Anemia
Anemia (year of private-and ancient Greek haimos, "blood") is an abnormal blood count characterized by a decrease in hemoglobin concentration intraerythrocytic (and sometimes the lack of erythrocytes or red blood cells ). This lack leads to poor transport of oxygen through the blood.
It is diagnosed by blood count, a test performed on blood.
If the drop on the red blood cells and platelets or leukocytes, are referred to as bicytopenia. If the three lines are down, we speak of pancytopenia.
Signs and symptoms
The signs and symptoms common to several anemia are:
* Weight Loss
* Lack of appetite
* Fatigue (tiredness);
* Muscle fatigue;
* Dyspnea, panting;
* Tachycardia, palpitations (indeed, to maintain proper oxygenation of peripheral tissues with less GR (therefore low hemoglobin), the heart must accelerate its pace)
* Pallor (especially at the level of the conjunctiva: look inside the lower eyelid; fingertips as well);
* Headache;
* False dizziness;
* Faintness;
* Disorders of skin appendages: hair brittle nails flattened.
In worsening anemia generate dizziness and rapid heartbeat during intense efforts even slightly. On some sites, it can manifest as chest pain (angina). If anemia is chronic and very prolonged (several years), it may even appear to see run, non-obstructive hypertrophic cardiomyopathy.
In cardiac auscultation, one can find a functional murmur (that is to say without underlying cardiac abnormality). Indeed, the decline in the number of red cells in the blood causes a decrease in blood viscosity. Laminar flow normally in the heart becomes turbulent and therefore creates a heart murmur reversible after correction of anemia.
Causes
Anemias are classified into several families according to the mechanism of anemia:
* Central Anemia: the reticulocyte is reduced:
o myelosuppression
o abnormal structure of the bone marrow hematopoietic
o hormonal stimulation decreased (EPO)
o iron deficiency anemia (IDA)
iron malabsorption
malnutrition
occult bleeding (GI) / heavy periods (chlorosis of young girls ")
o deficiency anemia B12 or folate
o production of inhibitors of erythropoiesis, as in inflammation.
* Anemia device: the reticulocyte count is normal or increased
o acute blood loss
bleeding, including bleeding and repeated hidden in a colon cancer
o hemolytic anemia: red blood cell destruction (hemolysis)
Because extra-corpuscular:
# Immunologic, autoimmune
# Hemolytic disease of the newborn
# Splenomegaly: spleen too big trap red blood cells
question particle: the globule is destroyed because of its fragility
# Sickle cell disease (SCD)
# Thalassemia
o anemia plant regeneration after
They can also be classified according to their characteristics on blood counts:
* Anemia aregenerative: reticulocytes are no longer produced the sign anemia plant.
* Hypochromic anemia
* Macrocytic anemia: the size of erythrocytes (mean corpuscular volume) is greater than the standard, vitamin B12 or folate for example.
* Microcytic anemia: the size of red cells (complete blood count |MCV) is less than the standard, for example iron deficiency.
Exploration of anemia
It is important to note that the number of red blood cells and hemoglobin are lower in women and children than men (because of its androgenic impregnation).
1) The number of red cells is normally:
* 5 (4.5 to 5.5) million / cu mm in adult males;
* 4.5 (3.9 to 5.0) million / mm ³ in adult women and children.
2) The hemoglobin (Hb) of blood is normally:
* 15 (13.5 to 16) g/100 mL in adult males;
* 13.5 (11.5 to 15) per 100 mL in the adult woman and child.
There is talk of anemia if the hemoglobin level below 13 g / dL in adult men and less than 12 g / dL in women.
In pregnant women, there is a physiological hemodilution, then placed the minimum rate at 10.5 g / dL.
Laboratory tests
To diagnose anemia, only the NFS (Blood count and globular) is required. In addition, we will assay of reticulocyte if anemia or macrocytic normo. Indeed, the account of reticulocytes to determine if the anemia is regenerative (there is increased birth of new GR to adapt, so the manufacturing process of GR works fine but there is a loss to explain the increased anemia) or aregenerative (there is no manufacture of new GR or less, no adjustment of production (which should increase) in the loss.
To determine the etiology of anemia, as the context, we can perform various tests by the suspected cause:
* Iron status: serum iron, ferritin, total iron fixation capacity of transferrin, transferrin saturation
* Vitamin B12 serum ± intraerythrocytic
* Serum Folate ± intraerythrocytic
* CRP
* Profile inflammatory protein
* Ultra-sensitive TSH, T4
* Total bilirubin and conjugated
* Lactate dehydrogenase (LDH)
* Haptoglobin
* Finger blood smear
* Search by irregular agglutinins direct Coombs test Coombs ± sensitized
* Blood cultures
* Parasitic Serology
* Thick blood smear and in search of malaria
* Hemoglobin electrophoresis
* medullary bone marrow± biopsy puncture with Perls stain
* Test of resistance of erythrocytes to hemolysis in sucrose or in acidic
* Determination of G6PD and pyruvate kinase
* Study the life of erythrocytes labeled with technetium 99m
* Schilling Test
* Blood lead levels, because anemia can be induced by lead poisoning
* Exploration of hemostasis: PT, APTT, Bleeding time, Clotting Factors
* Creatinine, urea, uric acid
Special cases
* Aplastic anemia: this is a rare type of unknown cause. It is characterized by the absence or decrease of erythroblasts (red blood cell precursors) in bone marrow. It may also be due to leukemia.
* Sickle cell anemia: blood cells have a shape stretched reducing their ability to transport oxygen. It is a mutation of hemoglobin molecules.
* Iron deficiency anemia: The origin is a lack of iron scavenger of oxygen.
* Anemia with paroxysmal nocturnal hemoglobinuria.
Treatment
The principle of treatment of anemia is the treatment of its etiology. In some emergency situations where anemia is symptomatic, if not deep, blood transfusion is performed.
See also Blood Transfusion
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