Blood Transfusions for Anemia in the Hospital

How much blood do you need?

Getting a blood transfusion in the hospital can save your life. You may need a lot of blood if you are bleeding heavily because of an injury or illness.

But anemia is usually not urgent. And usually you don’t need a lot of blood. You may only need one unit of blood while you are in the hospital. Or you may not need any blood at all. Here’s why:

What is anemia?

If you have anemia, your blood doesn’t have enough red blood cells, or they don’t work properly. Red blood cells carry hemoglobin. This is an iron-rich protein that helps bring oxygen to the body. Anemia is measured in hemoglobin levels.

There are a number of reasons you may become anemic while you are in the hospital, including:

• Bleeding
• Frequent blood draws
• Liver and kidney damage
• A chronic condition or disease
• Medications
• Kidney disease
• Chronic infections
• Cancer

Extra blood units are not helpful.

A normal hemoglobin level is 11 to 18 grams per deciliter (g/dL), depending on your age and gender. But 7 to 8 g/dL is a safe level. Your doctor should use just enough blood to get to this level. Often, one unit of blood is enough.

Some doctors believe that hospital patients who fall below 10 g/dL should get a blood transfusion. But recent research found that:

• Many patients with levels between 7 and 10 g/dL may not need a blood transfusion.
• One unit of blood is usually as good as two, and it may even be safer.
• Some patients in intensive care may do better when they receive less blood.

Using more blood units may increase risks.

In the U.S., the blood is generally very safe (see Advice column). The risks when you get blood are very small. They include:

• Cardiac overload—severe shortness of breath from overloading the heart with fluid
• Lung injury
• Infections

These problems can happen with any transfusion. But the risks are higher if you get more blood.

Blood transfusions can cost a lot.

A unit of blood usually costs about $200 to $300. There are added costs for storage and processing, as well as hospital and equipment fees. Costs can be much higher if the transfusion causes an infec­tion or serious problem. Also, if you only use the blood you need, you are helping to keep a blood supply for other people.

Do patients ever need more than one unit?

Most patients do well with just one unit of blood, if the transfusion is not for an emergency. But some people may need more blood. Discuss this with your doctor.

You may need more than one unit if:

• You have bleeding that is not well controlled, such as bleeding that continues during surgery.
• You have severe anemia and unstable chest pain. (“Unstable” means that your symptoms keep changing.)

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2018 Consumer Reports. Developed in cooperation with the American Society of Hematology.

4/2015

Iron-Deficiency Anemia in Children | Cedars-Sinai

Not what you’re looking for?

What is iron-deficiency anemia in children?

Anemia is a common health problem in children. The most common cause
of anemia is not getting enough iron. A child who is anemic does not have enough red
blood cells or enough hemoglobin. Hemoglobin is a protein that lets red blood cells
carry oxygen to other cells in the body. Iron is needed to form hemoglobin.

What causes iron-deficiency anemia in a child?

Iron-deficiency anemia can be caused by:

• Diets low in iron. A
  child gets iron from the food in his or her diet. But, only a small amount of the
  iron in food is actually absorbed by the body.
  • Full-term newborns, born to
    healthy mothers, have iron that they get during the last 3 months of
    pregnancy.
  • Infants of mothers with anemia
    or other health problems may not have enough iron stored. And infants born
    early may not get enough iron.
  • At 4 to 6 months of age, the
    iron stored during pregnancy is at a low level. And more iron is used as the
    infant grows.
  • The American Academy of
    Pediatrics (AAP) advises feeding your baby only breastmilk for the first 6
    months. But breastmilk does not have a lot of iron, so infants that are
    breastfed only, may not have enough iron.
  • Older infants and toddlers may
    not get enough iron from their diets.
• Body changes. When the
  body goes through a growth spurt, it needs more iron for making more red blood
  cells.
• Gastrointestinal tract
  problems. Poor absorption of iron is common after some forms of
  gastrointestinal surgeries. When you eat foods containing iron, most of the iron is
  absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI)
  tract could alter iron absorption and cause iron-deficiency anemia.
• Blood loss. Loss of
  blood can cause a decrease of iron. Sources of blood loss may include
  gastrointestinal bleeding, menstrual bleeding, or injury.

What are the symptoms of iron-deficiency anemia in a child?

These are the most common symptoms of iron-deficiency anemia:

• Pale skin
• Irritability or fussiness
• Lack of energy or tiring easily (fatigue)
• Fast heart beat
• Sore or swollen tongue
• Enlarged spleen
• Wanting to eat odd substances, such as dirt or ice (also called pica)

How is iron-deficiency anemia diagnosed in a child?

In most cases, anemia is diagnosed with simple blood tests. Routine anemia screening is done because anemia is common in children and they often have no symptoms.

• The AAP recommends anemia screening with a hemoglobin blood test for all infants at 12 months of age. The screening should also include a risk assessment. This is a group of questions to find risk factors for iron-deficiency anemia. Risk factors include feeding problems, poor growth, and special healthcare needs.
• If the hemoglobin level is low, more blood tests are done.
• If your child has a risk factor at any
  age, blood tests are done. 
• Blood tests for anemia may also be done during routine physical exam or checkups in children of any age.

Most anemia in children is diagnosed with these blood tests:

• Hemoglobin and
  hematocrit. This is often the first screening test for anemia in
  children. It measures the amount of hemoglobin and red blood cells in the blood.
• Complete blood count
  (CBC). A complete blood count checks the red and white blood cells, blood
  clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It
  includes hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral smear.A small sample of blood is examined under a microscope. Blood cells are checked
  to see if they look normal or not.
• Iron studies. Blood
  tests can be done to measure the amount of iron in your child’s body.

How is iron-deficiency anemia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

To prevent iron-deficiency anemia,
the AAP says: 

• Beginning at 4 months of age, infants that are only breastfed or partially breastfed should be given a daily iron supplement until they begin eating iron-rich foods.
• Infants that are formula-fed do not need iron supplements. The formula has iron added to it. Whole milk should not be given to infants less than 12 months old.
• Infants and toddlers from 1 to 3 years old should have foods rich in iron. They include cereal that has iron added, red meats, and vegetables with iron. Fruits with vitamin C are also important. The vitamin C helps the body absorb the iron.

Treating iron-deficiency anemia includes:

• Iron supplements. Iron
  drops or pills are taken over several months to increase iron levels in the blood.
  Iron supplements can irritate the stomach and discolor bowel movements. They should
  be taken on an empty stomach or with orange juice to increase absorption. They are
  much more effective than dietary changes alone. If the child can’t take drops or
  pills, IV iron may be needed, but this is very unusual.
• Iron-rich diet. Eating a
  diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron
  include:
  • Iron-enriched cereals, breads,
    pasta, and rice
  • Meats, such as beef, pork, lamb,
    liver, and other organ meats
  • Poultry, such as chicken, duck,
    turkey, (especially dark meat), and liver
  • Fish, such as shellfish,
    including clams, mussels, and oysters, sardines, and anchovies
  • Leafy greens of the cabbage
    family, such as broccoli, kale, turnip greens, and collards
  • Legumes, such as lima beans and
    green peas; dry beans and peas, such as pinto beans, black-eyed peas, and
    canned baked beans
  • Yeast-leavened whole-wheat bread
    and rolls

What are possible complications of iron-deficiency anemia in a
child?

Iron-deficiency anemia may cause delayed growth and development.

What can I do to prevent iron-deficiency anemia in my child?

You can often prevent iron-deficiency anemia through screening and taking iron supplements.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your infant is not nursing well. Or if your toddler or child has any of the signs of iron-deficiency anemia.

Key points about iron-deficiency anemia in children

• Iron-deficiency anemia is not having enough iron in the blood. Iron is needed for hemoglobin.
• Breastfed only infants should be given iron beginning at 4 months of age.
• When infants are 12 months old, they should be screened for iron-deficiency anemia.
• Iron supplement and iron-rich foods are used to treat iron-deficiency anemia.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Not what you’re looking for?

Anemia – StatPearls – NCBI Bookshelf

Continuing Education Activity

Anemia is a reduction in hemoglobin (Hb) or hematocrit (HCT) or RBC count. It is a presentation of an underlying condition and can be subdivided into macrocytic, microcytic, or normocytic. Patients with anemia typically present with vague symptoms such as lethargy, weakness, and tiredness. Severe anemia may present with syncope, shortness of breath, and reduced exercise tolerance. This activity outlines the evaluation and treatment of anemia and explains the role of the interprofessional team in managing patients with this condition.

Objectives:

• Summarize the etiology of anemia.

• Describe the pathophysiology of anemia.

• Outline the use of dietary supplements in the treatment of anemia.

• Explain the importance of collaboration and communication among the interprofessional team to improve outcomes for patients affected by anemia.

Earn continuing education credits (CME/CE) on this topic.

Introduction

Anemia is described as a reduction in the proportion of the red blood cells. Anemia is not a diagnosis, but a presentation of an underlying condition. Whether or not a patient becomes symptomatic depends on the etiology of anemia, the acuity of onset, and the presence of other comorbidities, especially the presence of cardiovascular disease. Most patients experience some symptoms related to anemia when the hemoglobin drops below 7.0 g/dL. 

Erythropoietin (EPO), which is made in the kidney, is the major stimulator of red blood cell (RBC) production. Tissue hypoxia is the major stimulator of EPO production, and levels of EPO are generally inversely proportional to the hemoglobin concentration. In other words, an individual who is anemic with low hemoglobin has elevated levels of EPO. However, levels of EPO are lower than expected in anemic patients with renal failure. In anemia of chronic disease (AOCD), EPO levels are generally elevated, but not as high as they should be, demonstrating a relative deficiency of EPO.

Normal Hemoglobin (Hgb)-specific laboratory cut-offs will differ slightly, but in general, the normal ranges are as follows:

• 13.5 to 18.0 g/dL in men

• 12.0 to 15.0 g/dL in women

• 11.0 to 16.0 g/dL in children

• Varied in pregnancy depending on the trimester, but generally greater than 10.0 g/dL

Etiology

The etiology of anemia depends on whether the anemia is hypoproliferative (i.e., corrected reticulocyte count <2%) or hyperproliferative (i.e., corrected reticulocyte count >2%).

Hypoproliferative anemias are further divided by the mean corpuscular volume into microcytic anemia (MCV<80 fl), normocytic anemia (MCV 80-100 fl), and macrocytic anemia (MCV>100 fl). 

 1) Hypoproliferative Microcytic Anemia (MCV<80 fl)

2) Hypoproliferative Normocytic Anemia (MCV 80-100 fL)

Macrocytic anemia can be caused by either a hypoproliferative disorder, hemolysis, or both. Thus, it is important to calculate the corrected reticulocyte count when evaluating a patient with macrocytic anemia. In hypoproliferative macrocytic anemia, the corrected reticulocyte count is <2%, and the MCV is greater than 100 fl. But, if the reticulocyte count is > 2%, hemolytic anemia should be considered.

3) Hypoproliferative Macrocytic Anemia (MCV>100 fL)

• Alcohol

• Liver disease

• Hypothyroidism

• Folate and Vitamin B12 deficiency [3]
• Myelodysplastic syndrome (MDS)

  • Refractory anemia (RA)

  • Refractory anemia with ringed sideroblasts (RA-RS)

  • Refractory anemia with excess blasts (RA-EB)

  • Refractory anemia with excess blasts in transformation

  • Chronic myelomonocytic leukemia (CMML)

• Drug-induced

  • Diuretics 

  • Chemotherapeutic agents

  • Hypoglycemic agents

  • Antiretroviral agents

  • Antimicrobials

  • Anticonvulsants

 4) Hemolytic anemiaHemolytic anemia (HA) is divided into extravascular and intravascular causes.

• Extravascular hemolysis: red cells are prematurely removed from the circulation by the liver and spleen. This accounts for a majority of cases of HA

  • Hemoglobinopathies (sickle cell, thalassemias)

  • Enzyemopathies (G6PD deficiency, pyruvate kinase deficiency)

  • Membrane defects (hereditary spherocytosis, hereditary elliptocytosis)

  • Drug-induced

• Intravascular hemolysis: red cells lyse within the circulation, and is less common. 

  • PNH

  • AIHA

  • Transfusion reactions

  • MAHA

  • DIC

  • Infections

  • Snake bites/venom

Epidemiology

Anemia is an extremely common disease affecting up to one-third of the global population. In many cases, it is mild and asymptomatic and requires no management. 

The prevalence increases with age and is more common in women of reproductive age, pregnant women, and the elderly.

The prevalence is more than 20% of individuals who are older than the age of 85. The incidence of anemia is 50%-60% in the nursing home population. In the elderly, approximately one-third of patients have a nutritional deficiency as the cause of anemia, such as iron, folate, and vitamin B12 deficiency. In another one-third of patients, there is evidence of renal failure or chronic inflammation. [4]

Classically, mild iron-deficiency anemia is seen in women of childbearing age, usually due to poor dietary intake of iron and monthly loss with the menstrual cycles. Anemia is also common in elderly patients, often due to poor nutrition, especially of iron and folic acid. Other at-risk groups include alcoholics, the homeless population, and those experiencing neglect or abuse.

New-onset anemia, especially in those over 55 years of age, needs investigating and should be considered cancer until proven otherwise. This is especially true in men of any age who present with anemia. 

Apart from age and sex, the race is also an important determinant of anemia, with the prevalence increasing in the African American population.  

Pathophysiology

The pathophysiology of anemia varies greatly depending on the primary cause. For instance, in acute hemorrhagic anemia, it is the restoration of blood volume with intracellular and extracellular fluid that dilutes the remaining red blood cells (RBCs), which results in anemia. A proportionate reduction in both plasma and red cells results in falsely normal hemoglobin and hematocrit. 

RBC are produced in the bone marrow and released into circulation. Approximately 1% of RBC are removed from circulation per day. Imbalance in production to removal or destruction of RBC leads to anemia. [5]

The main mechanisms involved in anemia are listed below:

1. Increased RBC destruction

• Blood loss

  • Acute- hemorrhage, surgery, trauma, menorrhagia

  • Chronic- heavy menstrual bleeding, chronic gastrointestinal blood losses [6] (in the setting of hookworm infestation, ulcers, etc.), urinary losses (BPH, renal carcinoma, schistosomiasis)
• Hemolytic anemia

  • Acquired- immune-mediated, infection, microangiopathic, blood transfusion-related, and secondary to hypersplenism

  • Hereditary- enzymopathies, disorders of hemoglobin (sickle cell), defects in red blood cell metabolism (G6PD deficiency, pyruvate kinase deficiency), defects in red blood cell membrane production (hereditary spherocytosis and elliptocytosis)

2. Deficient/defective erythropoiesis

• Microcytic

• Normocytic, normochromic

• Macrocytic

History and Physical

A thorough history and physical must be performed.

Some important questions to obtain in a history:

• Obvious bleeding- per rectum or heavy menstrual bleeding, black tarry stools, hemorrhoids

• Thorough dietary history

• Consumption of nonfood substances

• Bulky or fatty stools with foul odor to suggest malabsorption

• Thorough surgical history, with a concentration on abdominal and gastric surgeries

• Family history of hemoglobinopathies, cancer, bleeding disorders

• Careful attention to the medications taken daily

1) Symptoms of anemia

Classically depends on the rate of blood loss. Symptoms usually include the following: 

• Weakness

• Tiredness

• Lethargy

• Restless legs

• Shortness of breath, especially on exertion, near syncope

• Chest pain and reduced exercise tolerance- with more severe anemia

• Pica- desire to eat unusual and nondietary substances 

• Mild anemia may otherwise be asymptomatic 

2) Signs of anemia

• Skin may be cool to touch

• Tachypnea

• Hypotension (orthostatic)

• HEENT:

  • Pallor of the conjunctiva                                                                                                                                                                                               

  • “Boxcars” or “sausaging” of retinal veins: suggestive of hyperviscosity which can be seen in myelofibrosis                                                               

  • Jaundice- elevated bilirubin is seen in several hemoglobinopathies, liver diseases and other forms of hemolysis                                         

  • Lymphadenopathy: suggestive of lymphoma or leukemia                                                                                                                                           

  • Glossitis (inflammation of the tongue) and cheilitis (swollen patches on the corners of the mouth): iron/folate deficiency, alcoholism, pernicious anemia 

• Abdominal exam:

  • Splenomegaly: hemolysis, lymphoma, leukemia, myelofibrosis                                                                                                                                         

  • Hepatomegaly: alcohol, myelofibrosis                                                                                                                                                                 

  • Scar from gastrectomy: decreased absorptive surface with the loss of the terminal ileum leads to vitamin B12 deficiency                                                       

  • Scar from cholecystectomy: Cholesterol and pigmented gallstones are commonly seen in sickle cell anemia are hereditary spherocytosis

• Cardiovascular:

  • Tachycardia                                                                                                                                                                                                           

  • Systolic flow murmur                                                                                                                                                                                                   

  • Severe anemia may lead to high output heart failure

• Neurologic exam: Decreased proprioception/vibration: vitamin B12 deficiency

• Skin:

  • Pallor of the mucous membranes/nail bed or palmar creases: suggests hemoglobin < 9 mg/dL                                                                                   

  • Petechiae: thrombocytopenia, vasculitis                                                                                                                                                               

  • Dermatitis herpetiformis (in iron deficiency due to malabsorption- Celiac disease)                                                                                                         

  • Koilonychia (spooning of the nails): iron deficiency

• Rectal and pelvic exam: These examinations are usually overlooked and underperformed in the evaluation of anemia. If a patient has heavy rectal bleeding, one must evaluate for the presence of hemorrhoids or hard masses that suggest neoplasm as causes of bleeding.

Evaluation

Approach to anemia includes identification of the type of anemia: [7][8]

1. Complete blood count (CBC) including differential

2. Calculate the corrected reticulocyte count = percent reticulocytes x (patient’s HCT/normal HCT)

For normal HCT, use 45% in men and 40% in women

If result > 2, this suggests hemolysis or acute blood loss, while results < 2 suggests hypoproliferation.

3. After calculating the reticulocyte count, check the MCV.

• MCV (

  • Iron deficiency- decreased serum iron, percent saturation of iron, with increased total iron-binding capacity (TIBC), transferrin levels, and soluble transferrin receptor 

  • Lead poisoning- basophilic stippling on the peripheral blood smear, ringed sideroblasts in bone marrow, elevated lead levels 

  • AOCD- may be normocytic

  • Thalassemia- RBC count may be normal/high, low MCV, target cells, and basophilic stippling are on peripheral smear. Alpha thalassemia is differentiated from beta-thalassemia by a normal Hgb electrophoresis in alpha thalassemia.  Elevated Hgb A2/HgbF is seen in the beta-thalassemia trait.

  • Sideroblastic anemia- elevated serum iron and transferrin with ringed sideroblasts in the bone marrow 

• MCV (90-100fl)

  • Renal failure: BUN/Creatinine 

  • Aplastic anemia- ask for drug exposure, check for infections (EBV, hepatitis, CMV, HIV), test for hematologic malignancies and paroxysmal nocturnal hemoglobinuria (PNH)

  • Myelofibrosis/myelophthisis- check bone marrow biopsy 

  • Multiple myeloma- serum and urine electrophoresis 

  • Pure red cell aplasia- test for Parvovirus B19, exclude thymoma

• MCV (>100 fl)

  • B12/folate levels- B12 and folate deficiency can be differentiated by an elevated methylmalonic and homocysteine level in B12 deficiency and only an elevated homocysteine level in folate deficiency. Methylmalonic levels are relatively normal.  

  • MDS- hyposegmented PMNs on peripheral smear, bone marrow biopsy 

  • Hypothyroidism- TSH, free T4

  • Liver disease- check liver function 

  • Alcohol- assess alcohol intake 

  • Drugs

Steps to evaluate for hemolytic anemia

1) Confirm the presence of hemolysis- elevated LDH, corrected reticulocyte count >2%, elevated indirect bilirubin and decreased/low haptoglobin

2) Determine extra vs. intravascular hemolysis- 

3) Examine the peripheral blood smear [9]

• Spherocytes: immune hemolytic anemia (Direct antiglobulin test DAT+) vs. hereditary spherocytosis (DAT-)

• Bite cells: G6PD deficiency 

• Target cells: hemoglobinopathy or liver disease 

• Schistocytes: TTP/HUS, DIC, prosthetic valve, malignant HTN

• Acanthocytes: liver disease

• Parasitic inclusions: malaria, babesiosis, bartonellosis

4) If spherocytes +, check if DAT is + 

Other investigations that might be warranted include esophagogastroduodenoscopy for the determination of an upper GI bleed, colonoscopy for the determination of a lower GI bleed, and imaging studies if malignancy, or internal hemorrhage is suspected. If a menstruating woman has heavy vaginal bleeding, evaluate the presence of fibroids with a pelvic ultrasound. 

Treatment / Management

Management depends primarily on treating the underlying cause of anemia.

1) Anemia due to acute blood loss- Treat with IV fluids, crossmatched packed red blood cells, oxygen. Always remember to obtain at least two large-bore IV lines for the administration of fluid and blood products. Maintain hemoglobin of > 7 g/dL in a majority of patients. Those with cardiovascular disease require a higher hemoglobin goal of > 8 g/dL.

2) Anemia due to nutritional deficiencies: Oral/IV iron, B12, and folate. 

• Oral supplementation of iron is by far the most common method of iron repletion. The dose of iron administered depends on the patient’s age, calculated iron deficit, the rate of correction required, and the ability to tolerate side effects. The most common side effects include metallic taste and gastrointestinal side effects such as constipation and black tarry stools. For such individuals, they are advised to take oral iron every other day, in order to aid in improved GI absorption. The hemoglobin will usually normalize in 6-8 weeks, with an increase in reticulocyte count in just 7-10 days.  

•  IV iron may be beneficial in patients requiring a rapid increase in levels. Patients with acute and ongoing blood loss or patients with intolerable side effects are candidates for IV iron.

3) Anemia due to defects in the bone marrow and stem cells: Conditions such as aplastic anemia require bone marrow transplantation.

4) Anemia due to chronic disease: Anemia in the setting of renal failure, responds to erythropoietin. Autoimmune and rheumatological conditions causing anemia require treatment of the underlying disease. 

5) Anemia due to increased red blood cell destruction:

• Hemolytic anemia caused by faulty mechanical valves will need replacement.

• Hemolytic anemia due to medications requires the removal of the offending drug.

• Persistent hemolytic anemia requires splenectomy.

• Hemoglobinopathies such as sickle anemia require blood transfusions, exchange transfusions, and even hydroxyurea to decrease the incidence of sickling. 

• DIC, which is characterized by uncontrolled coagulation and thrombosis, requires the removal of the offending stimulus. Patients with life-threatening bleeding require the use of antifibrinolytic agents. 

Differential Diagnosis

Hemolysis during phlebotomy and significant hemodilution due to large volume fluid resuscitation may lead to a falsely low red cell count.

In acute blood loss from trauma, anemia may not immediately be present on laboratory testing, as the fluid shifts have not had time to occur to normalize the circulating volume, thus diluting the number of red blood cells remaining

Anemia of chronic disease: consider renal failure, underlying malignancies, and autoimmune conditions

Bone marrow infiltration: consider in a patient with weight loss, fatigue.

Macrocytic anemia with B12/folate deficiency: consider in a patient with paresthesias, vegans/vegetarians or in patients with recent gastric bypass surgeries

Hemolytic anemia: consider in all patients with jaundice, dark urine. Always question the recent use of medications. 

Acute upper or lower GI bleed: trauma, carcinoma, peptic ulcer disease, use of NSAIDs.

Prognosis

The prognosis for anemia depends on the cause of anemia.

Nutritional replacements of (iron, B12, folate) should begin immediately. In iron deficiency, replacements must continue for at least three months after the normalization of iron levels, in order to restore iron stores. Usually, nutritional deficiencies have a good prognosis if treated early and adequately.

Anemia, due to acute blood loss, if treated and stopped early, has a good prognosis.

Complications

Anemia, if undiagnosed or left untreated for a prolonged period of time can lead to multiorgan failure and can even death.

Pregnant women with anemia can go into premature labor and give birth to babies with low birth weight [10]. Anemia during pregnancy also increases the risk of anemia in the baby and increased blood loss during pregnancy. 

Complications are more predominant in the older population due to multiple comorbidities [11]. The cardiovascular system is the most commonly affected in chronic anemia. Myocardial infarction, angina, and high output heart failure are common complications. Other cardiac complications include the development of arrhythmias and cardiac hypertrophy.

Severe iron deficiency is associated with restless leg syndrome and esophageal webs.

Severe anemia from a young age may lead to impaired neurological development in the form of cognitive, mental, and developmental delays. These complications are unlikely to be amenable to medical management. 

Consultations

• Gastroenterologist if a gastrointestinal bleed is suspected

• Nephrologist if anemia of chronic disease in the setting of renal failure is suspected

• Hematologist if a bone marrow disorder is suspected

• Gynecologist if intractable menorrhagia is suspected

• Cardiologist if severe anemia leads to angina, myocardial infarction, heart failure, or arrhythmias

Deterrence and Patient Education

Patients with nutritional anemia due to iron deficiency should be educated on food which is rich in iron. Foods such as green leafy vegetables, tofu, red meats, raisins, and dates contain a lot of iron. Vitamin C helps to increase dietary iron absorption. Patients must be advised to avoid excess tea or coffee, as these can decrease iron absorption. Patients on oral iron supplementation must be educated that there is an increased risk of constipation and of the risk of passing black tarry stools. Patients must be advised to contact their doctor if there is severe intolerance to oral iron, as they may be candidates for IV iron supplementation. 

Vegan and vegetarian patients, who may be deficient in B12 must be advised to consume food fortified with vitamin B12, such as certain plant and soy products. Patients who had gastric sleeve operations and sleeve gastrectomies are at an increased risk of vitamin B12 and folate deficiency, due to the loss of absorptive surface at the terminal ileum.

Pearls and Other Issues

Always send blood films in patients with an unclear etiology of anemia.

Start haematinics early (iron, B12, and folate).

Inform patients of the side effects of iron therapy, including constipation and black, tarry stools.

Consider screening for sickle cell and thalassemia in patients with unexplained anemia or with a family history of these diseases.

Vitamin C aids iron absorption, so coadministration of vitamin C with iron, or encouraging the patients to take iron supplements with orange juice, will aid therapy.

Enhancing Healthcare Team Outcomes

Anemia is a heterogeneous condition caused by a variety of diseases. Identifying the cause of anemia and treating it appropriately is very crucial in the management of anemia. This requires interprofessional teamwork between the patient, the patient’s primary care provider, and consultant physician based on the cause, such as a gastroenterologist, nephrologist, cardiologist, hematologist, or gynecologist. Taking all necessary medications along with lifestyle modifications and frequent follow up with the team of doctors is essential to prevent the development of complications. Pharmacists provide education to patients about compliance and side effects of medication, as well as checking for drug interactions. Nurses assist with the education of patients and arrange followup laboratory evaluations and appointments. Only with collaborative interprofessional care can anemia cases achieve optimal outcomes. [Level 5]

Continuing Education / Review Questions

Figure

Aplastic anemia bone marrow. Contributed by Ruozhi Xiao

Figure

Macrocytic anemia. Contributed by Ruozhi Xiao via SlideShare, “Anemia Overview,”

Figure

Iron deficiency anemia. Image courtesy S Bhimji MD

Figure

Sideroblastic anemia. Image courtesy S Bhimji MD

Figure

Hypochromic microcytic anemia. Image courtesy S Bhimji MD

References

1.

Usuki K. [Anemia: From Basic Knowledge to Up-to-Date Treatment. Topic: IV. Hemolytic anemia: Diagnosis and treatment]. Nihon Naika Gakkai Zasshi. 2015 Jul 10;104(7):1389-96. [PubMed: 26513958]

2.

Bottomley SS, Fleming MD. Sideroblastic anemia: diagnosis and management. Hematol Oncol Clin North Am. 2014 Aug;28(4):653-70, v. [PubMed: 25064706]

3.

Engebretsen KV, Blom-Høgestøl IK, Hewitt S, Risstad H, Moum B, Kristinsson JA, Mala T. Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. Scand J Gastroenterol. 2018 Aug;53(8):917-922. [PubMed: 30231804]

4.

Patel KV. Epidemiology of anemia in older adults. Semin Hematol. 2008 Oct;45(4):210-7. [PMC free article: PMC2572827] [PubMed: 18809090]

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Badireddy M, Baradhi KM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 18, 2020. Chronic Anemia. [PubMed: 30521224]

6.

Amin SK, Antunes C. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 19, 2020. Lower Gastrointestinal Bleeding. [PubMed: 28846221]

7.

Jamwal M, Sharma P, Das R. Laboratory Approach to Hemolytic Anemia. Indian J Pediatr. 2020 Jan;87(1):66-74. [PubMed: 31823208]

8.

Mumford J, Flanagan B, Keber B, Lam L. Hematologic Conditions: Platelet Disorders. FP Essent. 2019 Oct;485:32-43. [PubMed: 31613566]

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Rashid A. A 65-year-old man with anemia: diagnosis with peripheral blood smear. Blood Res. 2015 Sep;50(3):129. [PMC free article: PMC4595576] [PubMed: 26457277]

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O’Farrill-Santoscoy F, O’Farrill-Cadena M, Fragoso-Morales LE. [Evaluation of treatment of iron deficiency anemia in pregnancy]. Ginecol Obstet Mex. 2013 Jul;81(7):377-81. [PubMed: 23971384]

11.

Triscott JA, Dobbs BM, McKay RM, Babenko O, Triscott E. Prevalence and Types of Anemia and Associations with Functional Decline in Geriatric Inpatients. J Frailty Aging. 2015;4(1):7-12. [PubMed: 27031910]

Iron-Deficiency Anemia – Hematology.org

Iron is very important in maintaining many body functions, including the production of hemoglobin, the molecule in your blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.

Iron from the food you eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron you ingest. The iron is then released into the blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body. 

Am I at Risk?

Iron deficiency is very common, especially among women and in people who have a diet that is low in iron. The following groups of people are at highest risk for iron-deficiency anemia:

• Women who menstruate, particularly if menstrual periods are heavy
• Women who are pregnant or breastfeeding or those who have recently given birth
• People who have undergone major surgery or physical trauma
• People with gastrointestinal diseases such as celiac disease (sprue), inflammatory bowel diseases such as ulcerative colitis, or Crohn disease
• People with peptic ulcer disease
• People who have undergone bariatric procedures, especially gastric bypass operations
• Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
• Children who drink more than 16 to 24 ounces a day of cow’s milk (Cow’s milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.)

Other less common causes of iron deficiency include:

• Blood loss from the gastrointestinal tract due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia (leaky blood vessels similar to varicose veins in the gastrointestinal tract), infections such as diverticulitis, or tumors in the esophagus, stomach, small bowel, or colon
• Blood loss from chronic nosebleeds
• Blood loss from the kidneys or bladder
• Frequent blood donations
• Intravascular hemolysis, a condition in which red blood cells break down in the blood stream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise, particularly jogging. This can cause trauma to small blood vessels in the feet, so called “march hematuria.” Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular hemolysis (DIC).

What Are the Signs and Symptoms of Iron-Deficiency Anemia?

Symptoms of iron-deficiency anemia are related to decreased oxygen delivery to the entire body and may include:

• Being pale or having yellow “sallow” skin
• Unexplained fatigue or lack of energy
• Shortness of breath or chest pain, especially with activity
• Unexplained generalized weakness
• Rapid heartbeat
• Pounding or “whooshing” in the ears
• Headache, especially with activity
• Craving for ice or clay – “picophagia”
• Sore or smooth tongue
• Brittle nails or hair loss

How Is Iron-Deficiency Anemia Diagnosed?

Iron-deficiency anemia is diagnosed by blood tests that should include a complete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results:

The peripheral smear or blood slide may show small, oval-shaped cells with pale centers. In severe iron deficiency, the white blood count (WBC) may be low and the platelet count may be high or low.

What Other Tests Will Be Done If Iron Deficiency Is Diagnosed?

Your doctor will decide if other tests are necessary. Iron deficiency is common in menstruating and pregnant women, children, and others with a diet history of excessive cow’s milk or low iron-containing foods. By talking with your doctor about your diet and medical history, your doctor may gain enough information to determine whether additional testing is needed. In patients such as men, postmenopausal women, or younger women with severe anemia, the doctor may recommend additional testing. These tests may include the following:

• Testing for blood in the stool (fecal occult blood test)
• Looking for abnormalities in the gastrointestinal tract – upper and lower endoscopy (looking into the stomach, esophagus, or colon with a tube), capsule enteroscopy (swallowing a tiny camera that takes images of the gastrointestinal tract), barium enema, barium swallow, or small bowel biopsy
• Testing the urine for blood or hemoglobin
• In women with abnormal or increased menstrual blood losses, a gynecologic evaluation that may include a pelvic ultrasound or uterine biopsy

Sometimes it is difficult to diagnose the cause of iron deficiency, or your doctor may be concerned that there is a problem other than iron deficiency causing the anemia. These may include inherited blood disorders called thalassemiasin which red blood cells also appear small and pale, hemoglobinopathies such as sickle cell disease (but not sickle cell trait alone), or other blood disorders. People with chronic infections or conditions such as kidney failure, autoimmune diseases, and inflammatory disorders may also have small red blood cells. When the cause of the anemia is not clear, your doctor may refer you to a hematologist, a medical specialist in blood disorders,for consultation and further evaluation.

How Is Iron Deficiency Treated?

Even if the cause of the iron deficiency can be identified and treated, it is still usually necessary to take medicinal iron (more iron than a multivitamin can provide) until the deficiency is corrected and the body’s iron stores are replenished. In some cases, if the cause cannot be identified or corrected, the patient may have to receive supplemental iron on an ongoing basis.

There are several ways to increase iron intake:

Diet

• Meat: beef, pork, or lamb, especially organ meats such as liver
• Poultry: chicken, turkey, and duck, especially liver and dark meat
• Fish, especially shellfish, sardines, and anchovies
• Leafy green members of the cabbage family including broccoli, kale, turnip greens, and collard greens
• Legumes, including lima beans, peas, pinto beans, and black-eyed peas
• Iron-enriched pastas, grains, rice, and cereals

Medicinal Iron

The amount of iron needed to treat patients with iron deficiency is higher than the amount found in most daily multivitamin supplements. The amount of iron prescribed by your doctor will be in milligrams (mg) of elemental iron. Most people with iron deficiency need 150-200 mg per day of elemental iron (2 to 5 mg of iron per kilogram of body weight per day). Ask your doctor how many milligrams of iron you should be taking per day. If you take vitamins, bring them to your doctor’s visit to be sure.

There is no evidence that any one type of iron salt, liquid, or pill is better than the others, and the amount of elemental iron varies with different preparations. To be sure of the amount of iron in a product, check the packaging. In addition to elemental iron, the iron salt content (ferrous sulfate, fumarate, or gluconate) may also be listed on the package, which can make it confusing for consumers to know how many tablets or how much liquid to take to get the proper dosage of iron.

Iron is absorbed in the small intestine (duodenum and first part of the jejunum). This means that enteric-coated iron tablets may not work as well. If you take antacids, you should take iron tablets two hours before or four hours after the antacid. Vitamin C (ascorbic acid) improves iron absorption, and some doctors recommend that you take 250 mg of vitamin C with iron tablets.

Possible side effects of iron tablets include abdominal discomfort, nausea, vomiting, diarrhea, constipation, and dark stools.

Intravenous Iron

In some cases your doctor may recommend intravenous (IV) iron. IV iron may be necessary to treat iron deficiency in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. If you need IV iron, your doctor may refer you to a hematologist to supervise the iron infusions. IV iron comes in different preparations:

• Iron dextran
• Iron sucrose
• Ferric gluconate

Large doses of iron can be given at one time when using iron dextran. Iron sucrose and ferric gluconate require more frequent doses spread over several weeks. Some patients may have an allergic reaction to IV iron, so a test dose may be administered before the first infusion. Allergic reactions are more common with iron dextran and may necessitate switching to a different preparation. Severe side effects other than allergic reactions are rare and include urticaria (hives), pruritus (itching), and muscle and joint pain.

Blood Transfusions

Red blood cell transfusions may be given to patients with severe iron-deficiency anemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency. Red blood cell transfusions will only provide temporary improvement. It is important to find out why you are anemic and treat the cause as well as the symptoms.

Where Can I Find More Information?

If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:

Results of Clinical Studies Published in 

Blood

Search Blood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article in Blood may obtain a copy by e-mailing a request to the Blood Publishing Office.

Patient Groups

A list of Web links to patient groups and other organizations that provide information.

Anemia in Children and Teens: Parent FAQs

Anemia is a condition in which the amount of red blood cells in the body is decreased below normal for your child’s age. It can make your child appear pale in color and feel cranky, tired, or weak. Though these symptoms may worry you, the most common causes of anemia―such as iron deficiency―are generally easy to treat, especially when it is detected early. In addition, parents need to be aware of the steps to take to prevent this condition.

Because rapid growth is a potential cause of the condition, the first year of life and adolescence are two age groups where infants and children are especially prone to anemia.

What is anemia?

Anemia means there are not enough red blood cells in the body. Red blood cells are filled with hemoglobin, a special pigmented protein that makes it possible to carry and deliver oxygen to other cells in the body. The cells in your child’s muscles and organs need oxygen to survive, and decreased numbers of red blood cells can place stress on the body.

Your child may become anemic if his or her body:

• 
  Does not produce enough red blood cells. This can happen if she does not have enough iron or other nutrients in her diet (e.g. iron-deficiency anemia).

• 
  Destroys too many red blood cells. This type of anemia usually happens when a child has an underlying illness or has inherited a red blood cell disorder (e.g.
  sickle-cell anemia).

• 
  Loses red blood cells through bleeding. This can either be obvious blood loss, such as heavy menstrual bleeding, or long-term low-grade blood loss, perhaps in the stool.

What are the common signs and symptoms of anemia?

• Pale or sallow (yellow) skin
• Pale cheeks and lips
• Lining of the eyelids and the nail beds may look less pink than normal
• Irritability
• Mild weakness
• Tiring easily, napping more frequently
• Children experiencing red blood cell destruction may become jaundiced (yellowing of the skin or eyes) and have dark tea or cola-colored urine

Children with severe anemia may have additional signs and symptoms:

• Shortness of breath
• Rapid heart rate
• Swollen hands and feet
• Headaches
• Dizziness and fainting
• Restless leg syndrome

When kids eat non-foods: 

​Children with anemia caused by very low levels of iron in their blood may also eat strange non-food things such as ice, dirt, clay, paper, cardboard, and cornstarch. This behavior is called “pica” (pronounced pie-kuh). Pica often occurs in children who are low in iron and can cause constipation. In these children, the pica usually stops after the anemia is treated with iron supplements. 

If your child shows any of these signs or symptoms, please see your pediatrician.

Even a low level of anemia can affect your child’s energy, focus, and ability to learn. Chronic iron deficiency anemia can result in long term, permanent impairment of development. In most cases, a simple blood count can diagnose anemia.

How can I prevent my child from becoming anemic?

Iron-deficiency anemia and other nutritional anemias can be prevented by ensuring that your child eats a well-balanced diet. Talk with your doctor about any specific dietary restrictions in your household as your child
may require a nutritional supplementation to prevent anemia. 

How can I manage anemia if my child has an inherited red blood cell disorder?

Your pediatrician will likely refer you to a
pediatric hematologist to provide you with supportive care and education on your child’s specific condition.

Remember:

If your child starts to show any signs or symptoms of anemia, be sure to tell your pediatrician. Also, find out if anyone in your family has a history of anemia or problems with easy bleeding. With proper treatment, your child’s anemia should improve quickly.

Additional Information:

​

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Iron deficiency anaemia – NHS

Iron deficiency anaemia is caused by lack of iron, often because of blood loss or pregnancy. It’s treated with iron tablets prescribed by a GP and by eating iron-rich foods.

Check if you have iron deficiency anaemia

Symptoms can include:

• tiredness and lack of energy
• shortness of breath
• noticeable heartbeats (heart palpitations)
• pale skin

Less common symptoms of iron deficiency anaemia

Less common symptoms of iron deficiency anaemia (that are not usually connected to pregnancy) include:

• headaches
• hearing ringing, buzzing or hissing noises inside your head (tinnitus)
• food tasting strange
• feeling itchy
• a sore tongue
• hair loss – you notice more hair coming out when brushing or washing it
• wanting to eat non-food items, such as paper or ice (pica)
• finding it hard to swallow (dysphagia)
• painful open sores (ulcers) in the corners of your mouth
• spoon-shaped nails
• restless legs syndrome

Non-urgent advice: See a GP if you have symptoms of iron deficiency anaemia

A simple blood test will confirm if you’re anaemic.

Information:

Coronavirus (COVID-19) update: how to contact a GP

It’s still important to get help from a GP if you need it. To contact your GP surgery:

• visit their website
• use the NHS App
• call them

Find out about using the NHS during COVID-19

What happens at your appointment

The GP will ask you about your lifestyle and medical history.

If the reason for the anaemia is not clear, they might order some tests to find out what might be causing the symptoms.

They might also refer you to a specialist for further checks.

Blood tests for iron deficiency anaemia

The GP will usually order a full blood count (FBC) test. This will find out if the number of red blood cells you have (your red blood cell count) is normal.

You do not need to do anything to prepare for this test.

Iron deficiency anaemia is the most common type of anaemia. There are other types, like vitamin B12 and folate anaemia, that the blood test will also check for.

Treatment for iron deficiency anaemia

Once the reason you have anaemia has been found (for example, an ulcer or heavy periods) the GP will recommend treatment.

If the blood test shows your red blood cell count is low, you’ll be prescribed iron tablets to replace the iron that’s missing from your body.

The prescribed tablets are stronger than the supplements you can buy in pharmacies and supermarkets.

You’ll need to take them for about 6 months. Drinking orange juice after you’ve taken a tablet may help your body absorb the iron.

Follow the GP’s advice about how to take iron tablets.

Some people get side effects when taking iron tablets like:

• constipation or diarrhoea
• tummy pain
• heartburn
• feeling sick
• black poo

Try taking the tablets with or soon after food to reduce the chance of side effects.

It’s important to keep taking the tablets, even if you get side effects.

Your GP may carry out repeat blood tests over the next few months to check that your iron level is getting back to normal.

Important

Keep iron supplement tablets out of the reach of children. An overdose of iron in a young child can be fatal.

Things you can do yourself

If your diet is partly causing your iron deficiency anaemia, your GP will tell you what foods are rich in iron so you can eat more of them.

Eat and drink more:

• dark-green leafy vegetables like watercress and curly kale
• cereals and bread with extra iron in them (fortified)
• meat
• dried fruit like apricots, prunes and raisins
• pulses (beans, peas and lentils)

Eat and drink less:

• tea
• coffee
• milk and dairy
• foods with high levels of phytic acid, such as wholegrain cereals, which can stop your body absorbing iron from other foods and pills

Large amounts of these foods and drinks make it harder for your body to absorb iron.

You might be referred to a specialist dietitian if you’re finding it hard to include iron in your diet.

Causes of iron deficiency anaemia

In pregnancy, iron deficiency anaemia is most often caused by a lack of iron in your diet.

Heavy periods and pregnancy are very common causes of iron deficiency anaemia. Heavy periods can be treated with medicine.

For men and for women whose periods have stopped, bleeding in the stomach and intestines is the most common cause of iron deficiency anaemia. This can be caused by:

Any other conditions or actions that cause blood loss could also lead to iron deficiency anaemia.

If iron deficiency anaemia is not treated

Untreated iron deficiency anaemia:

• can make you more at risk of illness and infection – a lack of iron affects the immune system
• may increase your risk of developing complications that affect the heart or lungs – such as an abnormally fast heartbeat (tachycardia) or heart failure
• in pregnancy, can cause a greater risk of complications before and after birth

Page last reviewed: 29 January 2021
Next review due: 29 January 2024

Anemia in Newborns

Overview

What is anemia in newborns?

Babies who have anemia have a red blood cell count that is lower than normal. Red blood cells carry oxygen throughout the body.

Symptoms and Causes

What causes anemia in newborns?

A newborn can develop anemia for several reasons. These can include:

• The baby’s body does not produce enough red blood cells. Most babies have some anemia in the first few months of life. This is known as physiologic anemia. The reason this anemia occurs is that baby’s body is growing fast and it takes time for red blood cell production to catch up.
• The body breaks down red blood cells too quickly. This problem is common when the mother’s and baby’s blood types do not match. This is called Rh/ABO incompatibility. These babies usually have jaundice (hyperbilirubenemia), which can cause their skin to turn yellow. In a few babies, anemia can also be caused by infections or genetic (inherited) disorders.
• The baby loses too much blood. Blood loss in the Neonatal Intensive Care Unit (NICU) usually occurs because the healthcare providers need to take frequent blood tests. These tests are needed to help the medical team manage your baby’s condition. The blood that is taken is not replaced quickly, which causes anemia.
• The baby is born premature. Babies who are born premature (early) have lower number of red blood cells. These red blood cells also have a shorter life span when compared to the red blood cells of full term babies. This is called anemia of prematurity.

Other causes include internal bleeding and the transfer of blood between the baby and the mother while the baby is still in the womb.

What are the symptoms of anemia in newborns?

Many babies with anemia don’t have any symptoms. When symptoms occur, they can include:

• Having pale skin.
• Feeling sluggish (having low energy).
• Poor feeding or getting tired while feeding.
• Having a fast heart rate and rapid breathing when resting.

Diagnosis and Tests

How is anemia in newborns diagnosed?

Anemia is diagnosed with a blood test by your healthcare provider. Tests that are used to help diagnose anemia include measurements of the following:

• Hemoglobin: The protein in red blood cells that carries oxygen.
• Hematocrit: The percentage of blood that is made up of red blood cells.
• Reticulocytes: The percentage of immature red blood cells in the blood. This is a measure of how many new cells are being created.

Management and Treatment

What treatments are used for anemia in newborns?

Your baby’s healthcare provider will determine what treatment is best for your baby. Many babies with anemia do not need any treatment. However, very premature babies or babies who are very sick may need a blood transfusion to increase the number of red blood cells in the body.

Other babies will be treated with medicine to help their bodies make more red blood cells. All babies with anemia will have their feedings checked, since the right diet will help your baby make red blood cells.

90,000 Anemia – what is it? – Baltic Medical Center

Anemia (anemia) is a pathological condition characterized by a low level of erythrocytes and / or hemoglobin in the blood, due to which the transfer of oxygen to tissues deteriorates and hypoxia occurs, i.e. oxygen starvation of tissues.

According to WHO, anemia is diagnosed at:

• hemoglobin concentration less than 130 g / l in men and women after menopause,

• hemoglobin concentration less than 120 g / l in women of childbearing age,

• hemoglobin concentration less than 110 g / l in pregnant women (in the first and third trimesters) or less than 105 g / l (in the second trimester).

The following degrees of severity of anemia are distinguished:

• mild grade (I˚) – Hb 120–95 g / l,

• medium degree (II˚) – Hb 94-80 g / l,

• severe degree (III˚) – Hb 79-65 g / l,

• degree, life-threatening (IV˚) – Hb <65 g / l.

According to the WHO, about 1 987 300 000 people suffer from anemia.

• Iron deficiency occurs in 3,580,000,000 people.

• Anemia occurs among women more often than among men.

• Anemia – iron deficiency affects 25-40% of newborns and 25% of adolescents.

• Anemia occurs in 10% of women of childbearing age.

• In the United States, anemia affects about 11% or 3.4 million people.

• Iron deficiency is the most common anemia, followed by chronic disease anemia.

The following factors increase the risk of anemia:

• demographic (older age, adolescence, pregnancy)

• nutritional factors (consumption of foods low in iron, lack of vitamin C, excessive consumption of coffee / tea, wasting diet)

• social factors (poverty, alcohol consumption, diseases of the digestive tract, depression, etc.disease)

Anemia is caused by one of three processes in the body:

• acute or chronic bleeding (over time, causes anemia of insufficient production).

• insufficient production of red blood cells in the bone marrow.

• increased destruction of erythrocytes (hemolysis).

Signs of anemia:

• general weakness

• lack of appetite

• hair loss

• lamination of nails

• tachycardia (rapid heart rate)

• shortness of breath

• edema (swelling of the legs, arms)

• angina pectoris (heart pain)

• disorders of the central nervous system (brain):

o irritability

o chronic fatigue

o violation of attention

o memory impairment

o dizziness

o lethargy

o apathy

o depression

• visual impairment (“flies” before the eyes), damage to muscles and bones:

o general muscle weakness

o rapid muscle fatigue

o twitching in muscles

o convulsion

o intermittent claudication

o poor bone healing (in case of fracture)

• digestive disorders:

o anorexia

o retardation in height and weight (in children)

o pagophagia (eating ice)

o geophagy (eating the earth)

o bad breath

o dysphagia (difficulty in swallowing)

o atrophic glossitis (tongue lesions)

o malabsorption (violation of the processes of absorption of substances in the intestine)

o exudative enteropathy (intestinal damage)

• weakened immunity

• late puberty

• menstrual irregularities

Treatment of anemia:

• elimination of the cause, treatment of the primary disease

• preparations with iron content, better together with vitamin C

• preparations of the group of vitamin B and folic acid

• blood transfusion

• long-term treatment from 3 months.

90,000 Iron deficiency anemia in children

Iron deficiency anemia in children is a type of deficiency anemia, which is based on absolute or relative iron deficiency in the body. The prevalence of iron deficiency anemia among children in the first 3 years of life is 40%; among adolescents – 30%; among women of reproductive age – 44%. It can be stated without exaggeration that iron deficiency anemia is the most common form faced by specialists in the field of pediatrics, obstetrics and gynecology, therapy, and hematology.

During fetal development, iron is supplied to the baby from the mother through the placenta. The most enhanced transplacental iron transport occurs between the 28th and 32nd weeks of pregnancy. By the time of birth, the body of a full-term baby contains 300-400 mg of iron, a premature baby – only 100-200 mg. In a newborn, the consumption of neonatal iron occurs for the synthesis of Hb, enzymes, myoglobin, regeneration of the skin and mucous membranes, compensation for physiological losses with sweat, urine, feces, etc.e. The rapid growth and development of young children determine the increased need of the body for iron. Meanwhile, the increased consumption of iron from the depot leads to a rapid depletion of its reserves: in full-term babies by the 5-6th month of life, in premature babies by the 3rd month.

For normal development, the daily diet of a newborn should contain 1.5 mg of iron, and the diet of a child 1-3 years old should contain at least 10 mg. If the loss and consumption of iron outweighs its intake and absorption, the child develops iron deficiency anemia.Iron deficiency and iron deficiency anemia in children contributes to hypoxia of organs and tissues, a decrease in immunity, an increase in infectious diseases, and impaired neuropsychic development of a child.

Causes of iron deficiency anemia in children

Antenatal and postnatal factors may be involved in the development of iron deficiency anemia in children.

Antenatal factors include the immature iron depot in the prenatal period. In this case, iron deficiency anemia usually develops in children under the age of 1.5 years.The early development of anemia in a child can be promoted by toxicosis, anemia of a pregnant woman, infectious diseases of a woman during gestation, the threat of termination of pregnancy, placental insufficiency, placental abruption, multiple pregnancies, premature or late umbilical cord ligation in a child. The most susceptible to the development of iron deficiency anemia are children born with a large weight, premature, with lymphatic-hypoplastic diathesis.

Postnatal iron deficiency anemia in children is associated with factors that act after childbirth, primarily, insufficient intake of iron from food.At risk for the development of iron deficiency anemia are children receiving artificial feeding with unadapted milk formulas, goat or cow’s milk. The nutritional causes of iron deficiency anemia in children also include the late introduction of complementary foods, the absence of animal protein in the diet, and unbalanced and irrational nutrition of a child at any age.

External and internal bleeding (gastrointestinal, into the abdominal cavity, pulmonary, nasal, traumatic), heavy menstruation in girls, etc., can lead to iron deficiency anemia in children.Iron deficiency accompanies diseases involving impaired absorption of trace elements in the intestine: Crohn’s disease, ulcerative colitis, Hirschsprung’s disease, enteritis, intestinal dysbiosis, cystic fibrosis, lactase deficiency, celiac disease, intestinal infections, giardiasis, etc.

Excessive iron loss is observed in children suffering from allergic skin manifestations and frequent infections. In addition, the cause of iron deficiency anemia in children may be impaired iron transport due to a decrease in the content and insufficient activity of transferrin in the body.

Symptoms of iron deficiency anemia in children

The clinic of iron deficiency anemia in a child is nonspecific and can occur with a predominance of asthenic-vegetative, epithelial, dyspeptic, cardiovascular, immunodeficiency, hepatolienal syndrome.

Astheno-vegetative manifestations in children with iron deficiency anemia are caused by hypoxia of organs and tissues, including the brain. In this case, muscle hypotension, a child’s lag in physical and psychomotor development (in severe cases, intellectual disability), tearfulness, irritability, vegetative-vascular dystonia, dizziness, orthostatic collapses, fainting, enuresis may be noted.

Epithelial syndrome in children with iron deficiency anemia is accompanied by changes in the skin and its appendages: dry skin, hyperkeratosis of the skin of the elbows and knees, cracks in the oral mucosa (angular stomatitis), glossitis, cheilitis, dullness and active hair loss, fragility and striation nails.

Dyspeptic symptoms in children with iron deficiency anemia include decreased appetite, anorexia, dysphagia, constipation, flatulence, diarrhea. Characterized by a change in smell (addiction to sharp smells of gasoline, varnishes, paints) and taste (desire to eat chalk, earth, etc.)). The defeat of the gastrointestinal tract leads to a violation of the process of iron absorption, which further aggravates iron deficiency anemia in children.

Changes in the cardiovascular system occur in severe iron deficiency anemia in children and are characterized by tachycardia, shortness of breath, arterial hypotension, heart murmurs, myocardial dystrophy. Immunodeficiency syndrome is characterized by prolonged unmotivated low-grade fever, frequent acute respiratory infections and acute respiratory viral infections, severe and protracted infections.

Hepatolienal syndrome (hepatosplenomegaly) commonly occurs in children with severe iron deficiency anemia, rickets, and anemia.

Diagnosis of iron deficiency anemia in children

Various specialists are involved in the diagnosis of iron deficiency anemia and its causes in children: neonatologist, pediatrician, hematologist, pediatric gastroenterologist, pediatric gynecologist, etc. cyanosis, dark circles under the eyes.

The most important laboratory criteria for judging the presence and degree of iron deficiency anemia in children are: Hb (63), serum ferritin (

Bone marrow puncture may be required to establish the factors and causes associated with iron deficiency anemia in children; FGDS, colonoscopy; Ultrasound of the abdominal organs, ultrasound of the pelvic organs; X-ray of the stomach, irrigoscopy, examination of feces for dysbiosis, occult blood, helminth eggs and protozoa.

Treatment of iron deficiency anemia in children

The basic principles of treatment of iron deficiency anemia in children include: elimination of the causes of iron deficiency, correction of the regimen and diet, the appointment of iron supplements.

The diet of children suffering from iron deficiency anemia should be enriched with foods rich in iron: liver, veal, beef, fish, egg yolk, legumes, buckwheat, oatmeal, spinach, peaches, apples, etc.

Elimination of iron deficiency in the child’s body is achieved by taking iron-containing drugs.It is convenient for young children to prescribe iron preparations in the form of liquid dosage forms (drops, syrups, suspensions). Iron preparations should be taken 1-2 hours before meals, washed down with water or juices. In the complex therapy of iron deficiency anemia in children, it is necessary to include vitamin and mineral complexes, adaptogens, herbal preparations, homeopathic preparations (as prescribed by a child homeopath).

For severe iron deficiency anemia, children undergo parenteral administration of iron preparations, transfusion of erythrocyte mass.

The main course of treatment for iron deficiency anemia in children is usually 4-6 weeks, maintenance – another 2-3 months. Simultaneously with the elimination of iron deficiency, it is necessary to treat the underlying disease.

Prediction and prevention of iron deficiency anemia in children

Adequate treatment and elimination of the causes of iron deficiency anemia in children leads to the normalization of peripheral blood counts and the complete recovery of the child. Children with chronic iron deficiency have a lag in physical and mental development, frequent infectious and somatic morbidity.

Antenatal prophylaxis of iron deficiency anemia in children consists in taking ferro-drugs or multivitamins to a pregnant woman, preventing and treating pregnancy pathologies, rational nutrition and a mother-to-be regimen. Postnatal prevention of iron deficiency anemia in children provides for breastfeeding, timely introduction of the necessary complementary foods, organization of proper care and regimen of the child. Preventive use of iron preparations is indicated for premature babies, twins, children with constitutional abnormalities, children in periods of rapid growth, puberty, adolescent girls with heavy menstruation.
Source: http://www.krasotaimedicina.ru/diseases/children/iron-deficiency-anemia

On the relationship of chronic obstructive pulmonary disease and anemia | Zhusina

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90,000 Anemia: Causes, Symptoms, Diagnosis and Treatment

Anemia is a pathological condition of the body, which is characterized by a decrease in the number of red blood cells and hemoglobin in a blood unit.More often, anemia is a symptom of a disease. People of different ages and gender face this condition.

Anemia is defined as a decrease in hemoglobin to below 110 g / l – in children 6 months – 6 years old, below 120 g / l – in children 6-14 years old, below 120 – in adult women, below 130 – in adult men.

Causes of disease

One of the most common causes of anemia is a lack of folic acid, iron or vitamin B12. Also, anemia develops due to heavy bleeding during menstruation or against the background of certain cancers.Often, anemia is manifested due to the lack of substances that are responsible for the production of hemoglobin, as well as disruptions in the formation of red blood cells. Inherited diseases and exposure to toxic substances can also cause anemia.

Depending on the causes of the onset of the disease, it is customary to divide all anemias into three types:

• posthemorrhagic,
• hemolytic,
• associated with impaired blood formation (deficient and hypoplastic).

Post-hemorrhagic anemias are associated with acute or chronic blood loss (bleeding, injury).

Hemolytic – develop due to increased destruction of red blood cells.

Deficiency anemias are caused by a lack of vitamins, iron or other trace elements that are necessary for blood formation.

Hypoplastic anemia is the most severe type of anemia and is associated with impaired blood formation in the bone marrow.

Symptoms

Anemia is manifested by dizziness, tinnitus, flashing of flies before the eyes, shortness of breath, palpitations.Dry skin, pallor are noted, ulceration and cracks appear in the corners of the mouth.

Typical manifestations are fragility and stratification of nails, their transverse striation. The nails become flat, sometimes taking a concave spoon-like shape.

Some patients note a burning sensation of the tongue. Perhaps a perversion of taste in the form of an indomitable desire to eat chalk, toothpaste, ash and the like, as well as an addiction to certain odors (acetone, gasoline).

In the early stages, anemia may not have pronounced manifestations; in this case, the diagnosis is made after special diagnostic measures.

Diagnostics

Blood tests, including blood counts, are required to make a diagnosis. A family history of the disease should also be compiled. When there are only mild manifestations of anemia, a radioactive chromium test can be done to determine the life span of blood cells, which is shortened by illness.

Other special tests may be needed to check for abnormalities in the red blood cell membrane, enzymes, or hemoglobin.Sometimes a bone marrow sample can be taken to determine what causes hemolytic anemia.

Treatment

A mild stage of anemia often does not require medication. It is recommended to consume more foods that contain iron, proteins and other vitamins and minerals, more often to be in the fresh air.

Drug therapy is prescribed by a doctor only when the type of anemia, cause and severity are clear. Not infrequently, anemia does not require medical correction, especially when the cause, against which the anemia appeared, has been eliminated.

If, nevertheless, the disease requires drug treatment, then the doctor prescribes drugs that will allow the bone marrow to quickly replenish the deficiency of red blood cells and hemoglobin in the blood.

In more severe cases, when iron preparations do not give a positive result, a hematologist may prescribe glucocorticoid hormones, erythropoietins, anabolic steroids, chemotherapeutic agents and other drugs that are treated in a hospital. Any type of drug therapy should be combined with a healthy diet and lifestyle.The patient needs to give up smoking, alcohol intake.

90,000 6 symptoms of iron deficiency anemia that are dangerous to ignore

What is anemia

Anemia is often confused with iron deficiency, and iron itself – with hemoglobin, but these are all different concepts. If the doctor wrote down “anemia” in the medical record, it means that the patient either lacks red blood cells (erythrocytes), or there is not enough hemoglobin protein inside these cells. Hemoglobin takes oxygen from the lungs and, together with red blood cells, carries it to the rest of the organs.With anemia, less oxygen is supplied to the tissues of the body than is needed for its normal functioning.

Iron is required for the production of hemoglobin. Iron deficiency on its own can be ^{enough to feel overwhelmed and constantly tired, but this is not anemia yet. When iron is so little that it affects to lower hemoglobin levels, then the condition can be called iron deficiency anemia. In addition, not all iron deficiency anemia – there are different types and causes of its occurrence.}

Why Iron Is Not Enough

Illustration: Vifor Pharma

We get iron from food, such as meat, seafood, beans and spinach. If there are few iron-containing foods in the diet, then the microelement will also be lacking in the body. Because of this, anemia often occurs in children. In the first 4 months of life, when the baby feeds on breast milk, ^{of all the necessary nutrients are received. But then the iron in the mother’s milk may not be enough. Vegetarians are also at risk: they get iron only from plant foods, and it is absorbed worse than .}

Basically, iron deficiency anemia occurs ^{due to bleeding, as well as in diseases that prevent iron from being absorbed normally in the intestine. Women tend to lose a lot of blood during childbirth or due to heavy periods. Patients with stomach ulcers or chronic bowel diseases also experience bleeding, and this is not always obvious. In some inflammatory diseases of the gastrointestinal tract, iron is simply not absorbed, even if the body gets enough of it from food.}

Iron deficiency anemia is easy to overlook: not everyone has symptoms and may not even be noticed at first. Blood donors, for example, often find out about low hemoglobin levels only when they are examined by a doctor before the next donation. But if the disease progresses, the symptoms become more pronounced. And without treatment, ^{anemia can lead to serious complications of the course of existing diseases or the development of new ones (cardiovascular, endocrine, respiratory, and so on), increasing the risk of adverse and fatal outcomes.}

Symptoms to look out for

1. Feeling tired

Coming home after work with a desire to drink tea and go to bed as soon as possible is normal. We are all tired. To maintain vigor, healthy people need to sleep well, eat a balanced diet and exercise. But if, after getting enough sleep, you wake up exhausted, feel sluggish and overwhelmed even after completing simple daily tasks, you may have chronic fatigue syndrome.Anemia is the first thing a doctor can suspect in such a situation.

Illustration: Vifor Pharma

2. Pallor

Our blood is red because of hemoglobin, which is just not enough in iron deficiency anemia. And then the skin turns pale, and the lips change their shade to bluish. Sometimes with iron deficiency anemia, the skin and eyes look painful yellow, although more often this is a sign of another type of disease – hemolytic anemia, in which red blood cells are destroyed ^{faster than new ones can appear.}

Pale skin and fatigue are the first signs of anemia. They may well appear ^{, even if the anemia has not yet had time to turn into a severe form.}

3. Shortness of breath

The longer the anemia develops, the more likely you will notice that it has become more difficult to play sports: the level of exertion has not changed, but you have to take rest breaks more often, and it becomes harder to breathe. If earlier it was not a problem to climb the stairs, now there is not enough oxygen, and it also happens that shortness of breath appears even from minor physical exertion.

Together with shortness of breath, symptoms develop from the heart: it beats unevenly or very often. You cannot saturate the whole body with oxygen-poor blood, so the heart has to work harder ^{, pumping it more and more.}

Illustration: Vifor Pharma

4. Desire to chew on ice

When the body lacks iron or other trace elements, it can behave strangely. For example, there is ^{a strong urge to gnaw ice, although it has no nutritional value at all.Why this happens is unknown to science . One study, , showed that anemic patients performed better on attention problems after chewing on ice. Ice helps someone to cheer up, like after a cup of coffee. This is probably how the body copes with the decline in productivity, which leads to anemia, but there is no reliable confirmation of this yet. With anemia, not only ice can become the object of desire, but also other inedible things, such as paint, starch or even sand.}

5. Brittle nails

Changes in the color, strength or shape of nails may indicate iron deficiency. Especially if the nails are slightly bent ^{in the center and rise along the edges (like a spoon).}

6. Restless legs syndrome

Restless legs syndrome is such uncomfortable sensations in the legs that ^{an irresistible desire to move or change position arises. The sensations themselves are described in different ways: it can be itching, aching, throbbing pain or what we call “frost on the skin.”The syndrome intensifies, as a rule, in the evenings and at night, which greatly affects the quality of life: sleep is disturbed, it is impossible to properly rest, because the discomfort goes away only if you constantly touch your legs.}

I have symptoms of anemia. What to do?

If you think you have anemia, see your doctor ^{. To begin with, see a therapist. He will try to understand the cause of the symptoms and only then refer you to a specialized specialist, if necessary. Iron deficiency anemia is treated by with iron preparations – they are taken in the form of tablets, drops or intravenous, when there are problems with the absorption of iron in the digestive system or the anemia is severe and you need to quickly eliminate the iron deficiency.}

This resource lists common symptoms of iron deficiency anemia, but it can manifest itself in many ways and in different ways. To learn more about iron deficiency and how to prevent, recognize, and treat anemia, visit Vifor Pharma’s Iron Deficiency.net website.

Learn

Ferritin

First, let’s understand the very concept of “ferritin”.

Ferritin is a complex protein complex that plays the role of the main intracellular iron depot.You can call it a kind of safe, where iron is collected and stored, which will be provided to the body in an emergency. It is ferritin that shows whether you have a predisposition to anemia, and not hemoglobin, as many think.

Typically, a ferritin reference value ranges from 5 μg / L to 148 μg / L. But how do you know which ferritin test value is your norm?

Remember, there is no perfect ferritin number. This is an INDIVIDUAL figure.

Low ferritin – a value of 5, 6, 7 – is an indicator at which you can live, but you don’t really want to: dizziness, headaches, low efficiency, constant fatigue – these figures accompany.

The lower limit of the value is an indicator of your weight.

The upper limit of ferritin, when we say that this is not a pathology, is 300 μg / l.

The individual ferritin level is calculated using the formula: your weight (kg) + 70 μg / l.

For example, a girl weighing 60 kg has an individual ferritin index of 130 μg / l.

We do not diagnose iron deficiency anemia by hemoglobin, it is necessary to see the value of ferritin, because this is the first and earliest indicator of a sign of iron deficiency. And it is desirable to know the indicators of erythrocytes, transferrin, transferrin saturation coefficient, TIBC, serum iron, color index, MCV, MCH.

It is wrong to base conclusions on iron deficiency anemia by looking at hemoglobin alone.Ferritin stores iron to prevent anemia in any emergency. If hemoglobin drops from 120, and ferritin is at – 6, anemia will not keep you waiting.

Think about iron stores for a “rainy” day now, then a drop in hemoglobin will not be accompanied by fatigue, low efficiency, and other unpleasant effects of anemia. After all, ferritin will come to the rescue.

Get tested, take into account all the factors and be healthy!

Iron deficiency anemia of nursing mothers

About 700 million people suffer from it.people all over the world. This is the most common form (80% of all) of anemia. 20-50% of women of childbearing age, 90% of women acquire anemia by the end of pregnancy.

Anemia means:

1. Your erythrocyte count is below normal 3.8-3.6 x 106g / l
2. Your hemoglobin level is below normal -115-110 g / l, that is, the amount of oxygen carried by the blood to the tissues is reduced.

Signs of anemia in your body (syndromes):

1. General anemic:
   Shortness of breath, tachycardia, fainting, weakness, pallor of the skin and mucous membranes.
2. Sideropenic (low iron): dry skin, premature wrinkles; brittle nails and hair, flat spoon-shaped nails, seizures in the corners of the mouth, inflammation of the red border of the lips, decreased immunity, frequent infections, chronic infections, muscle weakness (frequent urge to urinate, urinary incontinence when laughing, coughing, straining), taste perversion (desire there is chalk, lime, ice, paper), addiction to odors – substance abuse, morning swelling of the face above and under the eyes, pasty legs due to increased permeability of small vessels.

The physiological absorption of iron from food is limited. The diet of women is 2000-2500 kcal, ie. 12-15 mg of iron, of which 1-1.3 mg is absorbed, but with increased needs of the body for iron, a maximum of 2 mg can be absorbed from food. The daily requirement for iron in women during pregnancy and lactation often increases to 3.5 mg.

Preventive nutrition for anemia

Nutrition should be complete. Meat products are especially useful: 6% of iron is absorbed from meat, 2 times less from eggs, fish, and only 0.2% from plant foods. The diet should contain 120-200 g of meat or 125-250 g of fish per day, 1 egg, up to 1 kg.