Oncology

Understanding Anemia: Etiology, Pathophysiology, and Management

Dr. Niti Raizada Jul 26, 2024

Etiology of Anemia

Hypoproliferative Anemia (Corrected Reticulocyte Count <2%)

Microcytic (MCV <80 fL):
- Iron deficiency
- Anemia of chronic disease (AOCD)
- Sideroblastic anemia
- Thalassemia
- Lead poisoning
Normocytic (MCV 80-100 fL):
- AOCD
- Renal failure
- Aplastic anemia
Macrocytic (MCV >100 fL):
- Alcohol
- Liver disease
- B12/folate deficiency
- Myelodysplastic syndrome (MDS)

Hyperproliferative Anemia (Corrected Reticulocyte Count >2%)

Hemolytic Anemia:

Extravascular Hemolysis (RBCs removed by liver/spleen):
- Causes: Hemoglobinopathies, enzymopathies, drug-induced
Intravascular Hemolysis (RBCs lyse within circulation):
- Causes: Paroxysmal nocturnal hemoglobinuria (PNH), autoimmune hemolytic anemia (AIHA), transfusion reactions, infections

Pathophysiology

Anemia results from an imbalance between red blood cell production in the bone marrow and their destruction or removal. Mechanisms include increased RBC destruction and defective erythropoiesis (RBC production). Examples include blood loss, hemolytic anemia, and erythropoiesis defects.

Clinical Presentation

Common symptoms and signs include:

Weakness and lethargy
Shortness of breath
Chest pain
Pallor
Tachypnea
Hypotension
Splenomegaly and hepatomegaly
Neurological deficits related to vitamin B12 deficiency

Evaluation and Diagnosis

Initial tests include:

Complete blood count (CBC)
Corrected reticulocyte count
Stool occult blood test
Viral markers

Further tests might involve:

Serum iron, TIBC, and transferrin levels
Bone marrow biopsy
B12/folate levels
Peripheral blood smear
Hemoglobin electrophoresis
Antinuclear antibody (ANA) test

Management of Anemia

Acute Blood Loss: IV fluids, packed RBCs, maintain hemoglobin >7 g/dL
Nutritional Deficiencies: Oral/IV iron, B12, and folate supplementation
Bone Marrow Disorders: Treatment varies based on the underlying cause
Chronic Disease: Erythropoietin for renal failure, treat underlying diseases
Hemolytic Anemia: Address the cause (e.g., drug removal, splenectomy)
Cancer Treatment-Related: Specific management protocols

Complications of Anemia

Hypoxia
Severe fatigue
Physical and mental growth retardation in children
Neurological damage
Heart problems (irregular heart rate, heart enlargement, heart failure)
Pregnancy complications (e.g., premature birth)

Consultations and Patient Education

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Hematologists
Gastroenterologists
Nephrologists
Gynecologists
Cardiologists

Patient education should cover dietary advice, exercise, and the importance of follow-up for chronic conditions.

Key Takeaways

Early Detection and Management: Essential for preventing severe complications.
Holistic Approach: Address underlying causes and provide comprehensive care.

Understanding anemia is the first step toward effective management and improving quality of life. If you or a loved one are experiencing symptoms, seek medical advice promptly.

Dr. Niti Raizada | Fortis BG Road