Sideroblastic anemia: High serum iron, normal TIBC, and high ferritin.
• Thalassemia: Normal serum iron, normal TIBC, and normal ferritin.

For more detailed analysis, the doctor may also request a peripheral smear, hemoglobin electrophoresis, and even a bone marrow examination if necessary. If there’s a concern that you might be bleeding internally, you might need tests for your digestive tract like an endoscopy or a colonoscopy, or imaging studies if a tumor is suspected.

Treatment Options for Chronic Anemia

Managing long-term anemia mainly happens outside of a hospital setting. However, hospitalization may be necessary if the patient is showing symptoms, has a significant drop in their hemoglobin levels, needs a transfusion, or requires extensive medical tests.

If a patient’s hemoglobin is below 7 g/dL or if they are showing symptoms, a transfusion of packed red blood cells may be needed. But extra care should be taken when performing transfusions for patients with conditions like end-stage kidney disease requiring hemodialysis or congestive heart failure. These conditions can overload the body with fluid, making transfusions riskier.

Other treatments for chronic anemia center on addressing the underlying causes. These can include:

• For anemia caused by iron deficiency: Intravenous (a shot directly into the vein) or oral iron supplements can be beneficial.
• For anemia due to low Vitamin B12 and folic acid levels: Supplements for these vitamins can be given.
• For anemia resulting from bone marrow disorders: specific treatments for the underlying disorder are necessary.
• For patients with chronic kidney disease: EPO injections (a hormone that helps create red blood cells) can help treat anemia.
• For patients with hypothyroidism: medication like Synthroid can be useful.
• If medications are causing anemia: it might be necessary to stop or switch these drugs.
• For anemia due to gastritis and PUD causing blood loss: PPI’s (a type of stomach acid reducing medication) are usually part of the treatment.
• For women with heavy periods: finding ways to regulate their menstrual cycles might help in treating anemia.

Hospital admission might be necessary if:

• The patient has rapid and significant blood loss causing dizziness, a fast heart rate, and confusion.
• Overall, low counts of all blood cells are detected.
• If patients may not stick to their treatments or they require extensive medical testings.

What else can Chronic Anemia be?

When trying to diagnose chronic anemia, doctors must consider several other conditions that may have similar symptoms:

• Kidney failure
• A severe form of hypothyroidism known as myxedema coma
• Adrenal crisis, a critical drop in adrenal gland function
• Tuberculosis, a bacterial infection typically affecting the lungs
• HIV, a virus that weakens the immune system

By carefully considering these conditions and conducting necessary tests, an accurate diagnosis can be made.

What to expect with Chronic Anemia

The outlook for anemia varies depending on its cause. Several factors can influence the outcome, including the patient’s age, how severe the anemia is, how long it lasts, any additional health problems, availability of health care services, and diet.

Older patients often face a less favorable prognosis because they are typically dealing with other health problems and nutritional deficiencies. This is also the case for patients in developing regions of the world where nutritious food and speedy health care services are often inaccessible.

It’s important to note that if a person’s hemoglobin drops below 6.5 g/dL, the situation becomes life-threatening and could potentially lead to death.

Possible Complications When Diagnosed with Chronic Anemia

Anemia is a serious health condition where the blood doesn’t have enough capacity to carry oxygen in the body. If it’s not treated properly, it can lead to very dangerous situations, and even death.

In the beginning, our bodies can adapt to this decrease in oxygen with an increased heart rate and faster breathing. However, if anemia continues without treatment, it can lead to the failure of multiple organs. This could involve severe heart conditions, chest pain, irregular heartbeat, cognitive issues, and kidney failure.

Females who are pregnant should also take note as untreated anemia can potentially have complications. These could include premature delivery and having babies with low birth weight.

Common complications of untreated anemia:

• Increased heart rate
• Faster breathing
• Severe heart conditions
• Chest pain
• Irregular heartbeat
• Cognitive issues
• Kidney failure
• Premature delivery for pregnant women
• Low birth weight for babies of untreated mothers

Preventing Chronic Anemia

Anemia is a health issue where the blood doesn’t have enough capacity to transport oxygen throughout the body. It’s a prevalent issue, brought on by several factors, including a lack of certain nutrients like iron, vitamin B12, and folic acid, loss of blood, or more complex causes.

Anemia is usually detected using a complete blood count. Treatment methods range from taking nutritional supplements, like iron, vitamin B12, and folic acid, to receiving a blood transfusion or addressing complex underlying health conditions.

It’s critical for patients to maintain regular check-ups with their healthcare providers and sometimes with specialists to manage anemia. This is because if anemia is left untreated, it can pose a serious risk to life and may even result in death.