What is aplastic anemia. How does aplastic anemia affect the body. What are the main symptoms of aplastic anemia. Can aplastic anemia be treated effectively. How is aplastic anemia diagnosed. What are the risk factors for developing aplastic anemia. How can aplastic anemia be prevented.

Understanding Aplastic Anemia: A Rare Blood Disorder

Aplastic anemia is a serious and rare blood disorder that occurs when the body fails to produce enough new blood cells. This condition affects the bone marrow, which is responsible for creating red blood cells, white blood cells, and platelets. As a result, individuals with aplastic anemia often experience fatigue, increased susceptibility to infections, and a higher risk of uncontrolled bleeding.

Is aplastic anemia a life-threatening condition? While the severity can vary, aplastic anemia can indeed be life-threatening in some cases, especially if left untreated. The condition can develop suddenly or progress slowly over time, affecting people of all ages.

Recognizing the Symptoms of Aplastic Anemia

Identifying aplastic anemia early is crucial for effective treatment. Common symptoms include:

• Fatigue and weakness
• Shortness of breath, especially during physical activity
• Rapid or irregular heart rate
• Pale skin
• Frequent or prolonged infections
• Unexplained or easy bruising
• Nosebleeds and bleeding gums
• Prolonged bleeding from cuts
• Skin rashes
• Dizziness and headaches
• Fever

Do all patients with aplastic anemia experience the same symptoms? Not necessarily. Some individuals may have no symptoms at all, while others may experience a combination of the above signs. The severity and duration of symptoms can vary greatly from person to person.

Exploring the Causes of Aplastic Anemia

Understanding the root causes of aplastic anemia is essential for proper diagnosis and treatment. The condition arises when stem cells in the bone marrow are damaged, leading to insufficient blood cell production. Several factors can contribute to this damage:

1. Autoimmune disorders: The body’s immune system may mistakenly attack stem cells in the bone marrow.
2. Radiation and chemotherapy treatments: Cancer-fighting therapies can inadvertently damage healthy stem cells.
3. Exposure to toxic chemicals: Pesticides, insecticides, and benzene have been linked to aplastic anemia.
4. Certain medications: Some antibiotics and drugs used to treat rheumatoid arthritis can cause aplastic anemia.
5. Viral infections: Hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV may play a role in developing the condition.
6. Pregnancy: In rare cases, the immune system may attack bone marrow during pregnancy.
7. Idiopathic causes: Sometimes, the exact cause remains unknown.

Can aplastic anemia be inherited? While most cases are acquired, a rare inherited condition called Fanconi’s anemia can lead to aplastic anemia. Children born with Fanconi’s anemia often have physical abnormalities and are diagnosed through specialized blood tests.

Diagnosing Aplastic Anemia: Tests and Procedures

Proper diagnosis of aplastic anemia involves a combination of physical examinations, medical history review, and specific tests. Common diagnostic procedures include:

• Complete blood count (CBC): Measures the levels of red blood cells, white blood cells, and platelets.
• Bone marrow biopsy: Involves removing a small sample of bone marrow for examination.
• Reticulocyte count: Assesses the production of new red blood cells.
• Imaging tests: X-rays or CT scans may be used to rule out other conditions.
• Genetic testing: To identify inherited forms of aplastic anemia or associated disorders.

How long does it take to diagnose aplastic anemia? The diagnostic process can vary in duration, depending on the complexity of the case and the availability of test results. In some cases, a diagnosis can be made within a few days, while in others, it may take several weeks to confirm the condition and determine its underlying cause.

Treatment Options for Aplastic Anemia

The treatment approach for aplastic anemia depends on the severity of the condition, the patient’s age, and overall health. Common treatment options include:

1. Blood transfusions: To temporarily increase blood cell counts and alleviate symptoms.
2. Immunosuppressive therapy: Medications that suppress the immune system to prevent it from attacking bone marrow cells.
3. Stem cell transplantation: Also known as bone marrow transplant, this procedure replaces damaged stem cells with healthy ones from a donor.
4. Growth factors: Medications that stimulate the production of specific blood cells.
5. Antibiotics and antiviral drugs: To prevent and treat infections in patients with weakened immune systems.

What is the success rate of treatment for aplastic anemia? The success rate varies depending on the treatment method and individual factors. Stem cell transplantation can offer a cure in up to 80-90% of cases when a suitable donor is available. Immunosuppressive therapy can lead to significant improvement in about 70-80% of patients who are not candidates for transplantation.

Managing Aplastic Anemia: Lifestyle Considerations

Living with aplastic anemia requires careful management and lifestyle adjustments. Patients can improve their quality of life by:

• Following a balanced, nutrient-rich diet to support overall health
• Engaging in gentle exercise as recommended by healthcare providers
• Avoiding activities with a high risk of injury or bleeding
• Practicing good hygiene to prevent infections
• Managing stress through relaxation techniques and support groups
• Attending regular check-ups and monitoring appointments

Can individuals with aplastic anemia lead normal lives? With proper treatment and management, many people with aplastic anemia can lead fulfilling lives. However, ongoing medical care and lifestyle adjustments are often necessary to maintain health and prevent complications.

Complications and Long-Term Outlook for Aplastic Anemia Patients

While treatment can significantly improve outcomes, aplastic anemia can lead to various complications if not managed effectively:

• Severe infections due to low white blood cell counts
• Bleeding problems resulting from low platelet counts
• Fatigue and shortness of breath from anemia
• Iron overload from frequent blood transfusions
• Development of other blood disorders, such as myelodysplastic syndromes

What is the long-term prognosis for aplastic anemia? The long-term outlook has improved significantly with advances in treatment. Many patients achieve remission or cure with appropriate therapy. However, ongoing monitoring is essential, as there is a risk of relapse or development of secondary conditions.

Research and Future Directions in Aplastic Anemia Treatment

Ongoing research in the field of aplastic anemia aims to improve treatment outcomes and quality of life for patients. Current areas of focus include:

1. Development of novel immunosuppressive therapies with fewer side effects
2. Improvements in stem cell transplantation techniques
3. Gene therapy approaches for inherited forms of aplastic anemia
4. Identification of biomarkers for early detection and personalized treatment
5. Investigation of new growth factors to stimulate blood cell production

How might future treatments change the landscape for aplastic anemia patients? Emerging therapies and improved understanding of the disease mechanisms may lead to more targeted and effective treatments, potentially increasing cure rates and reducing long-term complications.

Aplastic Anemia in Special Populations

Certain groups may require special considerations when diagnosing and treating aplastic anemia:

• Children: Pediatric patients may have different treatment protocols and long-term follow-up needs.
• Pregnant women: Management during pregnancy requires careful balancing of maternal and fetal health.
• Elderly patients: Age-related factors may influence treatment choices and outcomes.
• Individuals with other health conditions: Comorbidities can complicate treatment approaches and require multidisciplinary care.

How does aplastic anemia management differ in these special populations? Treatment strategies often need to be tailored to address the unique needs and risks of each group, considering factors such as growth and development in children, pregnancy-related changes, and age-related health issues in older adults.

Support and Resources for Aplastic Anemia Patients

Living with aplastic anemia can be challenging, but various resources are available to support patients and their families:

• Patient support groups and online communities
• Educational materials from reputable health organizations
• Financial assistance programs for medical costs
• Psychological counseling services
• Rehabilitation programs to address physical and cognitive effects

Where can patients find reliable information and support for aplastic anemia? Organizations such as the Aplastic Anemia and MDS International Foundation offer comprehensive resources, including educational materials, support networks, and information on clinical trials.

Preventing Aplastic Anemia: Risk Reduction Strategies

While many cases of aplastic anemia cannot be prevented, certain measures may help reduce the risk:

1. Avoiding exposure to known toxic chemicals and radiation
2. Using protective equipment when working with potentially harmful substances
3. Following safety guidelines during cancer treatments
4. Discussing medication side effects with healthcare providers
5. Maintaining overall health through a balanced diet and regular exercise

Can lifestyle changes prevent all cases of aplastic anemia? While adopting these strategies may lower the risk, it’s important to note that many cases of aplastic anemia occur due to unknown or unpreventable factors. Regular health check-ups and prompt attention to unusual symptoms remain crucial for early detection and treatment.

The Role of Genetics in Aplastic Anemia

Genetic factors play a significant role in some forms of aplastic anemia, particularly in inherited conditions like Fanconi anemia. Understanding the genetic basis of the disease can provide valuable insights:

• Identification of at-risk individuals through genetic testing
• Improved understanding of disease mechanisms
• Development of targeted therapies based on genetic profiles
• Genetic counseling for families with inherited forms of the condition

How does genetic testing contribute to aplastic anemia management? Genetic testing can help identify specific mutations associated with inherited forms of aplastic anemia, guiding treatment decisions and providing important information for family planning.

Aplastic Anemia and Quality of Life

The impact of aplastic anemia extends beyond physical symptoms, affecting various aspects of a patient’s life:

1. Emotional well-being: Coping with a chronic condition can lead to anxiety and depression
2. Social interactions: Fatigue and risk of infection may limit social activities
3. Educational and career pursuits: Treatment schedules and health limitations may affect academic or professional goals
4. Financial burden: Medical costs and potential loss of income can create financial stress
5. Relationships: The condition may strain personal relationships and family dynamics

What strategies can help improve quality of life for aplastic anemia patients? A holistic approach that addresses both medical and psychosocial needs is essential. This may include comprehensive care plans, supportive therapies, and lifestyle adaptations tailored to individual circumstances.

Advances in Blood Cell Production Technologies

Emerging technologies in blood cell production offer promising avenues for aplastic anemia treatment:

• Ex vivo expansion of stem cells to increase transplant success rates
• Artificial blood cell production using stem cell technologies
• Gene editing techniques to correct genetic defects in stem cells
• Bioengineered bone marrow models for studying disease mechanisms

How might these technological advances impact aplastic anemia treatment in the future? These innovations could potentially lead to more effective and less invasive treatments, improving outcomes and reducing the need for long-term immunosuppression or repeated transfusions.

Global Perspectives on Aplastic Anemia

Aplastic anemia presents unique challenges in different parts of the world:

1. Variations in prevalence and genetic factors across populations
2. Disparities in access to advanced treatments in developing countries
3. Cultural differences in perceptions and management of the disease
4. International collaborations for research and treatment protocols
5. Global efforts to improve diagnosis and care in resource-limited settings

How do global variations affect aplastic anemia management worldwide? Understanding these differences is crucial for developing tailored approaches to diagnosis, treatment, and support that address the specific needs and resources of different regions and populations.

Aplastic anemia – Symptoms & causes

Overview

Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. The condition leaves you fatigued and more prone to infections and uncontrolled bleeding.

A rare and serious condition, aplastic anemia can develop at any age. It can occur suddenly, or it can come on slowly and worsen over time. It can be mild or severe.

Treatment for aplastic anemia might include medications, blood transfusions or a stem cell transplant, also known as a bone marrow transplant.

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Symptoms

Aplastic anemia can have no symptoms. When present, signs and symptoms can include:

• Fatigue
• Shortness of breath
• Rapid or irregular heart rate
• Pale skin
• Frequent or prolonged infections
• Unexplained or easy bruising
• Nosebleeds and bleeding gums
• Prolonged bleeding from cuts
• Skin rash
• Dizziness
• Headache
• Fever

Aplastic anemia can be short-lived, or it can become chronic. It can be severe and even fatal.

Causes

Stem cells in the bone marrow produce blood cells — red cells, white cells and platelets. In aplastic anemia, stem cells are damaged. As a result, the bone marrow is either empty (aplastic) or contains few blood cells (hypoplastic).

Bone marrow

Bone marrow is a red, spongy material inside your bones that produces blood cells.

The most common cause of aplastic anemia is from your immune system attacking the stem cells in your bone marrow. Other factors that can injure bone marrow and affect blood cell production include:

• Radiation and chemotherapy treatments. While these cancer-fighting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments.
• Exposure to toxic chemicals. Toxic chemicals, such as some used in pesticides and insecticides, and benzene, an ingredient in gasoline, have been linked to aplastic anemia. This type of anemia might improve if you avoid repeated exposure to the chemicals that caused your illness.
• Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.
• Autoimmune disorders. An autoimmune disorder, in which your immune system attacks healthy cells, might involve stem cells in your bone marrow.
• A viral infection. Viral infections that affect bone marrow can play a role in the development of aplastic anemia. Viruses that have been linked to aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.
• Pregnancy. Your immune system might attack your bone marrow during pregnancy.
• Unknown factors. In many cases, doctors aren’t able to identify the cause of aplastic anemia (idiopathic aplastic anemia).

Connections with other rare disorders

Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria, which causes red blood cells to break down too soon. This condition can lead to aplastic anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria.

Fanconi’s anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be smaller than average and have birth defects, such as underdeveloped limbs. The disease is diagnosed with the help of blood tests.

Risk factors

Aplastic anemia is rare. Factors that can increase risk include:

• Treatment with high-dose radiation or chemotherapy for cancer
• Exposure to toxic chemicals
• The use of some prescription drugs — such as chloramphenicol, which is used to treat bacterial infections, and gold compounds used to treat rheumatoid arthritis
• Certain blood diseases, autoimmune disorders and serious infections
• Pregnancy, rarely

Prevention

There’s no prevention for most cases of aplastic anemia. Avoiding exposure to insecticides, herbicides, organic solvents, paint removers and other toxic chemicals might lower your risk of the disease.

Low Red Blood Cell Counts

• What is anemia?
• What causes anemia?
• Symptoms of anemia
• Tests for causes of anemia
• Problems anemia can cause
• Treatments for anemia
• Managing anemia at home

What is anemia?

When you don’t have enough healthy red blood cells, you have a condition called anemia. This means your blood has lower than normal hemoglobin (Hgb) levels. Hemoglobin is the part of the red blood cell (RBC) that carries oxygen to all the cells in your body. Anemia is a common side effect in patients with cancer.

What causes anemia?

There are many different reasons a person with cancer might have anemia. Some common causes are:

• The cancer itself
• Cancer treatment, such as radiation or chemotherapy
• Blood loss (this can be bleeding from a tumor, bleeding from cancer cells getting into blood vessels, or bleeding caused by other conditions like heavy menstruation or bleeding from a stomach ulcer)
• Missing certain vitamins or minerals in the diet because of not eating enough
• Low iron levels in blood
• Major organ problems (including severe heart, lung, kidney, or liver disease)
• Red blood cells (RBCs) being destroyed by the body before they’re replaced
• The body making fewer RBCs
• Having chronic kidney disease
• Having conditions like sickle cell disease or thalassemia (inherited disorders of red blood cells)
• A combination of any of these factors

Some risk factors may make a person with cancer more likely to have anemia. These include:

• Certain chemotherapy drugs such as platinum-based chemotherapy (this is a certain group of chemo drugs)
• Certain tumor types (such as lung or ovary tumors)
• Having a low hemoglobin level before you had cancer

Symptoms of anemia

Anemia often starts slowly, so you may not notice symptoms at first. As your hemoglobin level gets lower you may have one or more of these symptoms:

• Fast heartbeat
• Fast breathing rate
• Shortness of breath (trouble breathing)
• Trouble breathing when doing things like walking, climbing stairs, or even talking (exerting yourself)
• Dizziness or lightheadedness
• Chest pain
• Swelling in the hands and/or feet
• Color of skin, nail beds, mouth, and gums looking more pale than usual
• Extreme tiredness (fatigue)

Anemia can range from mild to life-threatening, depending on your hemoglobin level and the symptoms you are experiencing. Some of these symptoms are more serious than others. Your doctor will explain your hemoglobin level and the severity of your anemia.

If you have any of these symptoms, tell your doctor or nurse right away. If you can’t reach your cancer care team right away, you may need to get immediate care at an emergency room.

Let your cancer care team know if you have any other medical problems such as heart or lung disease, as this may make your symptoms from anemia worse. It’s important to watch for anemia and its symptoms throughout your treatment. Tell your cancer care team if you’re having any of the symptoms described here. Be sure to mention how the symptoms affect your day-to-day life. Doing so will help you get the treatment you need when you need it.

Tests for causes of anemia

A complete blood count (CBC) is a blood test that measures your hemoglobin level and other characteristics of your red blood cells (such as their size). This test not only shows if you have anemia, but it can also help your doctor figure out what might be causing it.

You might also need other tests to help to find what is causing it. These could include:

• Blood chemistry tests to check organ function and levels of vitamins and minerals
• A blood test called a reticulocyte count (Reticulocytes are very young red blood cells just released from the bone marrow, so this test shows how many new red cells your body is making.)
• A bone marrow exam to make sure your bone marrow is working as it should
• Blood tests to look at your iron, vitamin B12, and folate levels
• A test of your stool (feces) to check for blood (called a fecal occult blood test or FOBT)

Your doctor or nurse can use the results of these tests, along with your medical information and a physical exam, to get an idea of what might be causing your anemia. Sometimes no cause can be found other than “anemia of chronic disease.” This type of anemia is often found in people with long-lasting problems like congestive heart failure, inflammatory diseases, or cancer.

Problems anemia can cause

The first thing the doctor needs to know is how severe your anemia is. Anemia can affect your quality of life and has been found to shorten survival in people with cancer. It can make you feel very tired because cells in your body can’t get enough oxygen. In some cases, this lack of oxygen may be bad enough to threaten your life. Anemia can also make your heart work harder. So if you already have a heart problem, anemia can make it worse. Anemia can also make it hard for you to breath normally, making it challenging to do your usual activities.

Severe anemia may mean you have to delay your cancer treatment or have your treatment dose reduced. It can also cause some cancer treatments to not work as well as they should.

Your cancer care team may try to figure out your risk of serious problems from the anemia based on any symptoms you are having and your hemoglobin level. If you’re not having symptoms, they will try to figure out how likely you are to have them in the near future. This will be based on a number of things, including:

• Your hemoglobin level and other lab results
• The type of cancer treatments you’ve had in the past
• The chances that any treatments you’re now getting could make the anemia worse
• Whether you have lung, heart, or blood vessel (circulation) problems
• Your age

If you don’t seem to be at risk for problems from anemia, your cancer care team will watch your hemoglobin level closely and ask about symptoms each time you visit the office.

Treatments for anemia

Anemia in cancer patients is usually treated based on the cause. Sometimes, treatment of anemia delays cancer treatment until your red blood cells recover. There are 2 main goals in treating anemia:

• Treat the cause of the anemia
• Raise the hemoglobin level so that symptoms get better

The most common treatments of anemia in patients with cancer include:

• Iron therapy
• Red blood cell transfusion, commonly known as blood transfusion
• Erythropoiesis-stimulating agents (ESAs)
• Other drugs

Your doctor will look at your test results, symptoms, how long you’ve been having the symptoms, the cancer type, cancer treatment, and other factors. Talk to your cancer care team about what treatment is right for you. As with any medical problem, the expected benefits of treatment should always outweigh the possible risks.

Iron therapy

If your iron levels are low, your doctor may supplement them with iron pills or iron given through your veins (iron infusion). Iron infusions carry a risk of allergic reaction. Your doctor will discuss with you what form of iron would be best for your situation. Your doctor may also ask you to try to eat more iron-rich foods. There are two types of iron in food: heme and non-heme.

Heme iron is found in animal products. Heme iron is more easily absorbed by the body than non-heme iron. Examples of foods that contain heme iron are:

• Red meat
• Fatty fish
• Chicken and turkey

Non-heme iron is found in plant-based foods. Examples of foods that contain high amounts of non-heme iron include:

• Dark green leafy vegetables such as spinach, kale, collard greens, or chard
• Beans and lentils
• Tofu
• Fortified cereals
• Dried fruits such as raisins, apricots, and peaches
• Enriched pasta and rice.

Non-heme iron is best absorbed by the body when eaten at the same time as fruits and vegetables high in Vitamin C. Examples of foods high in vitamin C include

• Citrus fruits
• Tomatoes
• Dark green leafy vegetables
• Berries.

Blood transfusions to treat anemia

A blood cell transfusion is a safe and a common way to treat anemia in people with cancer. It can help the patient feel better and helps oxygen get to vital organs. While blood transfusions can help symptoms very quickly, sometimes the relief is temporary depending on the cause of anemia.

Whether a blood transfusion might be needed depends on how severe your symptoms are and your hemoglobin level. A transfusion might be done if your hemoglobin level reaches a certain number or if your symptoms get too bothersome

A blood transfusion requires careful matching of donated blood to the recipient’s blood. Blood products are tested to be sure they are safe and the same kind of blood type as the recipient. But, receiving a blood transfusion also has some risks

• Transfusion reaction: This happens when the patient’s immune system attacks proteins on the foreign blood cells. This often looks like an allergic reaction. Most of these reactions are minor and can be treated, but sometimes they can be more serious.
• Transfusion-related lung injury: This is one of the more serious risks. It can cause trouble breathing and require treatment in the hospital.
• Getting exposed to certain germs, such as the hepatitis B or C virus: The careful blood testing and screening that’s used today has greatly decreased the risk of infections.
• Transfusion-related circulatory overload (TACO): This can happen if blood is given too quickly for the heart to handle it.
• Iron overload: People who get many blood transfusions may end up with too much iron, which would then need to be treated.

Erythropoiesis-stimulating agents (ESAs)

Another way to treat anemia in some patients is to use drugs that tell the body to make more red blood cells. ESAs work like a hormone (called erythropoietin) made by the kidneys to help the body make its own new red blood cells. If one of these drugs is recommended, your health care provider will talk to you about the risks and the benefits of the drug. These drugs can cause very serious side effects. Still, they can help patients getting chemotherapy have higher hemoglobin levels and need fewer blood transfusions. This may result in a gradual improvement of anemia-related symptoms.

ESAs are given as shots under the skin, and how long they take before they start working may be different for different patients. Talk to your doctor about the risks and benefits of the ESA you will be receiving. .

Other drugs to treat anemia

Depending on the type of anemia you have, the anemia may also be treated with vitamin B12 or folic acid supplementation.

Talk to your doctor about what kind of anemia you have, the recommended treatment, and the risks and benefits of the treatment.

Managing anemia at home

What to look for

• New or worsening tiredness that makes it harder to do your regular activities
• Chest pain or shortness of breath when you’re active
• Skin, nail beds, or gums that are more pale than usual
• Dizziness
• Weakness
• Bright red, dark red, or black stool
• Dark brown or bright red vomit

(The last 2 are signs of bleeding, which can be a cause of anemia.)

What the patient can do

• Balance rest and activities. Only do activities that you can tolerate
• Keep a log of your symptoms, what time they occur, and what makes them worse or better, and discuss with your health care provider at your appointment
• Tell your cancer team if you’re not able to get around as well as usual.
• Plan your important activities when you have the most energy.
• Eat a balanced diet that includes protein (such as fish, meat, eggs, cheese, milk, nuts, peas, and beans). Try to include iron-rich foods in your diet
• Drink 8 to 10 glasses (8 oz) of water a day, unless you are given other instructions by your cancer care team. It’s OK to drink other liquids instead of water – just not beer, wine, or other alcoholic drinks. Check with your doctor to see what a safe amount of liquids is for you.

What caregivers can do

• Schedule friends and family members to prepare meals, clean the house, do yard work, or run errands for the patient. You can use websites that help organize these things, or get someone else to look into this for you.
• Watch for confusion, faintness, or dizziness.

Call the cancer care team if the patient

• Has chest pains
• Has shortness of breath when resting
• Feels dizzy or faint
• Gets confused or can’t concentrate
• Has not been able to get out of bed for more than 24 hours
• Has blood in their stool
• Has dark brown or bright red vomit

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Red Cross. Iron-rich foods. Accessed at www.redcrossblood.org/learn-about-blood/health-and-wellness/iron-rich-foods on September 17, 2019.

Bohlius J, Bohlke K, Castelli R, Djulbegovic B, Lustberg MB, Martino M, Mountzios G, Peswani N, Porter L, Tanaka TN, Trifirò G, Yang H, Lazo-Langner A. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH Clinical Practice Guideline Update. Journal of Clinical Oncology. 2019; 37(15):1336-1351.

Centers for Disease Control and Prevention. Iron.  https://www.cdc.gov/nutrition/infantandtoddlernutrition/vitamins-minerals/iron.html. Last reviewed December 3, 2018. Accessed December 7, 2020.  

Choe JH, Crawford J. Hematologic Problems and Infections: Disorders of blood cell production in clinical oncology. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:515-517.

Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer-related anemia. American Journal of Hematology. 2014;89(2):203-212.

National Comprehensive Cancer Network (NCCN). Hematopoietic growth factors. 2019. Version 2.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/growthfactors.pdf on September 17, 2019.

NIH U.S. National Library of Medicine. MedlinePlus. 2019. Anemia. Accessed at https://medlineplus.gov/anemia.html on September 17, 2019.

 

Last Revised: February 1, 2020

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Anemia

Anemia is a condition in which the amount of red blood cells and / or hemoglobin in them is reduced in the blood. This deficiency affects the function of transporting oxygen.

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This is one of the main results of blood circulation – it delivers O2 molecules to the tissues through the arteries and, thanks to the venous outflow, removes waste materials, including carbon dioxide. The main gas exchange occurs in the alveoli – the final formations of the bronchial tree. This is the part of the respiratory system where the blood releases some gases and takes in others. The insufficiency of this process leads to hypoxia – a reduced supply of oxygen to the tissues. This affects all processes in the body, the state of tissues and the cellular mechanism. Without the presence of oxygen, chemical reactions do not take place and energy exchange does not occur.

Outwardly, this is manifested by various clinical signs:

• pallor;
• weakness;
• increased heart rate and breathing – the body tries to compensate for the lack of oxygen;
• the possibility of loss of consciousness;
• decrease in working capacity;
• flashing “flies” before the eyes;
• dizziness;
• noise in ears;
• irritability;
• dyspnea.

These signs are the reason to go to a medical center for testing. Anemia is often a manifestation of pathology, since in itself, most often, it is a symptom. A full examination will show the cause of the condition and allow effective treatment to begin.

Anemia classification

There are several types of anemia, depending on the origin and pathogenesis of development. Understanding the nature of anemia will allow you to determine the tactics of treatment, since different types of this pathology have a different source of origin. Even a general blood test for different anemias is somewhat different – for this it is necessary to take into account not only the number of erythrocytes and hemoglobin, but also the color index, the size of erythrocytes, hematocrit and other research parameters. In some cases, a more detailed examination of the patient, clinical diagnosis, is required in order to say exactly what caused the disease.

Let us consider in more detail the types of anemia and the causes of their occurrence.



• Iron deficiency anemia is quite common, as many people around the world are iron deficient. The development of anemia depends on the degree of this insufficiency. A lack of glands can occur when there is a lack of it in food, with an increased consumption of iron by the body, as well as with some features of the digestive tract, when iron is not fully absorbed. It is the reduced amount of iron that leads to the development of 70% of all anemias, so that all other causes account for only 30% of this pathology. The basis of pathogenesis is a violation of the formation of hemoglobin, in which the iron molecule plays the main role. A reduced amount of protein that carries the blood affects the state of the body. Lack of oxygen has common signs of anemia, but with iron deficiency there are still some specific symptoms – hair loss, problems with nails, worsening of the heart, digestive tract. Sometimes there are distorted taste preferences – the desire to eat chalk or paint. This is all due to iron deficiency. The disease is more often observed in children, women during pregnancy, elderly patients. Laboratory diagnosis of iron deficiency involves an analysis of blood proteins that carry iron, the ability of blood serum to bind the trace element and other indicators that complement the usual diagnostic program for anemia.

• B12 deficiency anemia occurs when there is a deficiency in the body of the corresponding vitamin, which is contained in animal products, in particular meat. This explains the fact that the disease often occurs in those who have refused to use such products. This vitamin is the main participant in the formation of new blood cells – erythrocytes. The cause of the pathology may lie in endogenous factors – for example, with a deficiency of the Castle factor. It is a protein that is produced by the cells of the gastric mucosa and promotes the body’s intake of the vitamin from food. Anemia can occur after surgery, during which part of the intestine or stomach is removed. It could also be a vitamin deficiency. As a rule, a certain supply of a substance in the body is designed for several years, which explains the fact that the development of anemia occurs gradually even after a change in eating habits. The cause may be an inflammatory process in the tissues of the gastrointestinal tract, taking certain medications, a violation of the transport of the vitamin from the blood into the intracellular space, as well as an increased consumption of the vitamin by the body. In addition to the general symptoms of anemia, vitamin B12 deficiency causes ulcers on the oral mucosa, a violation of innervation, which is manifested by a deterioration in sensitivity, tingling and numbness, impaired memory and thinking. Additional tests involve an assessment of the amount of vitamin in the body, the study of pathologies that lead to its deficiency. The treatment will also be specific – it consists in the additional use of vitamin preparations, the normalization of the state of the digestive organs. Vitamin B12 is involved not only in the formation of red blood cells – its functions in the body are diverse, which is reflected in multiple complications of anemia, if the condition is not corrected.

• Folate deficiency anemia develops as a result of a deficiency of folic acid, a vitamin that, like B12, is involved in the formation of new red blood cells. Folic acid is also called vitamin B9. The lack of this substance in the body occurs with a reduced consumption of foods that contain it, sometimes this occurs against the background of alcohol abuse. Violation of vitamin absorption is observed in the pathology of digestion, during frequent urination, against the background of taking drugs that slow down the metabolism of vitamin B9. An increased consumption of folic acid accompanies oncological diseases, hematopoietic disorders, and infectious pathology. Symptoms of hypoxia in this type of anemia are supplemented by stool disorders, numbness in the muscles of the arms and legs, weakness of muscle tissue, distortion of taste perception, and emotional lability. Laboratory diagnosis of folate deficiency anemia includes such specific methods as the study of the level of the substance, as well as vitamin B12. In addition to laboratory tests, it is necessary to clarify the cause of the development of such a condition, for which instrumental studies are carried out. Establishing the cause will make the treatment more effective and speed up its result. Complications of anemia include a lack of other blood elements, the occurrence of many ulcerative necrotic processes, nausea and vomiting, and a decrease in the body’s immune defenses.

• Post-hemorrhagic anemia , if translated literally, means that the condition has developed after bleeding and associated blood loss. Violation of the integrity of blood vessels is the cause of internal and external bleeding. Depending on the intensity of the process and the rate of blood loss, anemia develops – a lack of red blood cells and, accordingly, a lack of oxygen transport. This can be determined by clinical signs – after blood loss, a person becomes pale, feels weak and has tinnitus. Of course, it is easier to determine blood loss when it is clearly accompanied by visible blood leakage. But, in some cases, the process is not so obvious. We are talking about internal bleeding, which can occur in the digestive organs, urogenital area, respiratory organs. It is not so fast to determine them; this requires diagnostic methods, including instrumental and laboratory ones. If blood loss passes in a short time, it is more dangerous for the body, vital functions are disturbed. Posthemorrhagic anemia occurs either after the loss of a significant volume of circulating blood, or with permanent damage to the blood vessels, which most often occurs in the internal organs. Significant surgical intervention, pathological menstruation, trauma, and pathology of the digestive tract can be the cause. In this case, it is possible to determine the mechanism of anemia by characteristic features in the general blood test, as well as due to a detailed examination of the body.

• Megaloblastic anemia combines pathologies associated with deficiency of folic acid and vitamin B12. In a blood test, this is displayed by an increase in the color index – this does not happen with other types of anemia. The concentration of hemoglobin in each erythrocyte increases, megaloblasts appear in the bone marrow, and the size of erythrocytes increases. In the blood serum, an increase in the concentration of iron can be observed.

• Hemolysis – the process of destruction of red blood cells, resulting in a corresponding, hemolytic anemia. The destruction of red blood cells leads to the formation of bilirubin, an extremely toxic substance that can lead to intoxication of the body. Such anemia is congenital and acquired. Congenital tendency to hemolysis accompanies intrauterine development mutations, genetic pathologies. Acquired pathology occurs against the background of an infectious process, disruption of the liver, taking certain medications, transfusion of incompatible blood. Recognize hemolytic anemia at the clinical stage is possible by the following signs: icteric color of the skin, convulsions, fever, an increase in the size of the liver and spleen. Diagnosis includes laboratory and instrumental methods that will confirm the specificity of anemia and indicate its cause. Depending on the cause of hemolysis, treatment tactics are selected, therefore it is so important to establish what led to this condition.

• Hypoplastic anemia – a disease in which the synthesis of all blood cells is impaired. Sometimes only a deficiency of red blood cells can occur. In any case, hypoxia is observed, a violation of oxygen transport in the tissues. This type of anemia can also be congenital or acquired. Among the causes are genetic mutations, exposure to radiation, chemotherapy, poisoning with certain substances, drugs. Clinical manifestations of hypoplastic anemia occur gradually and very slowly. In addition to the usual symptoms of anemia, one can distinguish a decrease in immunity, the occurrence of multiple inflammatory, purulent, necrotic processes, slow wound healing, and frequent colds. There may be hemorrhages with minor damage to the vessel, bleeding. It is necessary to study the internal organs, lymph nodes, bone marrow. Aplastic anemia has a characteristic clinical picture, specific changes in the analyzes. Treatment is carried out with potent drugs, and sometimes surgical methods are also needed. The main point is the timeliness of the start of treatment – the earlier it is started, the better the recovery rates and prognosis.

Anemia occurs in the chronic course of infectious, oncological and inflammatory pathologies. May be associated with a violation of iron synthesis, a reduction in the life of red blood cells, increased consumption of certain substances, chronic blood loss. It is necessary to determine the type of anemia, which is possible with the help of a laboratory test, and also to establish the cause of its occurrence. The treatment of the underlying disease can be supplemented by replenishing the deficiency of certain substances, which will speed up the healing process and improve the quality of life of the patient. The chronic course of the pathology implies the slow onset of symptoms. This suggests that it is necessary to be attentive to changes in various organs and systems and to seek medical help in a timely manner. If the symptoms are disturbing for a long time, it is necessary to undergo a full and comprehensive diagnosis.

Modern methods for diagnosing anemia

For the diagnosis of anemia, laboratory and instrumental research methods are used. For proper treatment, it is important to determine not only the fact of anemia and its type, but also the cause of this condition. Detection of the disease is best done in the early stages of the process and do this using a variety of diagnostic methods. A complete picture of the state of the body gives a more complete understanding of the pathology. Only after a qualitative examination can an effective treatment be prescribed.

• The main method for diagnosing anemia is complete blood count. with it, you can determine the number of red blood cells and hemoglobin, their ratio, color index, hematocrit, red blood cell diameter and other indicators. Sometimes, other indicators of the general blood test – the levels of other blood cells, ESR – can tell about the cause of the pathology. This analysis is given first of all if anemia is suspected. Depending on its results, other diagnostic methods are prescribed.

• Biochemical blood test will determine the level of serum iron, proteins that carry it, the amount of vitamins B12 and B9. It is biochemical analysis that helps to calculate the level of bilirubin and its fractions. thus, this manipulation is required to clarify the type of anemia. The analysis allows you to evaluate most of the processes in the body, provides comprehensive information about the work of internal organs.

• Study of free protoporphyrin in erythrocytes determines the ability of erythrocytes to carry oxygen and allows you to determine the causes of anemia. Impaired heme binding is observed in acute intoxications and can be detected using this technique.

• Analysis of bone marrow puncture shows the presence of blasts – precursors of blood cells. Diagnosis is used to confirm or rule out aplastic anemia. In addition, levels of other missing cells need to be corrected. The study is combined with other diagnostic methods. Early initiation of treatment improves the prognosis for the patient and is possible only after a qualitative diagnosis.

• Study of the acidity of gastric juice (pH-metry) is necessary for the diagnosis of iron deficiency anemia. It is necessary to determine for what reason the absorption of iron in the intestine is disturbed and for this purpose this diagnosis is carried out. Increased production of gastric juice negatively affects other functions of the body, leads to a chronic change in the mucous membrane and causes secondary disorders.

• The presence of parasites in the body leads to an increased consumption of most of the nutrients and can cause anemia. Their search is also included in the program for diagnosing anemia. It is the worms that can provoke the development of megaloblastic, iron deficiency anemia. In addition, a parasitic infection negatively affects other organs and systems, leading to chronic impairment of many functions.

• Examination of feces for occult blood allows you to determine the blood loss, due to which post-hemorrhagic anemia occurs. Also, blood loss is a sign of gastrointestinal pathology, which must be detected and treated. If you delay in finding the cause of anemia, the disease can progress, and the later stage of the process, the more difficult it is to treat.

• X-ray and endoscopic examination is necessary to identify the source of bleeding that led to anemia. This examination allows you to find a pathology that needs to be corrected not only for the treatment of anemia, but also for the full health of the body.

Reasons to undergo diagnostics at SZTsDM JSC

The laboratory of the center is equipped with the latest diagnostic equipment. Analyzes are performed quickly and efficiently. The staff of medical centers employs highly qualified specialists, which allows us to make diagnostics versatile and effective. The patient can not only establish the fact of anemia, but also undergo an extended body check, as well as treatment. For our doctors, there is no disease of a separate system – they assess the full condition of the patient and treat him, not pathology.

Anemia in children | Children’s City Hospital

What is anemia

Anemia is a decrease in the total concentration of red blood cells and hemoglobin in the blood. The task of red blood cells is to deliver oxygen to the tissues of the body. Therefore, with a decrease in their number, the body suffers from the so-called hypoxia – lack of oxygen. Children are especially sensitive to a decrease in hemoglobin.

According to statistics, anemia occurs in 15% of children. Anemias are very different – some are associated with a lack of B vitamins, others – with a lack of folic acid. But the vast majority of anemia develops due to iron deficiency. These anemias are called iron deficiency, and they are the most common (about 90% of all anemias). Let’s talk about iron deficiency anemia today.

Causes and symptoms of anemia

Causes of iron deficiency anemia are divided into three groups.

The first is the situation of blood loss. This includes bleeding from the gastrointestinal tract, menstrual bleeding, and any other blood loss.

The second group includes the lack of iron. And although this is possible only when fasting, this happens in children. For example, when vegetarian parents intentionally deprive their child of meat food – the main source of heme iron.

The next group of causes is iron malabsorption. With some diseases of the stomach or intestines, after abdominal operations on the gastrointestinal tract. The fact is that iron is absorbed mainly in the duodenum and in the upper sections of the small intestine. Therefore, any problems with these parts of the gastrointestinal tract can provoke anemia.

Anemia can also occur when there is insufficient production of red blood cells, impaired functioning and premature destruction of red blood cells.

Your child is pale, gets tired quickly, complains of muscle weakness, dizziness. These are the first signs of anemia. Such situations are typical for both schoolchildren and preschool children. Attentive parents will immediately go to see the doctor. If anemia is started, then soon your child will become inactive, cracks will appear in the corners of the mouth, the tongue will become smooth and glossy, “flies” will flash before the eyes. There will be perversions in food desires, especially the desire to lick nails and other metal objects.

Your task as parents and as your doctor is to identify its type, causes and eliminate iron deficiency.

Diagnosis and treatment of anemia

In order to confirm the diagnosis of anemia, you need to pass an elementary general blood test (from a finger). According to its results, it will be seen how critical the condition of the child is. If hemoglobin (HGB) is between 90 and 110, it is mild anemia; 90-70 – anemia of moderate severity; a score below 70 is a warning sign of severe anemia. Pay attention to the number of erythrocytes in the blood (RBC). Their norm for children is 4.0-7×1012 (depending on age).

A very important indicator of anemia is the color index of the blood. Normally, it should be equal to one. If its value is higher than 1.05, it becomes clear that anemia is caused by a deficiency of B vitamins or folic acid. If the CPU is less than 0.85, iron deficiency anemia is suspected. There are other criteria based on which the diagnosis of IDA is made, but we will provide their analysis to a knowledgeable doctor.

After the diagnosis, the doctor must determine the cause of the anemia, and you must help him with this. Be sure to tell your doctor if suddenly your child does not eat meat or fish, if he has gastrointestinal diseases (ulcerative and pre-ulcerative bowel conditions). It is very important to find out and eliminate the root cause of anemia, otherwise no treatment will give results, and after a few months anemia will reappear. Treatment of anemia should be comprehensive. Diet can eliminate only a small lack of iron, more serious situations require complex treatment that combines both a special diet and medications. But more on that later.

Treatment should ONLY be prescribed by a physician. And it is better if it is a qualified hematologist. An excess of iron is just as dangerous for a child’s body as its deficiency. Therefore, self-medicating, you run the risk of seeing overdose symptoms – cramps, vomiting and diarrhea.

Modern iron preparations are available in easy to take forms such as syrups, drops and even chewable tablets. For mild anemia, oral medication is sufficient. Moreover, it is better to drink them with juice, and be sure to take them outside of food! If the anemia is severe, hospital treatment, parenteral administration of drugs, and sometimes even blood transfusion are indicated. Therefore, do not risk the health of children and, at the slightest suspicion, seek medical help.

Nutrition for anemia. Prevention of anemia

Understanding the mechanism of absorption of iron from various sources is important for the formation of the correct principles of nutrition for a child. The fact is that in red meat, liver and eggs, iron is contained in a quickly digestible form – the so-called heme (heme) iron. Plant foods (legumes, buckwheat, pomegranates) are a storehouse of non-heme (non-heme) iron, which is absorbed worse. Therefore, the child’s menu must contain meat (beef, rabbit – 30 grams per day), sea fish, eggs (1-2 pieces), berries and juices rich in ascorbic acid. It is ascorbic acid and animal protein that improve the absorption of iron (with simultaneous use 3 times!).