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Understanding Anemia: Etiology and Pathophysiology
Definition
Anemia is a condition characterized by a lower than normal number of red blood cells (RBCs) or hemoglobin concentration within them. It is a symptom indicating an underlying condition rather than a diagnosis in itself.
Key Point
Anemia serves as a warning sign, necessitating further investigation to uncover the root cause.
Symptoms
Symptoms typically manifest when hemoglobin levels drop below 7.0 g/dL and include:
- Weakness
- Lethargy
- Shortness of breath
- Chest pain
- Bleeding
Normal Hemoglobin Ranges
- Men: 13.5 to 18.0 g/dL
- Women: 12.0 to 15.0 g/dL
- Children: 11.0 to 16.0 g/dL
- Pregnancy: Generally >10.0 g/dL, varies by trimester
Etiology of Anemia
Hypoproliferative Anemia: Characterized by a 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 use, liver disease, B12/folate deficiency, myelodysplastic syndromes (MDS).
Hyperproliferative Anemia: Corrected reticulocyte count >2%.
Hemolytic Anemia
- Extravascular Hemolysis: RBCs removed by the liver/spleen. Causes include hemoglobinopathies, enzymopathies, and drug-induced conditions.
- Intravascular Hemolysis: RBCs lyse within circulation. Causes include paroxysmal nocturnal hemoglobinuria (PNH), autoimmune hemolytic anemia (AIHA), transfusion reactions, and infections.
Epidemiology
- Prevalence: Affects up to one-third of the global population. Overall prevalence is 40.9%, higher among rural residents (46.6%) compared to urban residents (20.1%).
- At-risk Groups: Women of reproductive age, pregnant women, the elderly, and those with chronic conditions.
- Special Considerations: Higher prevalence in the elderly and those with poor nutrition.
Pathophysiology
- Production and Destruction Balance: The balance between RBC production in bone marrow and their destruction/removal.
- Mechanisms: Increased RBC destruction or deficient/defective erythropoiesis.
- Examples: Blood loss, hemolytic anemia, defects in erythropoiesis.
Clinical Presentation
- Symptoms: Weakness, lethargy, shortness of breath, chest pain, bleeding.
- Signs: Pallor, tachypnea, hypotension, splenomegaly, hepatomegaly, and neurological deficits related to vitamin B12 deficiency.
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