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What is anemia characterized by?
What is anemia characterized by?
What is the definition of anemia according to the World Health Organization?
What is the definition of anemia according to the World Health Organization?
What type of anemia is associated with deficiencies of vitamin B12 or folic acid?
What type of anemia is associated with deficiencies of vitamin B12 or folic acid?
What is the most sensitive marker for iron-deficiency anemia?
What is the most sensitive marker for iron-deficiency anemia?
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What is a cause of vitamin B12-deficiency anemia?
What is a cause of vitamin B12-deficiency anemia?
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What is anemia of inflammation (AI) also known as?
What is anemia of inflammation (AI) also known as?
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What is the recommended daily dosage of elemental iron for oral iron therapy?
What is the recommended daily dosage of elemental iron for oral iron therapy?
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Why should iron supplements be administered at least 1 hour before meals?
Why should iron supplements be administered at least 1 hour before meals?
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What can cause anemia by reducing absorption of folate?
What can cause anemia by reducing absorption of folate?
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In which situation would parenteral iron be considered?
In which situation would parenteral iron be considered?
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What type of anemia is associated with iron deficiency?
What type of anemia is associated with iron deficiency?
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What is the usual treatment duration for folic acid–deficiency anemia?
What is the usual treatment duration for folic acid–deficiency anemia?
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At what Hb level should RBC transfusions be limited to?
At what Hb level should RBC transfusions be limited to?
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What is the recommended daily dose of oral vitamin B12 supplementation?
What is the recommended daily dose of oral vitamin B12 supplementation?
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What can be considered to improve response to ESA treatment?
What can be considered to improve response to ESA treatment?
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Why is iron therapy not effective in anemia of inflammation?
Why is iron therapy not effective in anemia of inflammation?
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What is a potential toxicity of exogenous ESA administration?
What is a potential toxicity of exogenous ESA administration?
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What is associated with increased mortality and cardiovascular events?
What is associated with increased mortality and cardiovascular events?
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What is the treatment approach for anemia of inflammation?
What is the treatment approach for anemia of inflammation?
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When should parenteral vitamin B12 therapy be used?
When should parenteral vitamin B12 therapy be used?
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In what population is parenteral iron often used?
In what population is parenteral iron often used?
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How long should iron therapy continue in responders?
How long should iron therapy continue in responders?
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What is the daily dose of folic acid?
What is the daily dose of folic acid?
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When can an increase in Hb be seen in IDA?
When can an increase in Hb be seen in IDA?
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What is A-AI typically associated with?
What is A-AI typically associated with?
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What is the characteristic of acute-onset anemia?
What is the characteristic of acute-onset anemia?
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Which laboratory test is most sensitive for IDA?
Which laboratory test is most sensitive for IDA?
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What is the characteristic of anemia with folate deficiency?
What is the characteristic of anemia with folate deficiency?
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What is the goal of treatment for anemia?
What is the goal of treatment for anemia?
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What is the characteristic of chronic anemia?
What is the characteristic of chronic anemia?
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What is the laboratory change in A-AI?
What is the laboratory change in A-AI?
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What is the initial evaluation of anemia?
What is the initial evaluation of anemia?
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Study Notes
Anemia Introduction
- Anemia is a group of diseases characterized by a decrease in hemoglobin (Hb) or red blood cells (RBCs), resulting in decreased oxygen-carrying capacity of blood.
- The World Health Organization defines anemia as Hb less than 13 g/dL in men or less than 12 g/dL in women.
Pathophysiology
- Functional classification of anemias is based on cell size.
- Morphologic classifications are based on cell size, including:
- Macrocytic cells, larger than normal, associated with deficiencies of vitamin B12 or folic acid.
- Microcytic cells, smaller than normal, associated with iron deficiency.
- Normocytic anemia, associated with recent blood loss or chronic disease.
Iron-Deficiency Anemia (IDA)
- Characterized by decreased levels of ferritin (most sensitive marker) and serum iron, and decreased transferrin saturation.
- Caused by inadequate dietary intake, inadequate gastrointestinal absorption, increased iron demand, blood loss, and chronic diseases.
Vitamin B12-Deficiency Anemia
- Characterized by macrocytic anemia, caused by inadequate dietary intake, malabsorption syndromes, and inadequate utilization.
- Deficiency of intrinsic factor causes decreased absorption of vitamin B12 (pernicious anemia).
Folic Acid-Deficiency Anemia
- Caused by inadequate dietary intake, hyperutilization due to pregnancy, hemolytic anemia, malignancy, chronic inflammatory disorders, long-term dialysis, or growth spurt.
- Deficiency can be caused by drugs reducing absorption of folate or through folate antagonism.
Anemia of Inflammation (AI)
- Characterized by decreased serum iron, but normal or increased serum ferritin concentration.
- Associated with malignant, infectious, or inflammatory processes, tissue injury, and conditions associated with release of proinflammatory cytokines.
Clinical Presentation
- Acute-onset anemia: characterized by cardiorespiratory symptoms.
- Chronic anemia: characterized by weakness, fatigue, headache, orthopnea, dyspnea on exertion, vertigo, faintness, cold sensitivity, pallor, and loss of skin tone.
- Iron deficiency anemia: glossal pain, smooth tongue, reduced salivary flow, pica, and pagophagia.
- Vitamin B12 deficiency: neurologic effects (numbness, paraesthesis), psychiatric findings (irritability, depression, memory impairment).
Diagnosis
- Rapid diagnosis is essential because anemia is often a sign of underlying pathology.
- Initial evaluation involves complete blood cell count (CBC), reticulocyte index, and examination of stool for occult blood.
- Decreased serum ferritin is the earliest and most sensitive laboratory change for IDA.
- Mean corpuscular volume is usually elevated in macrocytic anemias.
Treatment
Iron-Deficiency Anemia
- Oral iron therapy with soluble ferrous iron salts at a daily dosage of 150-200 mg elemental iron in two or three divided doses.
- Parenteral iron preparations are available for patients with iron malabsorption, intolerance of oral iron therapy, or nonadherence.
Vitamin B12-Deficiency Anemia
- Oral vitamin B12 supplementation is as effective as parenteral, even in patients with pernicious anemia.
- Parenteral therapy acts more rapidly than oral therapy and is recommended if neurologic symptoms are present.
Folate-Deficiency Anemia
- Oral folic acid supplementation of 1 mg daily for 4 months is usually sufficient for treatment.
Anemia of Inflammation
- Treatment focuses on correcting reversible causes, reserving iron therapy for established IDA.
- RBC transfusions are effective but should be limited to Hb of 7-8 g/dL.
- Erythropoiesis-stimulating agents (ESAs) can be considered, but response can be impaired in patients with AI.
Pediatric Populations
- Infants aged 9-12 months: Administer ferrous sulfate 3-6 mg/kg/day (elemental iron) divided once or twice daily between meals for 4 weeks.
- Vitamin B12 and folic acid dosages should be titrated according to clinical and laboratory response.
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Description
Learn about anemia, a group of diseases characterized by a decrease in hemoglobin or red blood cells, resulting in decreased oxygen-carrying capacity of blood. Understand the definition and classification of anemia.
