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Anemia diarrhea. Understanding Anemia: Symptoms, Types, and Treatment Options

by alexxlab

What are the common symptoms of anemia. How can different types of anemia be identified. What treatment options are available for various forms of anemia. How does anemia impact daily life and overall health. Why is early detection and proper management of anemia crucial.

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The Basics of Anemia: An Overview

Anemia is a condition characterized by a lack of healthy red blood cells to carry adequate oxygen to the body’s tissues. It can occur due to various reasons, ranging from nutritional deficiencies to chronic diseases. Understanding the nuances of this condition is crucial for early detection and proper management.

How does anemia affect the body? At its core, anemia results in insufficient oxygen supply to organs and tissues, leading to a range of symptoms that can significantly impact daily life. The severity of these symptoms often correlates with the degree of anemia, with mild cases sometimes going unnoticed while severe cases can be debilitating.

Common Symptoms Across Different Types of Anemia

While anemia can manifest in various forms, several symptoms are common across most types:

  • Fatigue and weakness
  • Dizziness, especially when standing up quickly
  • Shortness of breath
  • Headaches
  • Cold hands and feet
  • Pale skin, particularly noticeable in the gums and nail beds
  • Chest pain
  • Irregular heartbeat (arrhythmia)

Why is fatigue the most prevalent symptom of anemia? Fatigue occurs because the body’s cells are not receiving sufficient oxygen to function optimally. This lack of cellular energy can leave individuals feeling exhausted and unable to perform daily activities with their usual vigor.

Differentiating Between Various Types of Anemia

While some symptoms are universal, certain types of anemia present with unique characteristics that can aid in diagnosis:

Aplastic Anemia

This rare but serious condition occurs when the body stops producing enough new blood cells. Distinctive symptoms include:

  • Nausea
  • Skin rashes
  • Increased susceptibility to infections

Fanconi Anemia

An inherited disorder affecting bone marrow function, Fanconi anemia can lead to:

  • Delayed physical development
  • Learning difficulties
  • Birth defects

Folic Acid Deficiency Anemia

Caused by insufficient folic acid (vitamin B9) in the diet, this type of anemia may present with:

  • Irritability
  • Diarrhea
  • A smooth tongue

Hemolytic Anemia

In this condition, red blood cells are destroyed faster than they can be replaced. Unique symptoms include:

  • Jaundice (yellowing of the skin and eyes)
  • Leg ulcers
  • Abdominal pain

Iron Deficiency Anemia: The Most Common Type

Iron deficiency anemia is the most prevalent form of anemia worldwide. How does it differ from other types? This condition arises when the body lacks sufficient iron to produce hemoglobin, the protein in red blood cells that carries oxygen.

Distinct symptoms of iron deficiency anemia include:

  • Unusual cravings for non-food items (pica), such as ice or dirt
  • Brittle nails
  • Swollen or sore tongue
  • Angular cheilitis (cracks at the corners of the mouth)
  • Increased susceptibility to infections

Why do some people with iron deficiency anemia develop pica? While the exact mechanism is not fully understood, it’s believed that the body may attempt to compensate for the lack of iron by craving substances that might contain traces of this essential mineral.

Pernicious Anemia: When Vitamin B12 is the Culprit

Pernicious anemia occurs due to a lack of vitamin B12 or the inability to absorb it properly. This type of anemia can lead to neurological complications if left untreated.

Unique symptoms of pernicious anemia include:

  • Nerve damage
  • Confusion and memory problems
  • Depression
  • Gastrointestinal issues like nausea and heartburn
  • Weight loss
  • A smooth, beefy red tongue

How does vitamin B12 deficiency affect the nervous system? Vitamin B12 plays a crucial role in maintaining the myelin sheath that surrounds and protects nerves. Without adequate B12, this protective layer can degrade, leading to various neurological symptoms.

Sickle Cell Anemia: A Genetic Blood Disorder

Sickle cell anemia is an inherited condition where red blood cells are abnormally shaped, leading to various complications.

Distinctive features of sickle cell anemia include:

  • Sudden, severe pain episodes (sickle cell crises)
  • Swelling in hands and feet
  • Increased risk of infections
  • Vision problems
  • Delayed growth in children

Why do sickle cell crises occur? These painful episodes happen when the abnormally shaped red blood cells cluster together, blocking small blood vessels and restricting blood flow to various parts of the body.

Diagnosis and Treatment: Navigating the Path to Recovery

Diagnosing anemia typically involves a combination of physical examination, medical history review, and blood tests. The specific type of anemia will determine the most appropriate treatment approach.

Common treatments for anemia include:

  1. Dietary changes to increase iron, folate, or vitamin B12 intake
  2. Nutritional supplements
  3. Medications to stimulate red blood cell production
  4. Blood transfusions in severe cases
  5. Treatment of underlying conditions causing anemia

How effective are iron supplements in treating iron deficiency anemia? For most people with iron deficiency anemia, oral iron supplements can effectively restore iron levels within 2-3 months. However, it’s crucial to address the underlying cause of iron deficiency to prevent recurrence.

Living with Anemia: Strategies for Management and Prevention

While anemia can be challenging, many individuals lead fulfilling lives with proper management. Key strategies include:

  • Following a balanced diet rich in iron, folate, and vitamin B12
  • Regular exercise to improve cardiovascular health
  • Adequate rest and stress management
  • Consistent medical follow-ups
  • Avoiding substances that can interfere with iron absorption, such as tea or coffee, when taking iron supplements

How can dietary choices impact anemia management? A well-planned diet can significantly support anemia treatment. For instance, consuming vitamin C-rich foods alongside iron-rich meals can enhance iron absorption, while avoiding calcium-rich foods during iron supplement intake can prevent absorption interference.

The Role of Exercise in Anemia Management

While it might seem counterintuitive, moderate exercise can be beneficial for individuals with anemia. How does exercise help? Regular physical activity can stimulate red blood cell production, improve cardiovascular health, and enhance overall well-being. However, it’s crucial to consult with a healthcare provider to determine an appropriate exercise regimen based on the severity of anemia and overall health status.

Emotional and Psychological Aspects of Living with Anemia

The chronic nature of some types of anemia can take a toll on mental health. Many individuals with anemia report feelings of frustration, anxiety, or depression related to their condition. How can these psychological challenges be addressed? Strategies may include:

  • Joining support groups or online communities
  • Practicing mindfulness and relaxation techniques
  • Seeking professional counseling when needed
  • Educating friends and family about the condition to foster understanding and support

Anemia in Special Populations: Pregnancy, Elderly, and Chronic Diseases

Certain groups are at higher risk for developing anemia or experiencing more severe complications from the condition. Understanding these special considerations is crucial for effective management.

Anemia During Pregnancy

Pregnancy increases the body’s demand for iron and folate, making pregnant women more susceptible to anemia. How does anemia affect pregnancy outcomes? Untreated anemia during pregnancy can lead to complications such as:

  • Preterm birth
  • Low birth weight
  • Increased risk of postpartum depression
  • Delayed fetal development

Regular prenatal check-ups and appropriate supplementation are crucial for preventing and managing anemia during pregnancy.

Anemia in the Elderly

Older adults are at increased risk of developing anemia due to various factors, including chronic diseases, nutritional deficiencies, and medication side effects. How does anemia impact the quality of life in the elderly? Anemia in older adults can lead to:

  • Increased risk of falls and fractures
  • Cognitive decline
  • Reduced physical function and independence
  • Higher hospitalization rates

Regular health screenings and addressing underlying causes are essential in managing anemia in the elderly population.

Anemia in Chronic Diseases

Certain chronic conditions, such as kidney disease, cancer, and inflammatory bowel diseases, can increase the risk of anemia. How does chronic disease-related anemia differ from other types? This form of anemia often results from complex interactions between the disease process, inflammation, and treatment effects. Management typically involves treating the underlying condition alongside anemia-specific interventions.

Emerging Research and Future Directions in Anemia Treatment

The field of anemia research is continually evolving, with new treatments and management strategies on the horizon. What are some promising areas of research?

  • Gene therapy for inherited anemias like sickle cell disease
  • Novel iron formulations for improved absorption and reduced side effects
  • Targeted therapies for specific types of anemia
  • Advanced diagnostic tools for early detection and precise classification of anemia

How might these advancements impact anemia treatment in the future? As research progresses, we may see more personalized treatment approaches, improved quality of life for individuals with chronic anemia, and potentially curative therapies for certain inherited forms of the condition.

The Role of Artificial Intelligence in Anemia Management

Artificial intelligence (AI) is increasingly being explored as a tool to enhance anemia diagnosis and management. How can AI contribute to anemia care? Potential applications include:

  • Automated analysis of blood smears for faster and more accurate diagnosis
  • Predictive models to identify individuals at high risk of developing anemia
  • Personalized treatment recommendations based on individual patient data
  • Remote monitoring of anemia patients through wearable devices and AI-powered analysis

Global Health Perspectives: Anemia as a Public Health Challenge

Anemia remains a significant public health issue, particularly in developing countries. How does anemia impact global health? The World Health Organization estimates that anemia affects about 1.62 billion people globally, with iron deficiency being the primary cause.

What strategies are being implemented to combat anemia on a global scale?

  • Food fortification programs to increase iron intake at a population level
  • Public health campaigns to raise awareness about anemia and its prevention
  • Integration of anemia screening and treatment into existing health programs
  • Efforts to improve sanitation and reduce parasitic infections that can contribute to anemia

How effective are these public health interventions? While progress has been made, challenges remain in reaching vulnerable populations and addressing the multifaceted causes of anemia in different regions.

The Economic Impact of Anemia

Beyond its health implications, anemia can have significant economic consequences. How does anemia affect productivity and economic growth? Studies have shown that anemia can lead to:

  • Reduced work capacity and productivity
  • Increased healthcare costs
  • Lost educational opportunities due to cognitive impairment in children
  • Decreased overall quality of life, impacting social and economic participation

Addressing anemia not only improves individual health outcomes but can also contribute to broader economic development, particularly in regions with a high prevalence of the condition.

Empowering Patients: Education and Self-Management in Anemia Care

Patient education plays a crucial role in the effective management of anemia. How can individuals with anemia take an active role in their care? Key aspects of self-management include:

  • Understanding the specific type of anemia and its causes
  • Adhering to prescribed treatments and follow-up appointments
  • Monitoring symptoms and reporting changes to healthcare providers
  • Making informed lifestyle choices to support overall health
  • Staying informed about new developments in anemia research and treatment

What resources are available for patients seeking to learn more about their condition? Many hospitals, clinics, and patient advocacy organizations offer educational materials, support groups, and online resources tailored to different types of anemia.

The Role of Telemedicine in Anemia Care

Telemedicine has emerged as a valuable tool in managing chronic conditions like anemia. How can telemedicine benefit anemia patients? Potential advantages include:

  • Improved access to specialists, particularly for patients in rural areas
  • More frequent check-ins without the need for in-person visits
  • Remote monitoring of symptoms and treatment response
  • Easier coordination of care among different healthcare providers

While telemedicine cannot replace all in-person care, it offers a complementary approach that can enhance the overall management of anemia, particularly for patients with stable conditions or those facing barriers to frequent clinic visits.

In conclusion, anemia is a complex condition with wide-ranging impacts on health and quality of life. By understanding its various forms, recognizing symptoms early, and engaging in proactive management, individuals with anemia can lead fulfilling lives. As research continues to advance, we can look forward to more effective treatments and improved outcomes for those affected by this common blood disorder.

A Guide to Anemia Symptoms

There are many different types of anemia with many different causes. A handful of symptoms are shared by nearly all types of anemia, whether you have iron deficiency anemia or Fanconi anemia.

And each type of anemia shares a basic end effect: Your body does not have enough oxygen-bearing red blood cells for its needs.

How severe or frequent your symptoms are relates to how severe your anemia is. People who have mild anemia, from a mild iron deficiency, for instance, may not have any symptoms at all, while people with severe anemia can have much more noticeable and longer lasting symptoms.

Anemia symptoms include:

  • Fatigue. This is by far the most common anemia symptom. You may feel very tired or weak and unable to summon the energy for most daily activities.
  • Dizziness. Dizziness is most likely to occur when you stand up from a sitting or resting position.
  • Shortness of breath
  • Headaches
  • Cold skin, especially the hands and feet
  • Paleness. Your gums and the base of your nails may be especially pale.
  • Chest pain. Without enough oxygen-rich red blood cells, your heart has to work much harder to keep your body supplied with the nutrients it requires. You may feel pain and tightness in your chest when your heart muscle is not getting the oxygen it needs.
  • Arrhythmia. Also known as dysrhythmia or an abnormal heart rhythm, an uneven or altered rate or pattern of heartbeats can also result from your heart working harder to circulate blood.

If the condition is severe enough, these symptoms are found to some degree in every type of anemia.

Differentiating Anemia Symptoms

There are many different types of anemia, some with symptoms that set them apart:

  • Aplastic anemia. Nausea and skin rashes are known signs of this type of anemia, which occurs when the bone marrow stops making enough red blood cells.
  • Fanconi anemia. This is a rare inherited disorder that prevents your bone marrow from making all three needed types of blood cells and results in delayed development in a multitude of areas, from learning abilities to physical growth.
  • Folic acid deficiency anemia. Not having enough folic acid — one of the B vitamins, also known as folate — in your diet may lead to this type of anemia. Symptoms unique to this anemia include irritability, diarrhea, and a smooth tongue.
  • Hemolytic anemia. Jaundice, leg ulcers, and abdominal pain are hallmarks of this type of anemia, in which red blood cells are prematurely destroyed within the body. The excess hemoglobin released by this destructive process causes many of the symptoms.
  • Iron deficiency anemia. This type of anemia is due to a lack of iron in your diet or chronic blood loss. Iron deficiency anemia can be identified through symptoms that include unusual cravings (such as ice or dirt), brittle nails, a swollen or sore tongue, tiny cracks on the sides of your mouth, and frequent infections.
  • Pernicious anemia. This type of anemia is caused by a lack of vitamin B12. Not having enough vitamin B12, or being unable to absorb it, can lead to symptoms such as nerve damage, confusion, dementia, memory loss, depression, nausea, heartburn, weight loss, and a smooth, beefy red tongue.
  • Sickle cell anemia. Sudden pain throughout the body is a hallmark of this type of anemia, which occurs because the body makes red blood cells shaped like sickles (or a “C” shape) instead of smooth disc shapes. These abnormally shaped cells can clump together, blocking blood flow in many organs and causing painful sickle cell crises. Swelling in the hands and feet and damage to the spleen are also symptoms of this type of anemia.

Symptoms of anemia cover a wide range, depending on the cause of the anemia and the severity of the condition. However, there are a few symptoms, especially tiredness, that occur with all types of anemia. If you suspect you have anemia, talk to your doctor about your options.

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Anemia and diseases of the gastrointestinal tract

AAG – autoimmune atrophic gastritis

AD – gluten-free diet

HZ – gluten sensitive celiac disease

IDA – iron deficiency anemia

Gastrointestinal tract

PPI – proton pump inhibitor

CO – mucous membrane

Anemia is a clinical and hematological syndrome characterized by a decrease below the norm in the concentration of hemoglobin and / or erythrocytes per unit volume of blood.

The development of anemia may be due to a deficiency of iron in the body (iron deficiency) or vitamin B 12 and folic acid (megaloblastic). Anemia can be formed due to increased destruction of erythrocytes (hemolytic) or impaired erythropoiesis (aplastic) [1]. The most common anemia is due to iron deficiency (about 90% of all anemias). The causes of iron deficiency are as follows [2]:

– reduced intake from food;

– violation of the absorption of the microelement;

– increased bleeding loss;

– increased consumption of iron (for example, during pregnancy).

The gastrointestinal tract (GIT) is an organ directly associated with the formation of deficiency anemia. According to K.K. Noskovy et al. [3], when assessing the prevalence of anemia among patients undergoing examination and treatment in a specialized gastroenterological hospital, the incidence of anemic syndrome was 8.25–9.02%. Among all the causes of iron deficiency in the body in men and postmenopausal women, the most common is loss during bleeding from the gastrointestinal tract. The most important sources of blood loss from the gastrointestinal tract include the following [1]:

– peptic ulcers;

– damage to the mucous membrane (SO) against the background of taking non-steroidal anti-inflammatory drugs;

– malignant tumors;

– nonspecific ulcerative colitis;

– hemorrhoids;

– diaphragmatic hernia;

– diverticulosis.

Of course, when searching for the cause of anemia, it is first necessary to exclude diseases that create conditions for blood loss, however, iron deficiency, like vitamin B 12 , may be due to a violation of their absorption. Iron absorption is carried out in the duodenum and in the initial part of the jejunum and goes through the following stages: capture by CO cells (villi) of the small intestine of ferrous iron and its oxidation to trivalent in the microvilli membrane; the transfer of iron to its own shell, where it is captured by transferrin and quickly passes into the plasma.

Absorption of vitamin B 12 occurs in the ileum with the help of highly specific receptors located on the membrane of the villi of enterocytes, then endocytosis and intracellular binding of vitamin B 12 to transcobalamin II occur [4].

In this regard, the cause of the development of iron and vitamin B 12 -deficiency anemia may be the pathology of the small intestine. The most common disease of this organ is gluten-sensitive celiac disease (gluten enteropathy, “gluten-sensitive celiac disease”, GC). In patients with iron deficiency anemia (IDA) of unknown etiology or refractory to treatment, celiac disease occurs quite often. Studies by Israeli scientists show that in patients with unexplained IDA, celiac disease is diagnosed in 4-6% of cases [2]. Iranian doctors confirmed HC in 10% of patients with IDA [5], while S. Fayed et al. when examining 25 patients with treatment-refractory IDA, HC was found in 44% [6].

HC is an immune-dependent inflammation characterized by the development of atrophy of the small intestine mucosa in individuals with a genetically determined hypersensitivity to the vegetable protein gluten.

Gluten in the composition of gliadin and other proteins of cereals (wheat, rye, barley) penetrates the epithelial intestinal barrier, reaches the cells presenting the antigen, and activates them. In response, antibodies are formed to gliadin, tissue transglutaminase, endomysium; there is a synthesis of pro-inflammatory cytokines, in particular interleukin-15, which activates intraepithelial lymphocytes, leading to the destruction of the intestinal epithelium. Intraepithelial lymphocytes are a heterogeneous population of T cells, composed primarily of cytotoxic CD8 lymphocytes, whose main role is to maintain the integrity of the small intestinal mucosal epithelium by eliminating damaged cells and promoting the formation of new ones. Dysregulation of the activation of intraepithelial lymphocytes plays a key role in the death of the intestinal epithelium and the development of villous atrophy [7]. The association of the disease with class II histocompatibility genes HLA DQ2 and DQ8 has been proven [8]. As a result of immune inflammation, the villi are shortened and the SO crypts are significantly lengthened, the epithelium is flattened, and is abundantly infiltrated by intraepithelial lymphocytes. The lamina propria showed lymphoplasmacytic infiltration. From the toxic effects of gluten, the duodenum and proximal jejunum are most affected. It is in these departments that iron is absorbed [9].

In adults, the clinical picture of HC most often consists of symptoms of IDA, malaise, increased fatigue. The severity of anemia depends on the severity of damage to the intestinal epithelium. Diarrhea is noted, more often episodic or nocturnal. Most patients have no gastrointestinal symptoms [10]. Perhaps the formation of osteoporosis due to deficiency of vitamin D and calcium, coagulopathy with the development of vitamin K deficiency. The clinical picture may include dermatitis herpetiformis, liver steatosis, infertility and miscarriage, mental and neurological disorders. Latent forms occur 6–7 times more often than with clinical manifestations [11].

Diagnosis is based on the detection of antibodies to gliadin (sensitivity of the method is 75-90%, specificity – 82-95%), endomysium (sensitivity 85-98%, specificity 97-100%), tissue transglutaminase (sensitivity 93%, specificity 99% ). Genetic testing can only exclude Hcy (HLA DQ2/DQ8). Duodenal biopsy and morphological examination of the mucosa of the distal part of the duodenum remains the “gold standard” for diagnosing HC [5, 12, 13].

The basis of the treatment of the disease is a gluten-free diet (AD). The most dangerous cereals are wheat, rye, barley. Safe foods include rice, potatoes, soybeans, corn, buckwheat, and millet. The effect of AD is assessed after 1-6 months. Nutrient deficiency is corrected: enzyme preparations, preparations of vitamins A, B, D, E, K, PP, folic acid, iron. However, anemia can gradually disappear only if blood pressure is observed. F. Zamani et al. demonstrated an increase in mean hemoglobin levels from 9.9±1.6 to 12.8±1.0 g/dl (p<0.01) in patients with HC after 6 months of blood pressure compliance without receiving iron supplements [10].

Current research is focused on finding new options for the treatment of HC. Attempts are being made to reduce the immunogenicity of gluten-containing grains, to create enzymes that break down gluten, to inhibit the binding of gluten to antigen-presenting cells, and to limit T-cell migration in the small intestine [14]. However, this is a matter for the future.

In the absorption of iron and vitamin B 12 The stomach also plays an important role. Hydrochloric acid is necessary for the transition of ionic ferric iron to the ferrous form. Under the influence of hydrochloric acid and gastric juice proteases, vitamin B 12 is released from food, cyanocobalamin is transferred to the internal factor for further transportation. Intrinsic factor (gastric juice glycoprotein) is secreted by the parietal cells of the gastric fundus [1, 4]. In this regard, the reason for the formation of iron and vitamin B 12 – deficiency anemia can become atrophic gastritis. Atrophy is defined as the loss of the corresponding glands. There are two forms of atrophic gastritis, which are formed due to autoimmune processes, as well as under the influence of prolonged persistence of Helicobacter pylori [15].

C. Hershko and A. Ronson found autoimmune gastritis in 20-27% of patients with anemia of unknown etiology, 50% had evidence of active infection H. pylori [2].

Autoimmune atrophic gastritis (AAG) is an immune-mediated form of chronic gastritis with parietal cell reduction, hypo- or achlorhydria, and decreased cobalamin levels. It occurs much less frequently than other forms of gastritis: no more than 5% of all cases of chronic gastritis. In pathogenesis, antibodies to parietal cells, intrinsic factor, H + /K + -ATPase are formed, which leads to atrophy of CO, mainly the fundus of the stomach. There is lymphoplasmacytic infiltration of the lamina propria, pseudohypertrophy of parietal cells, hypertrophy and hyperplasia of enterochromaffin cells. In the absence of infection H. pylori no changes in CO in the antrum. AAH is a morphological diagnosis [16, 17]. Detection of antibodies to gastric parietal cells and intrinsic factor, the presence of both basal and stimulated achlorhydria, hypergastrinemia, decreased pepsinogen activity, and low serum cobalamin levels (<100 pg/mL) help in diagnosis [18].

The clinical picture shows idiopathic B 12 -deficiency anemia (pernicious, Addison-Birmer’s anemia). Possible hematological manifestation of the disease in the form of fatigue, striation and brittle nails, vitiligo, “crimson tongue”. Gastrointestinal manifestation: decreased appetite, diarrhea, development of malabsorption syndrome. Neurological manifestation: funicular myelosis. Possible asymptomatic course [19].

There is no clearly developed tactics for the treatment of patients with AAH. Rational nutrition (vegetables, fruits), smoking cessation are recommended. The management of patients with anemia associated with AAH is focused on lifelong cobalamin replacement therapy [18].

The second most common form of atrophic gastritis is associated with long-term exposure to H. pylori infection . After colonization of the stomach H. pylori chronic inflammation of the mucosal system is formed. There is an infiltration by plasma cells, the production of pro-inflammatory cytokines, the formation of specific antibodies. Through antigenic mimicry of antibody H. pylori act against the parietal cells of the stomach, resulting in the formation of atrophy mainly in its antrum [20]. Successful eradication of H. pylori significantly reduces the severity of atrophy both in the antrum and in the body of the stomach, which was proved by Japanese researchers in a long-term (for 8.6 years) observation of 118 patients with atrophic gastritis associated with H. pylori [21].

In recent years infection H. pylori is considered as a triggering factor in the development of idiopathic anemia. Microorganisms are detected in 48-50% of cases of refractory IDA [2, 6, 22]. W. Xia et al. examined adolescent girls with IDA and found H. pylori infection in 46.9%, while eradication therapy led to a faster response to treatment with iron preparations [23]. Similar results were obtained by G. Vitale et al.: eradication of H. pylori increased the level of iron and vitamin B 12 in blood serum [24]. A meta-analysis including 16 studies (956 patients) showed that eradication therapy for H. pylori infection in combination with iron preparations statistically significantly increased the level of hemoglobin by 1.48 times (p<0.00001), serum iron by 1. 15 times (p<0.00001) and ferritin 1.84 times (p<0.00001) compared with iron therapy alone. The study showed that eradication of H. pylori may be an effective treatment for anemia in patients infected with H. pylori [25]. All this allowed international experts studying H. pylori infection in 2010 to include IDA of unknown etiology as an additional indication for eradication therapy. [26]. According to the Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of H. pylori infection in adults, based on the Maastricht Agreement of the last (IV) revision, the main three-component treatment regimen includes a proton pump inhibitor (PPI) in a standard dose 2 times a day, clarithromycin 500 mg 2 times a day and amoxicillin 1000 mg 2 times a day or metronidazole 500 mg 2 times a day. To increase the effectiveness of standard three-component therapy, it is possible to increase the dose of PPI by 2 times, the duration of therapy up to 10-14 days, and the addition of a bismuth preparation. As second-line therapy, a four-component regimen can be prescribed, which includes PPI at a standard dose 2 times a day, bismuth tripotassium dicitrate 120 mg 4 times a day, tetracycline 500 mg 4 times a day and metronidazole 500 mg 3 times a day for 10 days. To overcome resistance H. pylori and improve the effectiveness of treatment, a three-component therapy with levofloxacin (PPI at a standard dose 2 times a day + levofloxacin 500 mg 2 times a day + amoxicillin 1000 mg 2 times a day for 10 days) and a sequential treatment regimen (in for 5 days PPI at a standard dose 2 times a day + amoxicillin 1000 mg 2 times a day, for the next 5 days PPI at the same dose and frequency rate + clarithromycin 500 mg 2 times a day + metronidazole 500 mg 2 times a day) [27 ].

Thus, pathology of the stomach and small intestine can play a role in the formation of iron and vitamin B 12 -deficiency anemia, leading to atrophy of the mucosa of these organs and leading to impaired absorption of nutrients. Patients with anemia of unspecified etiology or refractory to iron therapy should be evaluated for HC, autoimmune gastritis, and H. pylori infection. Recognition of the role of H. pylori , autoimmune gastritis and HC in the pathogenesis of iron and cobalamin deficiency may have significant implications in the development of a diagnostic algorithm for patients with anemia and the possibility of their successful treatment.

symptoms and signs, treatments

Anemic condition may result from iron deficiency at birth, unbalanced diet or rapid growth. In adults, anemia often occurs as a complication of diseases of internal organs and systems.

Several risk factors for the disease can be identified. For example, we are talking about a vegetarian diet that leads to vitamin B12 deficiency. Alcohol abuse can cause folic acid deficiency, which also increases the risk of anemia. Some types of pathology are hereditary in nature (for example, sickle cell anemia). In addition, the development of the disease can provoke the intake of certain medications and the presence of untreated infections.

What is anemia

As we have already noted, this pathological condition is characterized by a decrease in the level of red blood cells and / or hemoglobin in the blood. In men, anemia is considered to be a decrease in hemoglobin below 130 g / l, for women this indicator during the development of the disease is less than 120 g / l. For children – values ​​are determined taking into account age.

According to the World Health Organization, 2 billion people worldwide have been diagnosed with the disease. Anemia is much more common in women, and pathology is also quite common among children. It affects up to 30-40% of newborns and about 25% of adolescents.

Erythrocytes are produced in the bone marrow and after maturation enter the blood in a “kit” with hemoglobin molecules. Each hemoglobin molecule includes a protein and non-protein iron group. The main biological function of hemoglobin is to carry oxygen to tissues and transport carbon dioxide from tissues to the lungs. With the development of anemia, this process is disrupted, which leads to the development of hypoxia (oxygen starvation of tissues).

In most cases, anemia is not an independent disease, but only a manifestation of another pathology. Therefore, even mild forms of anemia require diagnostics to exclude recurrences of such situations.

Causes of the disease

The development of anemia in humans is often associated with impaired formation of new red blood cells and increased destruction of red blood cells. In addition, this condition may be the result of the loss of red blood cells during heavy bleeding.

The lower the hemoglobin level, the more severe the disease. The patient may face a number of serious complications and a significant deterioration in well-being. But the main danger of pathology is that it is often accompanied by more severe internal diseases.

Based on this, three main mechanisms for the development of pathology can be distinguished:

  • Violation of the formation of erythrocytes and hemoglobin synthesis.
  • The result of loss of red blood cells (most often due to bleeding).
  • Accelerated destruction of red blood cells.

The most common cause of anemia is blood loss. It may be acute or chronic. Acute bleeding is considered to be bleeding with a loss of more than 500-700 ml of blood (in an adult) in a short period of time. Such blood loss may be visible (for example, as a result of bleeding from a wound, epistaxis, or hematemesis) or hidden. The second option is more dangerous, since it cannot be noticed immediately. Hidden bleeding often occurs in the intestines or in the abdominal cavity.

Chronic bleeding is characterized by small but regular blood loss. It can be heavy menstruation in women, as well as stomach ulcers, oncological neoplasms, hemorrhoids and various intestinal lesions. Often this condition occurs after hemodialysis.

Impaired formation of red blood cells and hemoglobin synthesis is associated with the presence of a lack of iron, vitamin B12 or folic acid. Also the cause of anemia in this case may be diseases of the red bone marrow.

Iron deficiency is often the result of impaired intake, absorption or increased loss of iron in the body. In adult men, in half of the cases, this condition is caused by blood loss from the gastrointestinal tract. In women – heavy menstruation, pregnancy, lactation and recent childbirth. Particular attention should be paid to the diagnosis of iron deficiency in children, as it can be the result of a wide range of pathological processes.

If hematopoiesis is impaired, anemia can be provoked by the following reasons:

  • Damage to the bone marrow by toxins or ionizing radiation.
  • Insufficient intake or malabsorption of components necessary for the formation of new red blood cells (this is vitamin B12, folic acid, etc.).
  • The appearance of secondary tumor foci (metastases) in the bone marrow.
  • Violation of the formation of the non-protein part of hemoglobin.
  • Hormonal disorders leading to reduced production of red blood cells.
  • Development of antigen-antibody reaction after blood transfusion or allergy.

The list of possible causes of such disease as anemia can be continued. Unfortunately, there are many more factors that can cause the development of pathology…

Symptoms of anemia

Signs of anemia are often not sensitive or specific. Many types of anemia occur with minimal or no symptoms.

Possible non-specific symptoms include the following:

  • General weakness and fatigue.
  • Pale skin.
  • Drowsiness.
  • Frequent dizziness.
  • Shortness of breath, palpitations.
  • “Flies” before the eyes.

There are also signs that may indicate a specific cause of the disease:

  • Dark urine and yellowing of the skin (in the absence of liver pathologies) indicate hemolysis.
  • Weight loss may be one of the symptoms of malignancy.
  • The presence of blood in the stool is evidence of gastrointestinal bleeding.
  • Peripheral neuropathy develops in the presence of vitamin B12 deficiency.

Should alert dry skin, brittle nails and hair, cracks and “bites” in the corners of the lips, constant muscle weakness. In severe cases, the patient may experience convulsions, vomiting, nausea, and other symptoms.

One of the most common diseases among adults and children around the world is anemia, often referred to as anemia. However, this name does not fully reflect the features of the pathology, since the patient has a decrease in the number of erythrocytes and hemoglobin, and not all blood.

There are a lot of reasons that cause such a state. In women, the problem can be the result of heavy menstruation, pregnancy and breastfeeding. But there are also more serious causes, including hidden bleeding of the gastrointestinal tract and malignant neoplasms. Different degrees of anemia are often diagnosed in children, which can be the result of malnutrition, iron absorption disorders, or various diseases of the internal organs.

Let’s figure out why such a pathology occurs, how the diagnosis is made and what treatment methods exist.

Classification of the disease

Classification of anemia is carried out taking into account various factors. Pathologies associated with blood loss are usually divided into two categories:

  • acute
  • chronic

Depending on the nature of development, hereditary and acquired pathologies are distinguished. As for the origin of anemia, all forms can be divided into:

  • Hemolytic. Such anemias appear as a result of active destruction of red blood cells. Various factors can lead to this condition.
  • Aplastic. Directly related to the inability of the bone marrow to create new blood cells.
  • Posthemorrhagic. They are the result of a large loss of blood during bleeding.
  • Scarce. They arise due to a deficiency of various trace elements: iron, vitamins or proteins.

For anemia resulting from impaired hematopoiesis in the body, the following classification is used. Allocate anemia:

  • Associated with impaired DNA and RNA synthesis.
  • Caused by a disruption in the formation of hemoglobin.
  • Associated with abnormal division of red blood cells.
  • Caused by inhibition of bone marrow cell formation.

When diagnosing, it is important to determine the degree of anemia , as this will allow planning treatment tactics:

  • Mild degree. Decrease in hemoglobin up to 90 g/l. The patient may have minor symptoms, in some cases the pathology is asymptomatic.
  • Medium. Hemoglobin indicators remain in the range from 70 to 90 g / l. A person has general weakness and fatigue, often there are pronounced symptoms of the disease.
  • Heavy. This stage is characterized by a decrease in the level of hemoglobin less than 70 g / l. Significantly increases the risk of complications from the cardiovascular system.

One of the fairly common forms of anemia is iron deficiency anemia. It is most common in women of childbearing age and children under 4 years of age. Such a anemia in children is most often associated with a vegetarian or unbalanced diet, some hereditary factors. The disease is characterized by the presence of hypoxic and sideropenic syndromes.

Hypoxic syndrome is manifested by symptoms common to all forms of anemia. The patient has pallor, palpitations, headache, tinnitus, severe weakness and tiredness.

Sideropenic syndrome is manifested by dry skin, hair loss and other symptoms that indicate an iron deficiency in the body. In addition, with the development of the disease, numerous metabolic disorders occur. This provokes such a variety of clinical symptoms. In severe cases, neurotic reactions and neurasthenia may occur. Very often, patients have lesions of the gastrointestinal tract, which manifest themselves in the form of chronic gastritis or intestinal malabsorption syndrome.

Another common form of anemia is folate deficiency. It occurs as a result of a deficiency of folic acid and folates (that is, its derivatives). This condition can be the result of alimentary insufficiency, malabsorption in the intestine, taking certain medications.

Unfortunately, there is no exact data on the prevalence of this pathology in our country. However, in the course of research, it was possible to establish a connection between this type of anemia and alcohol abuse. In patients with folate deficiency anemia, weakness, fatigue, dizziness, shortness of breath, lethargy and poor appetite are observed. Often there is angular stomatitis, nausea, vomiting, diarrhea, abdominal pain.

Of particular danger is anemia that occurs with malignant neoplasms. This condition can be caused by both the presence of a tumor and its treatment. The pathogenesis of anemia in this case is quite complex and may be associated with direct and indirect consequences of the tumor process.

Diagnosis features

Suspect anemia based on history and physical examination. Most often, the initial diagnosis is performed by a general practitioner or pediatrician. Next, you may need to consult a hematologist, oncologist.

At the consultation, the specialist assesses the general well-being of the person, pays special attention to the presence of fatigue, weakness, pallor, shortness of breath during exertion.

To clarify and confirm the diagnosis, the following laboratory tests are carried out:

  • Clinical blood test with determination of the number of leukocytes and platelets.
  • Erythrocyte indices and morphology.
  • Peripheral blood smear.
  • Study of the number of reticulocytes.

In some cases the diagnosis of anemia includes aspiration and bone marrow biopsy. But the examination begins with a general blood test, as it allows you to identify the number of leukocytes and platelets, as well as determine the indicator of the distribution of red blood cells by volume. The choice of further procedures is based on the results of a general analysis, since already at this stage it is possible to identify the presence of anemia, the possible causes of its development.

Normal hemoglobin values ​​vary with sex and age of the patient, and sometimes with chronic diseases and underlying conditions. For men, additional diagnostics are prescribed when the values ​​are already below 130 g/l; in women, the doctor may suspect anemia at values ​​below 120 g/l. For children, the limits of the norm change significantly with age, so special tables are used to evaluate the results.

A peripheral blood smear is used to check for excess RBC production. Using this procedure, it is possible to identify various changes in the structure of erythrocytes and detect a number of other disorders.

The evaluation of the reticulocyte count plays an important role in the diagnosis of anemia. Normal values ​​range from 0.5% to 1.5% (as a percentage) or from 50,000 to 150,000 / µl (in absolute terms). It is this parameter that makes it possible to evaluate the reaction of the bone marrow to insufficient production of red blood cells or their excessive destruction. A decrease in normal values ​​indicates the presence of the first problem, an increase indicates an increased destruction of red blood cells.

In some cases, bilirubin and lactate dehydrogenase (LDH) levels may also be assessed. These indicators help to differentiate between hemolysis and bleeding. Since in the first case, the values ​​\u200b\u200bare increased, and with blood loss they remain within the normal range.

If a violation of the process of cell maturation is suspected, the patient is prescribed a bone marrow biopsy. With the help of such diagnostics, it is possible to assess the distribution and number of erythrocyte precursors, the features of iron accumulation in cells, etc. Most often, manipulation is performed in the presence of unexplained anemia or a suspected primary bone marrow disease.

Additionally, the patient may be prescribed X-ray or CT scan of the chest, ultrasound of the abdominal cavity, ultrasound of the thyroid gland, ECG. Such studies will help assess the state of internal systems and identify concomitant diseases.

Treatment

Treatment of anemia is always selected individually and depends on the symptoms present , causes, stage of development of the disease.

Key clinical guidelines include:

  • Management of acute or chronic blood loss.
  • Restoration of normal factors of growth and division of erythrocytes.
  • Elimination of the causes of destruction of red blood cells.
  • Treatment of diseases that cause a decrease in hemoglobin levels.

If there is a micronutrient deficiency, the patient is prescribed iron, folic acid, vitamins B6 and B12. In some cases, erythrocyte growth and reproduction stimulants are used. The normalization of nutrition is important – it is important for the patient to diversify the diet with foods high in proteins and vitamins. This will make up for the deficiency of important trace elements.

Severe cases may require blood transfusion or surgery (eg bone marrow transplant).

Hemolytic anemia is diagnosed with hormonal therapy, treatment with immunosuppressants or cytostatics, and sometimes with blood or plasma transfusions. This is required in order to eliminate the hemolyzing factor of the disease. Sometimes antibiotic therapy is performed to prevent infectious complications. In severe cases, bone marrow transplantation is used.

Often, especially in children, anemia is associated with infection with worms or other parasites. In this case, competent antiparasitic treatment will be required.

To prevent disease, it is recommended to visit a doctor regularly (once a year) and take a general blood test. This will allow you to track the decrease in hemoglobin and start early treatment. The diet should include offal, red meat, vegetables, fruits. Refusal of alcohol and smoking, prevention of helminthic invasion, taking medications only as prescribed by a doctor will also become important measures for the prevention of anemia. Pregnant women are prescribed an additional intake of folic acid and iron to prevent pathology.

If you notice signs of anemia, you should not postpone your visit to the doctor. You can seek help from our medical center “Yunona” – the specialists of the clinic will help determine the causes of your condition and select an effective treatment!

Author

Kaplina E.

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