Anemia of Inflammation or Chronic Disease

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What is anemia of inflammation?

Anemia of inflammation, also called anemia of chronic disease or ACD, is a type of anemia that affects people who have conditions that cause inflammation, such as infections, autoimmune diseases, cancer, and chronic kidney disease (CKD).

Anemia is a condition in which your blood has fewer red blood cells than normal. Your red blood cells may also have less hemoglobin than normal. Hemoglobin is the iron-rich protein that allows red blood cells to carry oxygen from your lungs to the rest of your body. Your body needs oxygen to work properly. With fewer red blood cells or less hemoglobin, your body may not get enough oxygen.

In anemia of inflammation, you may have a normal or sometimes increased amount of iron stored in your body tissues, but a low level of iron in your blood. Inflammation may prevent your body from using stored iron to make enough healthy red blood cells, leading to anemia.

Anemia is a condition in which your blood has fewer red blood cells or less hemoglobin than normal.

Why is anemia of inflammation also called anemia of chronic disease?

Anemia of inflammation is also called anemia of chronic disease because this type of anemia commonly occurs in people who have chronic conditions that may be associated with inflammation.

Are there other types of anemia?

There are manytypes of anemia. Common types include

• iron-deficiency anemia, a condition in which the body’s stored iron is used up, causing the body to make fewer healthy red blood cells. In people with iron-deficiency anemia, iron levels are low in both body tissues and the blood. This is the most common type of anemia.
• pernicious anemia, which is caused by a lack of vitamin B12.
• aplastic anemia, a condition in which the bone marrow doesn’t make enough new red blood cells, white blood cells, and platelets because the bone marrow’s stem cells are damaged.
• hemolytic anemia, a condition in which red blood cells are destroyed earlier than normal.

How common is anemia of inflammation?

Anemia of inflammation is the second most common type of anemia, after iron-deficiency anemia.¹

Who is more likely to have anemia of inflammation?

While anemia of inflammation can affect people of any age, older adults are more likely to have this type of anemia because they are more likely to have chronic diseases that cause inflammation. In the United States, about 1 million people older than age 65 have anemia of inflammation.²

Does anemia of inflammation lead to other health problems?

Anemia of inflammation is typically mild or moderate, meaning that hemoglobin levels in your blood are lower than normal but not severely low. If your anemia becomes severe, the lack of oxygen in your blood can cause symptoms, such as feeling tired or short of breath. Severe anemia can become life-threatening.

In people who have CKD, severe anemia can increase the chance of developing heart problems.

What are the symptoms of anemia of inflammation?

Anemia of inflammation typically develops slowly and may cause few or no symptoms. In fact, you may only experience symptoms of the disease that is causing anemia and not notice additional symptoms.

Symptoms of anemia of inflammation are the same as in any type of anemia and include

• a fast heartbeat
• body aches
• fainting or feeling dizzy or light-headed
• feeling tired or weak
• getting tired easily during or after physical activity
• pale skin
• shortness of breath

What causes anemia of inflammation?

Experts think that when you have an infection or disease that causes inflammation, your immune system causes changes in how your body works that may lead to anemia of inflammation.

• Your body may not store and use iron normally.
• Your kidneys may produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells.
• Your bone marrow may not respond normally to EPO, making fewer red blood cells than needed.
• Your red blood cells may live for a shorter time than normal, causing them to die faster than they can be replaced.

Chronic conditions that cause anemia of inflammation

Many different chronic conditions can cause inflammation that leads to anemia, including

In people with certain chronic conditions, anemia may have more than one cause. For example

• Causes of anemia in CKD may include inflammation, low levels of EPO due to kidney damage, or low levels of the nutrients needed to make red blood cells. Hemodialysis to treat CKD may also lead to iron-deficiency anemia.
• People with IBD may have both iron-deficiency anemia due to blood loss and anemia of inflammation.
• In people who have cancer, anemia may be caused by inflammation, blood loss, and cancers that affect or spread to the bone marrow. Cancer treatments such as chemotherapy and radiation therapy may also cause or worsen anemia.

Other causes of inflammation that may lead to anemia

While anemia of inflammation typically develops slowly, anemia of critical illness is a type of anemia of inflammation that develops quickly in patients who are hospitalized for severe acute infections, trauma, or other conditions that cause inflammation.

In some cases, older adults develop anemia of inflammation that is not related to an underlying infection or chronic disease. Experts think that the aging process may cause inflammation and anemia.

How do health care professionals diagnose anemia of inflammation?

Health care professionals use a medical history and blood tests to diagnose anemia of inflammation.

Medical history

A health care professional will ask about your history of infections or chronic diseases that may lead to anemia of inflammation.

Blood tests

Health care professionals use blood tests to check for signs of anemia of inflammation, other types of anemia, or other health problems. A health care professional will take a blood sample from you and send the sample to a lab to test.

Blood count tests can check many parts and features of your blood, including

• the number of red blood cells
• the average size of red blood cells
• the amount of hemoglobin in your blood and in your red blood cells
• the number of developing red blood cells, called reticulocytes, in your blood

Some of these blood count tests and others may be combined in a test called a complete blood count. A blood smear may be used to examine the size, shape, and number of red blood cells in your blood.

A health care professional may also use blood tests to check the amount of iron in your blood and stored in your body. These tests may measure

• iron in your blood
• transferrin, a protein in your blood that carries iron
• ferritin, the protein that stores iron in your body’s cells

A health care professional may diagnose anemia of inflammation if blood test results suggest that you have anemia, a low level of iron in your blood, and a normal level of iron stored in your body tissues.

If blood test results suggest you have anemia of inflammation but the cause is unknown, a health care professional may perform additional tests to look for the cause.

For a blood test, a health care professional will take a blood sample from you and send the sample to a lab.

How do health care professionals treat anemia of inflammation?

Health care professionals treat anemia of inflammation by treating the underlying condition and by treating the anemia with medicines and occasionally with blood transfusions.

Treating the underlying condition

Health care professionals typically treat anemia of inflammation by treating the underlying condition that is causing inflammation. If treatments are available that can reduce the inflammation, the treatments may cause the anemia to improve or go away. For example, taking medicines to treat inflammation in rheumatoid arthritis can improve anemia.

Medicines

A health care professional may prescribe the erythropoiesis-stimulating agents (ESAs) epoetin alpha or darbepoetin alpha to treat anemia related to CKD, chemotherapy treatments for cancer, or certain treatments for HIV. ESAs cause the bone marrow to make more red blood cells. Health care professionals typically give ESAs as shots and may teach you how to give yourself these shots at home. A health care professional may prescribe iron supplements, given as pills or shots, to help ESAs work.

If you’re on hemodialysis, you may be able to receive intravenous (IV) ESAs and iron supplements during hemodialysis. Read more about treatments for anemia in CKD.

Blood transfusions

In some cases, health care professionals may use blood transfusions to treat severe anemia of inflammation. A blood transfusion can quickly increase the amount of hemoglobin in your blood and boost oxygen.

Can I prevent anemia of inflammation?

Experts have not yet found a way to prevent anemia of inflammation. For some chronic conditions that cause inflammation, treatments may be available to reduce or prevent the inflammation that can lead to anemia. Talk with your doctor about treatments and follow the treatment plan your doctor recommends.

How does eating, diet, and nutrition affect anemia of inflammation?

If you have a chronic condition that is causing anemia of inflammation, follow the advice of your doctor or dietitian about healthy eating and nutrition.

Clinical Trials for Anemia of Inflammation

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions, including blood diseases.

What are clinical trials for anemia of inflammation?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of anemia of inflammation, including new treatments for this condition.

Find out if clinical studies are right for you.

What clinical studies for anemia of inflammation are looking for participants?

You can find clinical studies on anemia of inflammation at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the NIH does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

[1] Nemeth E, Ganz T. Anemia of inflammation. Hematology/Oncology Clinics of North America. 2014;28(4):671–681.

[2] Fraenkel PG. Anemia of inflammation: a review. The Medical Clinics of North America. 2017;101(2):285−296.

Anemia in Children | Cedars-Sinai

Not what you’re looking for?

What is anemia in children?

Anemia is a common problem in
children. About 20% of children in the U.S. will be diagnosed with anemia at some point.
A child who has anemia does not have enough red blood cells or hemoglobin. Hemoglobin is
a type of protein that allows red blood cells to carry oxygen to other cells in the
body.

There are many types of anemia.
Your child may have 1 of these:

• Iron
  deficiency anemia.This is not enough iron in the blood. Iron is needed to form hemoglobin. This is
  the most common cause of anemia. 
• Megaloblastic anemia.This is when red blood cells are too large from a lack of folic acid or vitamin
  B-12. One type of megaloblastic anemia is pernicious anemia. In this type, there
  is a problem absorbing vitamin B-12, important to
  making red blood cells.
• Hemolytic
  anemia. This is when red blood cells are destroyed. There are many different causes,
  such as serious infections or certain medicines.
• Sickle cell
  anemia.This is a type of hemoglobinopathy, an inherited type of anemia with
  abnormally-shaped red blood cells.
• Cooley’s
  anemia (thalassemia). This is another inherited type of anemia with
  abnormal red blood cells.
• Aplastic
  anemia.This is failure of the bone marrow to make blood cells.

What causes anemia in a child?

Anemia has 3 main causes:

• Loss of red blood cells
• Inability to make enough red blood cells
• Destruction of red blood cells

Decreased red blood cells or hemoglobin levels may be due to:

• Inherited red blood cell defects
• Infections
• Some diseases
• Certain medicines
• Lack of some vitamins or minerals in the diet

Which children are at risk for anemia?

Risk factors for anemia include:

• Premature or low birth weight
• Living in poverty or immigrating from developing country
• Early use of cow’s milk
• Diet low in iron, or some vitamins or minerals
• Surgery or accident with blood loss
• Long-term illnesses, such as infections, or kidney or liver disease
• Family history of an inherited type of anemia, such as sickle cell anemia

What are the symptoms of anemia in a child?

Most symptoms of anemia are due to
the lack of oxygen in the cells. Many of the symptoms do not occur with mild anemia.

These are the most common symptoms:

• Increased heart rate
• Breathlessness, or trouble catching a breath
• Lack of energy, or tiring easily
• Dizziness, or vertigo, especially when standing
• Headache
• Irritability
• Irregular menstrual cycles
• Absent or delayed menstruation
• Sore or swollen tongue
• Jaundice, or yellowing of skin, eyes, and mouth
• Enlarged spleen or liver
• Slow or delayed growth and development
• Poor wound and tissue healing

The symptoms of anemia may look like other blood problems or health conditions.  Anemia is often a symptom of another disease. Be sure to report any symptoms to your child’s doctor. Always see your child’s doctor for a diagnosis.

How is anemia diagnosed in a child?

Because anemia is common in
children, doctors do routine screening for it. Plus, it often has no symptoms. Most
anemia in children is diagnosed with these blood tests:

• Hemoglobin
  and hematocrit. This is often the first screening test for anemia in
  children. It measures the amount of hemoglobin and red blood cells in the blood.
• Complete
  blood count (CBC).A complete blood count checks the red and white blood cells, blood clotting
  cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes
  hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral
  smear. A small sample of blood is examined under a microscope to see if they look
  normal.

To get a blood sample, a healthcare
provider will insert a needle into a vein, usually in the child’s arm or hand. A
tourniquet may be wrapped around the child’s arm to help the healthcare provider find a
vein. Blood is drawn up into a syringe or a test tube. In some cases, blood can be taken
using a needle prick.

Blood tests may cause a little
discomfort while the needle is inserted. It may cause some bruising or swelling. After
the blood is removed, the healthcare provider will remove the tourniquet, put pressure
on the area, and put on a bandage.

Depending on the results of the
blood tests, your child may also have a bone marrow aspiration, biopsy, or both. This is
done by taking a small amount of bone marrow fluid (aspiration) or solid bone marrow
tissue (core biopsy). The fluid or tissue is examined for the number, size, and maturity
of blood cells or abnormal cells. 

How is anemia in a child treated?

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

The treatment for anemia depends on the cause. Some types do not require treatment. Some types may require medicine, blood transfusions, surgery, or stem cell transplants. Your child’s healthcare provider may refer you to a hematologist. This is a specialist in treating blood disorders. Treatment may include:

• Vitamin and mineral drops or pills
• Changing your child’s diet
• Stopping a medicine that causes anemia
• Medicine
• Surgery to remove the spleen
• Blood transfusions
• Stem cell transplants

What are possible complications of anemia in a child?

The complications of anemia depend on what is causing it. Some types have few complications, but others have frequent and serious complications. Some anemias may cause:

• Problems with growth and development
• Joint pain and swelling
• Bone marrow failure
• Leukemia or other cancers

What can I do to prevent anemia in my child?

Some types of anemia are inherited
and can’t be prevented. Iron deficiency anemia, a common form of anemia, may be
prevented by making sure your child gets enough iron in his or her diet. To do this:

• Breastfeed your baby if
  possible. He or she will get enough iron from the breastmilk.
• Give formula with iron. If
  your child is on formula, use formula with added iron.
• Don’t give cow’s milk until after
  age 1. Cow’s milk does not have enough iron. It should not be given to babies
  until after 1 year of age, when he or she is eating enough other food.
• Feed your child iron-rich
  foods. When your child eats solid foods, choose foods that are good sources of
  iron. These include iron-enriched grains and cereals, egg yolks, red meats, potatoes,
  tomatoes, and raisins.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if you notice that your child has any of the symptoms of anemia. And, if your child has not been checked for anemia, talk with the provider about your child’s risk of getting it.

Key points about anemia in children

• Anemia is a low red blood cell count or a low hemoglobin level.
• There are many different causes of anemia.  
• Children are usually screened for anemia. Often there are no symptoms.
• The treatment of anemia depends on what is causing it.

Next steps

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

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

Not what you’re looking for?

10 Common Causes & What to Ask

Have you ever been told that an older relative has anemia?

Or perhaps you noticed the red blood cell count flagged as “low” in the bloodwork report? Or noticed “low hemoglobin” in a doctor’s report?

Anemia means having a red blood cell count that is lower than normal, and it’s very common in older adults. About 10% of independently living people over age 65 have anemia. And anemia becomes even more common as people get older.

But many older adults and families hardly understand anemia.

This isn’t surprising: anemia is associated with a dizzying array of underlying health conditions, and can represent anything from a life-threatening emergency to a mild chronic problem that barely makes the primary care doctor blink.

Still, it worries me that older adults and families don’t know more about anemia. If you or your relative has this condition, it’s important to understand what’s going on and what the follow-up plan is. (I’ve so often discovered that a patient didn’t know he or she had had anemia!) Misunderstanding anemia can also lead to unnecessary worrying, or perhaps even inappropriate treatment with iron supplements.

Featured Download: What to Ask Your Health Providers About Anemia. Use this free PDF to make sure you ask key questions about your anemia condition, including what’s been done to diagnose the cause, and what the plan is for treatment. Click here to download.

And since anemia is often caused by some other problem in the body, not understanding anemia often means that people don’t understand something else that is important regarding their health.

Fortunately, you don’t have to be a doctor to have a decent understanding of the basics of anemia.

This post will help you understand:

• How anemia is detected and diagnosed in aging adults.
• Symptoms of anemia.
• The most common causes of anemia, and tests often used to check for them.
• What to ask the doctor.
• How to get better follow-up, if you or your relative is diagnosed with anemia.

Defining and detecting anemia

Anemia means having a lower-than-normal count of red blood cells circulating in the blood.

Red blood cells are always counted as part of a “Complete Blood Count” (CBC) test, which is a very commonly ordered blood test.

A CBC test usually includes the following results:

• White blood cell count (WBCs): the number of white blood cells per microliter of blood
• Red blood cell count (RBCs): the number of red blood cells per microliter of blood
• Hemoglobin (Hgb): how many grams of this oxygen-carrying protein per deciliter of blood
• Hematocrit (Hct): the fraction of blood that is made up of red blood cells
• Mean corpuscular volume (MCV): the average size of red blood cells
• Platelet count (Plts): how many platelets (a smaller cell involved in clotting blood) per microliter of blood

(For more information on the CBC test, see this Medline page. For more on common blood tests, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.)

By convention, to detect anemia clinicians rely on the hemoglobin level and the hematocrit, rather than on the red blood cell count.

A “normal” level of hemoglobin is usually in the range of 14-17gm/dL for men, and 12-15gm/dL for women. However, different laboratories may define the normal range slightly differently.

A low hemoglobin level — meaning, it’s below normal — can be used to detect anemia.  Clinicians often confirm the lower hemoglobin level by repeating the CBC test.

If clinicians detect anemia, they usually will review the mean corpuscular volume measurement (included in the CBC) to see if the red cells are smaller or bigger than normal. We do this because the size of the red blood cells can help point doctors towards the underlying cause of anemia.

Hence anemia is often described as:

• Microcytic: red cells smaller than normal
• Normocytic: red cells of a normal size
• Macrocytic: red cells larger than normal

Symptoms of anemia

The red blood cells in your blood use hemoglobin to carry oxygen from your lungs to every cell in your body. So when a person doesn’t have enough properly functioning red blood cells, the body begins to experience symptoms related to not having enough oxygen.

Common symptoms of anemia are:

• fatigue
• weakness
• shortness of breath
• high heartrate
• headaches
• becoming paler, which is often first seen by checking inside the lower lids
• lower blood pressure (especially if the anemia is caused by bleeding)

However, it’s very common for people to have mild anemia — meaning a hemoglobin level that’s not way below normal — and in this case, symptoms may be barely noticeable or non-existent.

That’s because the severity of symptoms depends on two crucial factors:

• How far below normal is the hemoglobin level?
• How quickly did the hemoglobin drop to this level?

This second factor is very important to keep in mind. The human body does somewhat adapt to lower hemoglobin levels, but only if it’s given weeks or months to do so.

So this means that if someone’s hemoglobin drops from 12.5gm/dL to 10gm/dL (which we’d generally consider a moderate level of anemia), they are likely to feel pretty crummy if this drop happened over two days, but much less so if it developed slowly over two months.

People sometimes want to know how low the hemoglobin has to be for anemia to be “severe.” This really depends on the past medical history of the person and on how fast the hemoglobin dropped, but generally, a hemoglobin of 6.5 to 7.9 gm/dL is often considered “severe” anemia.

People also sometimes want to know how low can hemoglobin go before causing death. In general, a hemoglobin less than 6.5 gm/dL is considered life-threatening. But again, how long the body can tolerate a low hemoglobin depends on many factors, and including whether the hemoglobin is continuing to drop quickly (due an internal bleed, for instance) or is slowly drifting down.  A study of Jehovah’s Witnesses who died after refusing transfusions found that those with hemoglobins between 4. 1 to 5 gm/dL died, on average, about 11 days later.

The most common causes of anemia in aging adults

Whenever anemia is detected, it’s essential to figure out what is causing the low red blood cell count.

Compared to most cells in the body, normal red blood cells have a short lifespan: about 100-120 days. So a healthy body must always be producing red blood cells. This is done in the bone marrow and takes about seven days, then the new red blood cells work in the blood for 3-4 months. Once the red blood cell dies, the body recovers the iron and reuses it to create new red blood cells.

Anemia happens when something goes wrong with these normal processes. In kids and younger adults, there is usually one cause for anemia. But in older adults, it’s quite common for there to be several co-existing causes of anemia.

A useful way to think about anemia is by considering two categories of causes:

• A problem producing the red blood cells, and/or
• A problem losing red blood cells

Here are the most common causes of low hemoglobin for each category:

Problems producing red blood cells. These includes problems related to the bone marrow (where red blood cells are made) and deficiencies in vitamins and other substances used to make red blood cells. Common specific causes include:

• Chemotherapy or other medications affecting the bone marrow cells responsible for making red blood cells.
• Iron deficiency. This occasionally happens to vegetarians and others who don’t eat much meat. But it’s more commonly due to chronic blood loss, such as heavy periods in younger women, or a slowly bleeding ulcer in the stomach or small intestine, or even a chronic bleeding spot in the colon.
• Lack of vitamins needed for red blood cells. Vitamin B12 and folate are both essential to red blood cell formation.
• Low levels of erythropoietin. Erythropoietin is usually produced by the kidneys, and helps stimulate the bone marrow to make red blood cells. (This is the “epo” substance used in “blood doping” by unethical athletes. ) People with kidney disease often have low levels of erythropoietin, which can cause a related anemia.
• Chronic inflammation. Many chronic illnesses are associated with a low or moderate level of chronic inflammation. Cancers and chronic infections can also cause inflammation. Inflammation seems to interfere with making red blood cells, a phenomenon known as “anemia of chronic disease.”
• Bone marrow disorders. Any disorder affecting the bone marrow or blood cells can interfere with red blood cell production and hence cause anemia.

Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:

• Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
• Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
• Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
• Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.

There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.

A major study of causes of anemia in non-institutionalized older Americans found the following:

• One-third of the anemias were due to deficiency of iron, vitamin B12, and/or folate.
• One-third were due to chronic kidney disease or anemia of chronic disease.
• One-third of the anemias were “unexplained.”

How doctors evaluate anemia

Once anemia is detected, it’s important for health professionals to do some additional evaluation and follow-up, to figure out what might be causing the anemia.

Understanding the timeline of the anemia — did it come on quickly or slowly? Is the red blood count stable or still trending down with time? — helps doctors figure out what’s going on, and how urgent the situation is.

Common follow-up tests include:

• Checking the stool for signs of microscopic blood loss
• Checking a ferritin level (which reflects iron stores in the body)
• Checking vitamin B12 and folate levels
• Checking kidney function, which is initially done by reviewing the estimated glomerular filtration rate (included in most basic bloodwork results)
• Checking the reticulocyte count, which reflects whether the bone marrow trying to produce extra red blood cells to compensate for anemia
• Checking levels of an “inflammation marker” in the blood, such as the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
• Evaluation of the peripheral smear, which means the cells in the blood are examined via microscope
• Urine tests, to check for proteins associated with certain blood cell disorders

If the anemia is bad enough, or if the person is suffering significant symptoms, doctors might also consider a blood transfusion. However, although even mild anemia has been associated with worse health outcomes, research suggests that transfusing mild to moderate anemia generally isn’t beneficial. (This issue especially comes up when people are hospitalized or acutely ill.)

What to ask the doctor about anemia

Featured Download: What to Ask Your Health Providers About Anemia. Use this free PDF to make sure you ask key questions about your anemia condition, including what’s been done to diagnose the cause, and what the plan is for treatment. Click here to download.

If you are told that you or your older relative has anemia, be sure you understand how severe it seems to be, and what the doctors think might be causing it. This will help you understand the plan for follow-up and treatment.

Some specific questions that can be handy include:

• How bad is this anemia? Does it seem to be mild, moderate, or severe?
• What do you think is causing it? Could there be multiple causes or factors involved?
• How long do you think I’ve had this anemia? Does it seem to be stable or is it getting worse?
• Is this the cause of my symptoms or do you think something else is causing my symptoms?
• Could any of my medications be involved?
• What is our plan for further evaluation?
• What is our plan for treating this anemia?
• When do you recommend we check the CBC again? What is our plan for monitoring the anemia?

Be sure to request and keep copies of your lab results. It will help you and your doctors in the future to be able to review your past labs related to anemia and any related testing.

Avoiding common pitfalls related to anemia and iron

A very common diagnosis in older adults is iron-deficiency anemia. If you are diagnosed with this type of anemia, be sure the doctors have checked a ferritin level or otherwise confirmed you are low on iron.

I have actually reviewed medical charts in which a patient was prescribed iron for anemia, but no actual low iron level was documented. This suggests that the clinician may have presumed the anemia was due to low iron.

However, although iron deficiency is common, it’s important that clinicians and patients confirm this is the cause, before moving on to treatment with iron supplements. Doctors should also assess for other causes of anemia, since it’s very common for older adults to simultaneously experience multiple causes of anemia (e.g. iron deficiency and vitamin B12 deficiency).

If an iron deficiency is confirmed, be sure the doctors have tried to check for any causes of slow blood loss.

It is common for older adults to develop microscopic bleeds in their stomach or colon, especially if they take a daily aspirin or a non-steroidal anti-inflammatory drug (NSAIDs) such as ibuprofen. (For this reason — and others — NSAIDs are on the Beer’s list of medications that older adults should use with caution.)

Bear in mind that iron supplements are often quite constipating for older adults. So you only want to take them if an iron-deficiency anemia has been confirmed, and you want to make sure any causes of ongoing blood loss (which causes iron loss) have been addressed.

The most important take home points on anemia in older adults

Here’s what I hope you’ll take away from this article:

1.Anemia is a very common condition for older adults, and often has multiple underlying causes.

2. Anemia is often mild-to-moderate and chronic; don’t let the follow-up fall through the cracks.

3. If you are diagnosed with anemia or if you notice a lower than normal hemoglobin on your lab report, be sure to ask questions to understand your anemia. You’ll want to know:

• Is the anemia chronic or new?
• Is it mild, moderate, or severe?
• What is thought to be the cause? Have you been checked for common problems such as low iron or low vitamin B12?

4. If you are diagnosed with low iron levels: could it be from a small internal bleed and could that be associated with aspirin, a non-steroidal anti-inflammatory medication such as ibuprofen, or another medication?

5. Keep copies of your lab reports.

6. Make sure you know what the plan is, for following your blood count and for evaluating the cause of your anemia.

Do you have questions about anemia in older adults? Please post them below!
Note: We have reached over 200 comments on this post, so comments will now be closed. If you have a question, chances are it’s already been asked and answered. Thank you!

You may also find it helpful to read these related articles:
Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults
How to Avoid Harm from Vitamin B12 Deficiency

Featured Download: What to Ask Your Health Providers About Anemia. Use this free PDF to make sure you ask key questions about your anemia condition, including what’s been done to diagnose the cause, and what the plan is for treatment. Click here to download.

This article was first published in 2016 & minor updates were made in Nov 2020. (The fundamentals of anemia in older adults don’t change much over time.)

Aplastic Anemia | Johns Hopkins Medicine

What is aplastic anemia?

Aplastic anemia occurs when your bone marrow doesn’t make enough red and white blood cells, and platelets. Having fewer red blood cells causes hemoglobin to drop.

Hemoglobin is the part of blood that carries oxygen through your body. Having fewer white blood cells makes you more likely to get an infection. And having fewer platelets makes the blood too thin. This means your blood can’t clot the way it should.

What causes aplastic anemia?

Aplastic anemia has many causes. Sometimes it occurs for no known reason. Other causes are linked to a previous illness or disorder. Acquired causes may include:

• History of certain infectious diseases (such as hepatitis, HIV, Epstein-Barr virus, CMV, or paravirus B19)

• History of taking certain medicines, such as antibiotics and anticonvulsants

• Exposure to certain toxins, such as heavy metals

• Exposure to radiation

• History of an autoimmune disease, such as lupus

• Inherited condition

Aplastic Anemia

Aplastic anemia occurs when your bone marrow doesn’t make enough red and white blood cells, and platelets. The body’s immune system is confused and begin to attack these critical performing cells.

Who is at risk for aplastic anemia?

Aplastic anemia can occur at any age. But it is more common among teens, young adults, and older adults. Your risk increases if you:

What are the symptoms of aplastic anemia?

Each person’s symptoms may vary. Symptoms may include:

• Headache

• Dizziness

• Upset stomach (nausea)

• Shortness of breath

• Bruising

• Lack of energy or tiring easily (fatigue)

• Abnormal paleness or lack of color in the skin

• Blood in stool

• Nosebleeds

• Bleeding gums

• Fevers

• Sore sinuses

• Enlarged liver or spleen

• White patches in the mouth (oral thrush)

These symptoms may look like other blood disorders or health problems. Always see your healthcare provider for a diagnosis.

How is aplastic anemia diagnosed?

Your healthcare provider will take your medical history and give you a physical exam. You may also have tests such as:

• Blood tests. These may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.

• Bone marrow aspiration or biopsy. This involves taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (called a core biopsy). These are usually taken from the hip bones. They are checked for the number, size, and maturity of blood cells or abnormal cells.

How is aplastic anemia treated?

Your healthcare provider will create a care plan based on:

• Your age, overall health, and medical history

• How sick you are

• How well you can handle certain medicines, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

Aplastic anemia is a serious illness. Treatment usually depends on the underlying cause. For certain causes, you may recover after treatment. But the condition can come back. To treat the low blood counts, early treatment may include:

• Blood transfusion (both red blood cells and platelets)

• Preventive antibiotic therapy

• Good hygiene to prevent infection

• Special care when making food (such as only eating well-cooked foods)

• Avoiding construction sites, which may be a source of certain fungi

• Medicines to stimulate the bone marrow to produce cells

• Treatment to reduce your body’s immune system response

• Hormone therapy

In certain people, a bone marrow transplant may cure aplastic anemia.

Living with aplastic anemia

Managing aplastic anemia includes working closely with your healthcare provider and following your treatment plan. Be sure to tell your healthcare provider about any symptoms you are having. You are more at risk of infections so you should:

• Stay away from people who are sick

• Avoid large crowds

• Wash your hands often

• Avoid foods that are not cooked all the way through

• Brush your teeth regularly

• Get your annual flu shot

• Develop a physical fitness plan with your provider

Key points about aplastic anemia

• Aplastic anemia occurs when your bone marrow doesn’t make enough red and white blood cells, and platelets.

• This condition can make you feel tired, raise your risk of infections, and make you bruise or bleed more easily.

• To treat the low blood counts, early treatment involves easing symptoms.

• Treatments may include blood transfusions, antibiotics, medicines to stimulate bone marrow production, and other therapies.

• In some cases, a bone marrow transplant may cure aplastic anemia.

Anemia of Chronic Kidney Disease

Topic Overview

What is anemia of chronic kidney disease?

Anemia means that you do not have enough red blood cells. Red blood cells carry oxygen from your lungs to your body’s tissues. If your tissues and organs do not get enough oxygen, they cannot work as well as they should.

Anemia is common in people who have chronic kidney disease. It can make you feel weak and tired. With treatment, you may feel better and enjoy life more.

What causes anemia of chronic kidney disease?

Red blood cells are made by the bone marrow. To get the marrow to make red blood cells, the kidneys make a hormone called erythropoietin, or EPO. When the kidneys are damaged, they may not make enough EPO. Without enough EPO, the bone marrow does not make enough red blood cells, and you have anemia.

In most cases, the more damaged the kidneys are, the more severe the anemia is. In general, people whose kidneys are working at one-third or less of their normal level may get anemia.

What are the symptoms?

Anemia may develop early in kidney disease, but you may not have symptoms until the late stages of the disease.

As anemia gets worse, you may:

• Feel weak and tire out more easily.
• Feel dizzy.
• Be irritable.
• Have headaches.
• Look very pale.
• Feel short of breath.
• Have trouble concentrating.

How is anemia of chronic kidney disease diagnosed?

Your doctor can check for anemia by doing two blood tests:

• Hemoglobin (Hgb) test. This test measures the level of hemoglobin in your blood. Hemoglobin is the substance in red blood cells that carries oxygen. This is the best test for anemia.
• Hematocrit (Hct). A hematocrit test shows your doctor how much of your blood is made up of red blood cells.

Your doctor will repeat these tests to see how well treatment is working.

How is it treated?

The two main treatments for anemia in kidney disease are erythropoietin (EPO) and iron.

• If tests suggest that your kidneys are not making enough EPO, you may need a man-made form of this hormone. It is called an erythropoietin-stimulating agent (ESA). This medicine is most often given as a shot under the skin (subcutaneous).
• To build the iron levels in your body, you may need to take iron pills or get iron through an injection into a vein (IV).

Both treatments can be given through an IV during dialysis.

Other possible treatments include:

• Vitamin B12 or folic acid supplements. You can take vitamin B12 by mouth, as a nasal spray or gel, or as a shot into the muscle. Folic acid comes in pill form.
• Diet changes. Ask your doctor if eating more foods high in iron, folic acid, and vitamin B12 could help your anemia. But don’t make changes to your diet until you talk to your doctor first.
• In rare cases, a blood transfusion. A blood transfusion gives you new blood or parts of blood you need, such as red blood cells. But this is done only if your anemia is severe.

Credits

Current as of: December 17, 2020

Author: Healthwise Staff
Medical Review: Martin J. Gabica MD – Family Medicine
Kathleen Romito MD – Family Medicine
Mitchell H. Rosner MD – Nephrology

Current as of: December 17, 2020

Anemia and blood testing for hemoglobin

Methods of hematocrit & hemoglobin testing 

Hemoglobin and hematocrit can be measured by a variety of methodologies. Point-of-care (POC) testing in hematology has continued to grow in popularity; the uptake throughout the world and rapid improvements in technology has led to the development of several devices. The measurement of hemoglobin is the most used parameter in POC hematology.8)

Cyanmethemoglobin (HiCN) – the reference method

The cyanmethemoglobin method works on the principle of conversion of hemoglobin to cyanmethemoglobin by the addition of potassium cyanide and ferricyanide whose absorbance is measured at 540 nm in a photometer against a standard solution. ⁽⁹⁾

Based on the first initiatives to standardize this method by Drabkin and Austin the “International Committee for Standardization in Haematology“ (ICSH) was founded in 1964. ICSH was given the task to develop recommendations for the measurement of hemoglobin which were then published in 1967. The CLSI (at that time NCCLS) converted these recommendations into a formal standard named NCCLS h25-A3. Both NCCLS and ICSH use the same method.

Today the HiCN method is still in routine use in laboratories in rural countries but being time consuming and dependent on cyanide (toxic) agents it is predominantly used as a reference method for the calibration of modern POC hemoglobin devices and lab analyzers.

Standardized, stable reference material is used for the calibration and ensures traceability of POC results back to the international reference method.

Vanzetti´s azide methemoglobin method

The first generation of portable POC hemoglobin devices with single use, dry reagent cuvettes operates based on a modification of Vanzetti´s azide methemoglobin method (EKF Hemo Control). The blood is drawn into the cuvette by capillary action and the walls of the red blood are destroyed (hemolysed) by the reagent. The free hemoglobin is oxidized to methemoglobin which is then converted into azide methemoglobin, a stable colored complex. This complex is then measured photometrically at 570 nm and at 880 nm for compensation of turbidity. A measurement takes between 15 – 60 seconds, depending on the hemoglobin concentration. All hemoglobin variants are converted (except SulfHb) and stable results are obtained during the ten minutes after filling the cuvette, shown in repetitive measurements. A high sensitivity and specificity has been described for this method ⁽⁹⁾ and today it is the most common and established POC method for measuring hemoglobin in clinical as well as in blood collection settings.

Reagent-less methods

A constant draw-back of the azide methemoglobin method is the susceptibility of the reagent to humidity, especially in challenging climate conditions. Cuvettes need to be stored in a carefully closed canister with desiccant and removed directly before usage. The shelf-life after opening the canister is limited to three months. POC devices using reagent-less cuvettes have been developed to overcome these limitations. The first device using reagent-less cuvettes was the HemoCue® 301, launched in 2006. It measures the absorbance of whole blood photometrically at a wavelength of 506 nm, and at 880 nm for turbidity compensation. At 506 nm the two main hemoglobin derivatives, oxy-hemoglobin (HbO2) and deoxy-hemoglobin (Hb) have their isosbestic point, a wavelength in which the absorbance of two or more species are the same. The DiaSpect Hemoglobin T and DiaSpect Tm use a slightly different technology. A white LED is flashed briefly and the light beam passes through the sample to a specially designed optical sensor element. The sensor detects the absorbance of the blood sample at a broad wavelength range to get an overall picture of the absorbance spectrum. A patented light trap prevents scattered light from arriving at the sensor. This is essential in order to obtain accurate results when measuring non-hemolyzed blood. Additional advantages besides the use of reagent-less cuvettes with long shelf lives (up to 2.5 years) are ease of use, a rapid measurement time of just about one second and a long standing time of the in-built rechargeable battery of 40 days in use.

Non-invasive methods

Recently, non-invasive methods have become commercially available using near-infrared spectroscopy to identify the spectral pattern of Hb in an underlying blood vessel and derive a measurement of Hb concentration.

Other non-invasive devices use white light and capture the reflected transmission data in order to measure Hb levels in tissue capillaries or multiple wavelength light absorption to calculate the Hb concentration. A finger-clip or ring is used to apply the sensor.

Given the advantage of obsolescence of finger-sticks and the option for more frequent measurements in clinical settings, the literature remains unclear about the precision and accuracy of the current non-invasive hemoglobin monitors. In practical use, patient movement, nail polish, skin color or ambient light have been shown to influence the measurement.¹⁰

Read our full guide to hemoglobin testing methods

Other methods of hematocrit & hemoglobin testing

Visual methods:

Sahli´s method

Sahli’s manual hemoglobinometer contains a comparator, hemoglobin tube, hemoglobin pipette and stirrer.

Hemoglobin is converted to acid hematin by the action of HCL. The acid hematin solution is further diluted until its color matches exactly with that of the permanent standard of the comparator block. The hemoglobin concentration is read directly from the calibration tube. In developing countries like India, Sahli’s method, invented in 1902, is still the most common method used for hemoglobin estimation. The method is simple and cheap but rather inaccurate. The color developed is unstable and must be read after 10 minutes standing. There is inter-observer variability and the use of manual pipetting makes it prone to errors and there is no international standard.⁹

WHO color scale (HbCS)

The HbCS relies on comparing the color of a drop of blood absorbed on a test strip of special chromatography paper with standard colors on a laminated card displayed in increments of 2g/dL (20 g/L).

The cost per test is very low and apart from materials for taking the blood sample no technical equipment is needed. However, the visual comparison is susceptible to inter-observer variability and a low sensitivity has been found in some studies.⁹

Copper sulphate (CuSO4)

The copper sulphate method is mostly used to ensure a certain Hb level for blood donation. It is based on the hemoglobin dependent gravity of blood. A blood droplet is allowed to fall into copper sulphate solution of a specific gravity, equivalent to that of blood with the cut-off hemoglobin level, e. g. 12.5 g/dL (125 g/L). If the drop of blood sinks to the bottom in an acceptable amount of time, the donor qualifies. If the drop of blood floats or takes too long to sink, the donor is deferred.

The CuSO4 method is hampered by a lack of quality control, problems with disposal of the biohazardous solutions and erroneous results in individuals with a very high serum protein concentration. Furthermore, there are concerns that the CuSO4 method might give falsely high deferral (i.e. ‘false-fail’) rates for donors, particularly in women.⁸ It is a common practice in many settings to re-test donors who failed in the CuSO4 test with a quantitative measurement.

Quantitative methods:

Hematology analyzer / CBC

Automated hematology analyzers can provide a high precision, enable high sample through-puts and analyze a number of different types of red and white blood cells (3-part, 5-part or 7-part differential), blood platelets, hemoglobin and hematocrit levels from the same blood sample.

But the investment costs for the analyzer are high and it may not be suitable outside a laboratory environment. Skilled laboratory personal, regular maintenance and stable climate conditions are needed to operate hematology analyzers. In most instances, the sample needs to be sent to the laboratory causing longer turn-around times for the results.

Blood gas analyzer (BGA)

Blood gas analyzers are used to measure combinations of pH, blood gas (i.e. pCO2 and pO2), electrolytes and metabolites parameters from whole blood samples, mainly from arterial blood.

They are commonly used in critical care units, operating theatres, delivery wards and emergency rooms. Technical improvements like ready-to-use sensor cassettes and solution packs have made the usage of BGA much more convenient but maintenance is still required. Recently, hand-held devices with single use cartridges have become available but the cost per test is high compared to a POC hemoglobin meter – if Hb is the primary interest. Besides, some cartridges require cool storage and pre-warming before the test can be done.

Microhematocrit centrifuge 

Microhematocrit centrifuges are used to determine the blood’s hematocrit—the ratio of red cell volume to whole blood volume, expressed as a decimal, a fraction, or a percentage. Diagnosis of anemia or determination of donor eligibility based on hematocrit is a common practice in many countries. A capillary of blood is spun and the separated red blood cell and plasma segments are measured. In some applications the plasma from the capillary is used for further analysis, e .g. for proteins prior to plasma donation.

A conversion factor of x 3 can be used to calculate the approximate hematocrit level from a hemoglobin measurement of healthy person and vice versa.

Variability in reported hemoglobin values can be caused by a number of physiological factors and sampling mistakes. It is of great importance to establish a standardized procedure when measuring hemoglobin.

Physiological factors

When carrying out comparative Hb testing for studies or evaluations, the samples should be taken under identical conditions.

Capillary sampling technique

Both accuracy and reliability of hemoglobin measurements can be affected by pre-analytical errors. Following a standardized procedure, as well as operator training and practice, is essential to obtain correct results especially from capillary sampling (finger sticks).

Potential sources of error are:

Hematocrit – Complete Blood Count

Hematocrit – Complete Blood Count

 Hematocrit

The hematocrit,
also known as the “Hct“, “crit”
or PCV (packed cell volume) determines the percentage of red
blood cells in the plasma. The term hematocrit means “to separate blood.”
When the patient’s blood sample is spun in a centrifuge, the white blood cells
and platelets rise to the top in what is known as the “buffy coat.”
The heavier red blood cells sink to the bottom, where they can be calculated
as a percentage of the total blood sample.

Normal hematocrit values
are:

• Newborn: up to
  60%
• Adults: (males):
  40- 54%
• (Females): 36
  – 46%
• Pregnancy: decreased
  hematocrit, especially in the last trimester as
  plasma volume increases
• Children: varies
  with age

If the RBC
and the hemoglobin are both normal, it is possible to estimate
the hematocrit as being approximately three times the hemoglobin. For example,
a person whose hematocrit is 30% would have a hemoglobin of approximately 10
gm.

Instant
Feedback:

Pregnant
women normally have a drop in hematocrit in the last trimester of pregnancy.

Because the hematocrit
is a percentage of red blood cells, as compared to the total volume of blood,
any increase or decrease in plasma volume affects the hematocrit.
A patient with a severe burn loses huge amounts of plasma from damaged capillaries.
As a result, the vascular space loses fluid in relation to cellular elements
and the patient’s hematocrit will be significantly increased.
A decreased hematocrit occurs due to overhydration, which lowers
the percentage of red blood cells in relation to the liquid plasma portion of
blood.

A hematocrit
is frequently done to assess the extent of significant blood loss. A hematocrit
that is done immediately after a hemorrhage usually does not show the extent
of RBC loss because at the time of the hemorrhage, plasma and red blood cells
are lost in equal proportions. However, within several hours after hemorrhage,
plasma volume increases due to a shift of interstitial fluid into the vascular
space. Red blood cells, however, cannot be replaced quickly, as the bone marrow
takes approximately ten days to produce mature red blood cells. As a result,
a hematocrit done several hours after a bleeding episode will
show a more accurate picture – the hematocrit will be decreased
because the plasma volume has compensated for fluid loss while the red blood
cells that have been lost cannot be replaced for days. It is important for the
nurse to remember that a hematocrit value must always be interpreted
in relation to the patient’s hydration status and to the time the sample was
drawn. When packed red blood cells are given to correct an anemia, the hematocrit
should rise approximately 3% for each unit transfused.

How a patient responds to
a low hematocrit depends on whether the blood loss is acute
or chronic. If a person with a normal blood cell volume loses blood suddenly
through a massive hemorrhage, the person may develop signs and symptoms of circulatory
shock; the blood pressure will fall and the patient will show signs of tissue
hypoxia and shock. However, a person with chronically low hemoglobin, such as
a patient on renal dialysis, may tolerate abnormally low hemoglobin. A major
reason for anemia in patients with renal failure is lack of erythropoetin to
stimulate bone marrow production.

Instant
Feedback:

Expect
a patient’s hematocrit to drop immediately after major hemorrhage.

Hematocrit: critical
low and high values:

• A hematocrit
  of less than 15% can result in cardiac failure
• A hematocrit
  of over 60% may result in spontaneous blood clotting

© RnCeus. com

90,000 Good hemoglobin is not yet an indicator

Are you tired out of the blue? Your body may be lacking iron.

Doctors say that many Belarusians experience iron deficiency, but they don’t even know about it.

– There are concepts of iron deficiency anemia and latent iron deficiency, – Tatyana Rachkova, head of the consulting department of the Minsk Clinical Consultative and Diagnostic Center , told the 1prof.by correspondent.

– Anemia is indicated by a low hemoglobin level, but a latent state is when the hemoglobin level is still normal, and iron stores are already depleted. One hundred percent confirmation of this condition is low ferritin levels. The development of iron deficiency can be caused by diseases of the gastrointestinal tract, and in women – gynecological problems. As practice shows, 30% of Belarusian women of reproductive age suffer from a latent form of iron deficiency, iron deficiency anemia occurs in 10%. This is a fairly large percentage, considering that I do not take into account pregnant and lactating women.

– What symptoms should make a person check the blood for ferritin and why is it about him?

– The level of ferritin always reflects the real picture of affairs, while serum iron is a rather subjective indicator, it can change for various reasons. As for the symptoms, it is better not to wait for them: any of us should have a routine blood test at least once a year.CBC and ferritin levels should be done overtime if you begin to feel unusual weakness during normal physical activity. Other common symptoms include: shortness of breath, a feeling of lack of air in a poorly ventilated room (although you previously tolerated such an environment quite calmly), light-headedness, brittle and depleted nails, hair loss, taste perversion: people want to eat dry buckwheat or chalk. To determine the cause of iron deficiency, it is necessary to undergo available examinations. For women, first of all, examination by a gynecologist is shown, since even heavy menstruation can gradually deplete iron stores. The second step is, as the people say, “swallow the probe”. The fact is that a biopsy performed during this procedure will help determine the problem that interferes with the absorption capacity of the stomach. If it is reduced, then, of course, a person will receive less of many useful substances, including iron.

– It turns out that people who eat meat with meat can have anemia?

– Of course.If the absorption capacity of the gastrointestinal tract changes, no matter how much beef or by-products we eat, the body will receive less than it needs.

– Let’s say the root cause has been eliminated. Can you replenish your iron stores with food alone?

– Not a single anemia can be treated solely by diet, since there is not enough iron in foods for the therapeutic effect. It requires taking special medications. When taken orally (pills), there will be no overdose: the body will remove the excess itself.An excess of iron, which is also dangerous to health, can cause intramuscular and intravenous injections. Therefore, you can not self-medicate, injections must be done strictly according to the appointment and under the supervision of a doctor.

– Are there any peculiarities of the development of iron deficiency in children?

– Yes. For example, babies whose mothers experienced a lack of an element during pregnancy are at risk. It should also be borne in mind that children of the first year of life grow very quickly and they need more iron than adults.That is why pediatricians advise to introduce complementary foods from the age of six months: oddly enough, but breast milk today contains less iron than special milk formulas. Another deficiency can provoke frequent infectious diseases (they require more iron intake). That is, if a child is healthy and is on an adequate, balanced diet, then, most likely, iron deficiency does not threaten him. But in any case, a blood test is required once a year for babies.

– You mentioned “adequate” nutrition. Is vegetarianism a risk factor or is it the norm?

– My answer is this. Iron is absorbed more intensively by our body in a bivalent (heme) form. Animal products contain just such iron, as well as essential amino acids and protein, which is necessary for the iron to be incorporated exactly where it needs to be. Plant food contains only ferric iron, that is, it is obviously absorbed much worse.If a vegetarian also has some concomitant health problems, we will definitely go to iron deficiency. I cannot dictate to a person his diet. But as a doctor, I am obliged to warn about such a development of events. It is clear that you do not need to overuse protein, but a complete rejection of it is also bad. Constantly replenishing iron with synthetic drugs is not an option. Iron in the form of tablets and vitamins is in a sense alien to the body. In fact, it is a corrosive chemical element that can cause micro-erosion during absorption. It is one thing when it is prescribed for medicinal purposes, and quite another when a person himself decided to make fun of the body, replacing food with a drug.

– Nowadays, doctors often prescribe a general blood test with an expanded leukocyte count. What it is?

– The general analysis includes only indicators of hemoglobin, platelets, leukocytes and erythrocytes. And they can be quite normal due to the adaptive capabilities of the body. And in the leukocyte formula, the percentage of various types of leukocytes is determined, which makes it possible to suspect even the prerequisites for a problem or a disease in the initial stage.Therefore, I insist on just such a detailed analysis.

– We spoke with you about low hemoglobin. And what does the increased indicator indicate?

– About the fact that you need to draw attention to yourself. Many rejoice seeing in the analyzes a very high level and in vain. This condition is called symptomatic erythrocytosis. First of all, smokers are susceptible to it (due to the constant lack of oxygen in the tissues), people with high blood pressure. In addition, high hemoglobin is associated with the risk of dangerous thrombotic situations.Therefore, even with a high level of hemoglobin, it is necessary to consult a specialist. It is also necessary to mention such an important indicator as platelets, I note that earlier this indicator was not included in a regular blood test. Now such research is required. And this is very good. For example, a low level of platelets (over 50 thousand) in ordinary life does not manifest itself in any way. But this is the first indicator of the risk of bleeding, which can reveal itself only with surgery. Therefore, I repeat once again: do not neglect preventive tests and take care of yourself.

Interviewed by Elena ORLOVA

Source: https://1prof.by/news/society/khoroshii_gemoglobin__eshche_ne_pokazatel_.html © 1prof.by

Low hemoglobin level

Low hemoglobin level is a common finding in blood tests. Hemoglobin (referred to as Hb or Hgb in test forms) is a blood protein found in red blood cells that carry oxygen throughout the body. Many people have a slight decrease in hemoglobin levels, which does not affect the well-being of the person himself.Anemia is a more serious condition in which there are other symptoms in addition to a decrease in hemoglobin levels.

A low hemoglobin level is considered to be less than 13.5 grams per deciliter of blood (or 135 grams per liter of blood) in men and less than 12 grams per deciliter of blood (or 120 grams per liter of blood) in women. In children, the values ​​of normal and low hemoglobin levels depend on age and gender.

A slight decrease in the level of hemoglobin in the peripheral blood is not always a sign of the disease.For some people, this condition may be a normal variant. For example, low hemoglobin levels are common in pregnant women.

Low hemoglobin levels can be associated with various diseases or conditions of the body that lead to a decrease in the number of red blood cells in the peripheral blood (erythrocytopenia).

Erythrocytopenia may result from the fact that:

• The body produces fewer red blood cells than usual
• Red blood cells are destroyed faster than new ones are formed
• There was massive blood loss

Causes of low hemoglobin level

Diseases and conditions that lead to a decreased content of red blood cells, and therefore to a decrease in the level of hemoglobin in the blood:

• Malignant (cancerous) tumors
• Anemia due to vitamin deficiency
• Iron deficiency anemia
• Aplastic anemia
• Cirrhosis of the liver
• Hodgkin’s lymphoma
• Hypothyroidism
• Chronic kidney disease
• Cystitis
• Gastritis
• Leukemia
• Multiple myeloma
• Myelodysplastic syndrome
• Taking certain medications (antiretroviral drugs for treating HIV infection, chemotherapy for treating cancer, etc.)

Diseases and conditions that lead to accelerated destruction of red blood cells, and therefore to a decrease in the level of hemoglobin in the blood:

• Splenomegaly
• Porphyria
• Urinary tract infections
• Thalassemia
• Vasculitis
• Hemolysis
• A decrease in hemoglobin levels is also possible with significant blood loss during:
• Bleeding from a wound or wounds
• Bleeding from a stomach or duodenal ulcer
• Bleeding from intestinal tumor
• Bleeding from the anal canal, for example with hemorrhoids
• Bleeding from the urinary tract
• Frequent blood donation
• Heavy menstrual bleeding

90,079 90,000 OAM UAC Bx blood.Make an appointment in Orekhovo. Reception of a doctor in Orekhovo.

During life, each person has to pass all kinds of tests many times. However, does everyone know what tests are, for what purpose they are taken and what their results indicate?

Why do they take tests?

Laboratory analyzes help to assess the state of health of children and adults as objectively and fully as possible. Any change in the state of the human body causes changes in its biological fluids: blood, urine, saliva, etc.e. Many diseases in the early stages are completely asymptomatic, but they are already beginning to “send signals” into the blood, changing its biochemical parameters. These “signals” can be easily identified by taking tests. Due to this, the disease, detected even before the onset of clinical symptoms, is much easier to treat. Most often, a clinical blood test and a general urine test are taken. The results of these analyzes in the most general form show whether a particular person is healthy or not.
What is a CBC?
Clinical, or general analysis – one of the most commonly used blood tests for the diagnosis of various diseases.

Complete blood count. Decoding, normal indicators.
General blood test norms
Hemoglobin
Reasons for an increase in hemoglobin
Low hemoglobin – causes
Erythrocyte count
Reasons for a decrease in erythrocyte count
Reasons for an increase in erythrocyte count
Total leukocyte count
Reasons for an increase in leukocytes
Reasons for an increase in leukocytes
Reasons for an increase in leukocytes
Reasons for an increase hematocrit
MCH, MCHC, MCV, color index (CP) – norm
Leukocyte formula
Neutrophils
What is the left and right shift of the leukocyte formula?
Eosinophils
Reasons for an increase in blood eosinophils
Reasons for a decrease in eosinophils
Monocytes
Reasons for an increase in monocytes (monocytosis)
Reasons for a decrease in monocytes (monocytopenia)
Basophils
Reasons for an increase in blood basophils
Reasons for an increase in lymphocytes
Reasons for an increase in lymphocytes
Platelets
Reasons for an increase in platelets
A decrease in platelet levels
ESR erythrocyte sedimentation rate
ESR rates
Reasons for an ESR increase
Reasons for a decrease in ESR
General blood count rates for adults

Complete blood count

We all had a general blood test at least once in our life.And each person was faced with a misunderstanding of what is written on the form, what do all these numbers mean? How to understand why this or that indicator is increased or decreased? How can an increase or decrease, for example, of lymphocytes threaten? Let’s look at everything in order.
A complete blood count is the basis for the diagnosis of most of the known diseases. Many of its indicators can form the basis for the final diagnosis and the correct prescription of adequate treatment. In the event that you received the results of your blood test, you can check them against the norm by going to the section of the article in which the table is provided with normal indicators.

Norms of a general blood test

Table of normal indicators of a general blood test
Analysis indicator Norm
Hemoglobin Men: 130-170 g / l
Women: 120-150 g / l
Red blood cell count Men: 4.0-5.0 1012 / l
Women: 3 , 5-4.7 × 1012 / l
Leukocyte count Within 4.0-9.0 × 109 / l
Hematocrit (ratio of plasma volume to blood cell elements) Men: 42-50%
Women: 38-47%
Average erythrocyte volume Within 86-98 μm3
Leukocyte formula Neutrophils:
Segmented forms 47-72%
Stab forms 1-6%
Lymphocytes: 19-37%
Monocytes: 3-11%
Eosinophils: 0.5- 5%
Basophils: 0-1%
Platelet count Within 180-320 109 / L
Erythrocyte sedimentation rate (ESR) Men: 3-10 mm / h
Women: 5-15 mm / h
Hemoglobin
Hemoglobin ( Hb) is a protein containing an iron atom that is capable of attaching and carrying oxygen.Hemoglobin is found in red blood cells. The amount of hemoglobin is measured in grams / liter (g / l). Determining the amount of hemoglobin is very important, since with a decrease in its level, the tissues and organs of the whole body experience a lack of oxygen.
The norm of hemoglobin in children and adults
age sex Units of measurement – g / l
Up to 2 weeks 134 – 198
from 2 to 4.3 weeks 107 – 171
from 4.3 to 8.6 weeks 94 – 130
from 8.6 weeks to 4 months 103 – 141
from 4 to 6 months 111 – 141
from 6 to 9 months 114 – 140
from 9 to 1 year 113 – 141
from 1 year to 5 years 100 – 140
from 5 to 10 years 115 – 145
from 10 to 12 years 120 – 150
from 12 to 15 years women 115 – 150
men 120 – 160
from 15 to 18 years old women 117 – 153
men 117 – 166
from 18 to 45 years old women 117 – 155 90 144 men 132 – 173 90 144 from 45 to 65 years old women 117 – 160 90 144 men 131 – 172 90 144 after age 65 women 120 – 161 90 144 men 126 – 174

Reasons for an increase in hemoglobin

Dehydration (decreased fluid intake, profuse sweating, impaired renal function, diabetes mellitus, diabetes insipidus, profuse vomiting or diarrhea, use of diuretics)
Congenital heart or lung defects
Pulmonary failure or heart failure
Kidney disease (benign renal artery stenosis, renal artery stenosis, kidney tumors)
Diseases of the hematopoietic organs (erythremia)
Low hemoglobin – causes
Anemia
Leukemia
Congenital blood diseases (sickle cell anemia, thalassemia)
Lack of iron
Lack of vitamins
Depletion of the body
Red blood cells small blood cells.These are the most abundant blood cells. Their main function is to carry oxygen and deliver it to organs and tissues. Erythrocytes are presented in the form of biconcave discs. Inside the erythrocyte there is a large amount of hemoglobin – the main volume of the red disk is occupied by it.
Normal level of erythrocytes in children and adults
Age indicator x 1012 / l
newborn 3.9-5.5
from 1 to 3 days 4.0-6.6
in 1 week 3.9-6.3
in 2 weeks 3.6-6.2
in 1 month 3.0-5.4
in 2 months 2.7-4.9
from 3 to 6 months 3.1-4.5
from 6 months up to 2 years old 3.7-5.3
from 2 to 6 years old 3.9-5.3
from 6 to 12 years old 4.0-5.2
at 12-18 years old boys 4.5-5, 3
at 12-18 years old girls 4.1-5.1
Adult men 4.0-5.0
Adult women 3.5-4.7

Reasons for a decrease in the level of erythrocytes

A decrease in the number of red blood cells is called anemia.There are many reasons for the development of this condition, and they are not always associated with the hematopoietic system.
Errors in nutrition (food poor in vitamins and protein)
Blood loss
Leukemia (diseases of the hematopoietic system)
Hereditary fermentopathies (defects in enzymes that are involved in hematopoiesis)
Hemolysis (death of blood cells as a result of exposure to toxic substances and autoimmune causes of increase)
erythrocyte count
Dehydration (vomiting, diarrhea, profuse sweating, decreased fluid intake)
Erythremia (diseases of the hematopoietic system)
Diseases of the cardiovascular or pulmonary system, which lead to respiratory and heart failure
Renal artery stenosis

Total leukocyte count

Leukocytes are living cells of our body that circulate with the blood stream.These cells exercise immune control. In the event of an infection, damage to the body by toxic or other foreign bodies or substances, these cells fight against damaging factors. The formation of leukocytes occurs in the red bone marrow and in the lymph nodes. Leukocytes are divided into several types: neutrophils, basophils, eosinophils, monocytes, lymphocytes. Different types of leukocytes differ in appearance and functions performed during the immune response.
Norm of leukocytes in children and adults
Age
indicator x109 / L
up to 1 year 6.0 – 17.5
from 1 year to 2 years 6.0 – 17.0
from 2 to 4 years 5.5 – 15 , 5
from 4 to 6 years 5.0 – 14.5
from 6 to 10 years old 4.5 – 13.5
from 10 to 16 years old 4.5 – 13.0
after 16 years old and adults 4.0 – 9.0

Reasons for an increase in leukocytes

Physiological increase in the level of leukocytes
After eating
After active physical activity
In the second half of pregnancy
After vaccination
During menstruation
Against the background of an inflammatory reaction
Pyoinflammatory processes (abscess, phlegmon, bronchitis, sinusitis, appendicitis, etc.)
Burns and injuries with extensive soft tissue injury

Post-operation

In the period of exacerbation of rheumatism
In the oncological process
In leukemia or malignant tumors of various localization, the immune system is stimulated.
Reasons for a decrease in leukocytes
Viral and infectious diseases (influenza, typhoid fever, viral hepatitis, sepsis, measles, malaria, rubella, mumps, AIDS)
Rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus)
Some types of leukemia4 Aminoses
antineoplastic drugs (cytostatics, steroid drugs)
Radiation sickness

Hematocrit

Hematocrit is the percentage ratio of the volume of the analyzed blood to the volume occupied by erythrocytes in it.This indicator is calculated as a percentage.
Norms of hematocrit in children and adults
Age sex Indicator in%
up to 2 weeks 41 – 65
from 2 to 4.3 weeks 33 – 55
4.3 – 8.6 weeks 28 – 42
From 8.6 weeks up to 4 months 32 – 44
From 4 to 6 months 31 – 41
From 6 to 9 months 32 – 40
From 9 to 12 months 33 – 41
from 1 to 3 years 32 – 40
From 3 to 6 years 32 – 42
From 6 to 9 years old 33 – 41
From 9 to 12 years old 34 – 43
From 12 to 15 years old women 34 – 44 90 144 men 35 – 45 90 144 From 15 to 18 years old women 34 – 44 90 144 men 37 – 48
From 18 to 45 years old women 38 – 47 90 144 men 42 – 50 90 144 From 45 to 65 years old women 35 – 47 90 144 men 39 – 50 90 144 after 65 years women 35 – 47 90 144 men 37 – 51

Reasons for an increase in hematocrit

Erythremia
Heart or respiratory failure
Dehydration due to profuse vomiting, diarrhea, extensive burns, diabetes
Causes of decreased hematocrit
Anemia
Renal failure
Second half of pregnancy
MCV, MCHC – norm
MCH – meancorpuscular hemoglobin.This index reflects the absolute hemoglobin content in one erythrocyte in picograms (pg). MCH is calculated by the formula:
MCH = hemoglobin (g / l) / number of erythrocytes = pg
Norm MCH
24 – 33 pg.
Color index (CP) is a classic method for determining the concentration of hemoglobin in red blood cells. Nowadays, it is gradually being replaced by the SIT index in blood tests. These indices reflect the same thing, only they are expressed in different units.
The norm of the color index (CP)
0.9-1.1
MCHC – meancorpuscular hemoglobin concentration.This index reflects the degree of saturation of the erythrocyte with hemoglobin and is expressed in%. That is, according to this index, one can say how many percent is the hemoglobin content in one erythrocyte. MCSU is calculated as follows:
MCSU = (hemoglobin (g / l) / hematocrit (%)) * 10 =%
MCSU rate
30 – 38%

MCV – meancorpuscular volume This indicator reflects the average volume of erythrocytes, expressed in microns cubic (μm3) or femtoliters (fl). Calculate MCV by the formula:
MCV = hematocrit (%) * 10 / number of erythrocytes (T / L) = μm3 (fl)
Norm MCV
80-95 μm3 (fl)
Leukocyte formula
Leukocyte formula is an indicator of the percentage of various types of leukocytes in the blood, their total number of leukocytes in the blood (this indicator is considered in the previous section of the article).The percentage of different types of leukocytes in infectious, blood diseases, oncological processes will change. Thanks to this laboratory symptom, the doctor can suspect the cause of a health problem.
Types of leukocytes, norm
Neutrophils Segmented forms 47-72%
Stab forms 1-6%
Eosinophils 0.5-5%
Basophils 0-1%
Monocytes 3-11%
Lymphocytes 19-37%
For to find out the age norm, click on the name of the leukocyte from the table.
Neutrophils
Neutrophils can be of two types – mature forms, which are also called segmented immature – stab. Normally, the number of stab neutrophils is minimal (1-3% of the total). With the “mobilization” of the immune system, there is a sharp increase (several times) in the number of immature forms of neutrophils (stab).
Norm of neutrophils in children and adults
Age Segmented neutrophils, rate in% Stab neutrophils, rate in%
Newborns 47 – 70 3 – 12
up to 2 weeks 30 – 50 1 – 5
From 2 weeks to 1 year 16 – 45 1 – 5
From 1 to 2 years 28 – 48 1 – 5
From 2 to 5 years 32 – 55 1 – 5
From 6 to 7 years 38 – 58 1 – 5
From 8 to 9 years 41 – 60 1 – 5
From 9 to 11 years old 43 – 60 1 – 5
From 12 to 15 years old 45 – 60 1 – 5
From 16 years old and adults 50 – 70 1 – 3
Increase in the level of neutrophils in the blood – this condition is called neutrophilia.
Reasons for an increase in the level of neutrophils
Infectious diseases (angina, sinusitis, intestinal infection, bronchitis, pneumonia)
Infectious processes – abscess, phlegmon, gangrene, traumatic soft tissue injuries, osteomyelitis
Inflammatory diseases of internal organs: pancreatitis, peritonitis, arthyroidism)
Heart attack (heart attack, kidney, spleen)
Chronic metabolic disorders: diabetes mellitus, uremia, eclampsia
Cancer tumors
The use of immunostimulating drugs, vaccinations
Decrease in the level of neutrophils – this condition is called neutropenia
Reasons for a decrease in the level of abdominal diseases
Neutrophilic diseases typhoid, brucellosis, influenza, measles, chickenpox (chickenpox), viral hepatitis, rubella)
Blood diseases (aplastic anemia, acute leukemia)
Hereditary neutropenia
High levels of thyroid hormones Thyrotoxicosis
Consequences of chemotherapy
rapia
The use of antibacterial, anti-inflammatory, antiviral drugs
What is the shift of the leukocyte formula to the left and to the right?
A shift in the leukocyte count to the left means that young, “immature” neutrophils appear in the blood, which are normally present only in the bone marrow, but not in the blood.A similar phenomenon is observed with mild and severe infectious and inflammatory processes (for example, with angina, malaria, appendicitis), as well as with acute blood loss, diphtheria, pneumonia, scarlet fever, typhus, sepsis, intoxication.
A shift in the leukocyte formula to the right means that the number of “old” neutrophils (segmented) in the blood increases, and the number of nucleus segments becomes more than five. Such a picture occurs in healthy people living in areas contaminated with radioactive waste.It is also possible in the presence of B12 – deficiency anemia, with a lack of folic acid, in people with chronic lung disease, or with obstructive bronchitis.
Eosinophils
Eosinophils are one of the types of leukocytes that are involved in cleansing the body of toxic substances, parasites, and is involved in the fight against cancer cells. This type of leukocytes is involved in the formation of humoral immunity (immunity associated with antibodies)
The norm of blood eosinophils in children and adults
age Indicator in%
Newborns 1 – 6
up to 2 weeks 1 – 6
from 2 weeks to 1 year 1 – 5
from 1 to 2 years 1 – 7
from 2 to 5 years 1 – 6
from 6 to 7 years 1 – 5
from 8 to 9 years 1 – 5
from 9 to 11 years 1 – 5
from 12 to 15 years old 1 – 5
from 16 years old and adults 1 – 5
Causes of increased blood eosinophils
Allergies (bronchial asthma, food allergies, allergies to pollen and other air allergens, atopic dermatitis, allergic rhinitis, drug allergies)
Parasitic diseases – intestinal parasites (giardiasis, ascariasis, enterobiasis, opisthorchiasis, echinococcosis)
Infectious diseases (scarlet fever, tuberculosis, mononucleosis, venereal diseases)
Cancer tumors
Diseases of the hematopoietic system (leukemias, lymphoma, lymphogranulomatosis) 9014 (rheumatoid arthritis, periarteritis nodosa, scleroderma)
Reasons for a decrease in eosinophils
Intoxication with heavy metals
Purulent processes, sepsis
The beginning of the inflammatory process
.
Monocytes
Monocytes are few in number, but the largest immune cells in the body. These white blood cells are involved in recognizing foreign substances and training other white blood cells to recognize them. They can migrate from blood to body tissues. Outside the bloodstream, monocytes change their shape and are converted into macrophages. Macrophages can actively migrate to the site of inflammation in order to take part in cleansing the inflamed tissue from dead cells, leukocytes, and bacteria.Thanks to this work of macrophages, all conditions are created for the restoration of damaged tissues.
Norms of blood monocytes in children and adults
age Indicator in%
Newborns 3 – 12
up to 2 weeks 5 – 15
From 2 weeks to 1 year 4 – 10
From 1 year to 2 years 3 – 10
From 2 to 5 years 3 – 9
From 6 to 7 years 3 – 9
From 8 to 9 years 3 – 9
From 9 to 11 years 3 – 9
From 12 to 15 years 3 – 9
From 16 years and adults 3 – 9
Reasons for increasing monocytes (monocytosis)
Infections caused by viruses, fungi (candidiasis), parasites and protozoa
Recovery period after an acute inflammatory process.
Specific diseases: tuberculosis, syphilis, brucellosis, sarcoidosis, ulcerative colitis
Rheumatic diseases – systemic lupus erythematosus, rheumatoid arthritis, periarteritis nodosa
diseases of the hematopoietic system.
Reasons for a decrease in monocytes (monocytopenia)
aplastic anemia
hairy cell leukemia
purulent lesions (abscesses, phlegmon, osteomyelitis)
childbirth
after surgery
taking steroid drugs (dexamethasone, prednisolone cells)
Basophilic cellsNormally, it may not be detected in a blood test. Basophils are involved in the formation of delayed-type immunological inflammatory reactions. They contain a large amount of substances that cause tissue inflammation.
The norm of blood basophils
0-0.5%
Reasons for an increase in blood basophils
chronic myeloid leukemia
a decrease in the level of thyroid hormones hypothyroidism
chickenpox
food and drug allergies
nephrosis
hemolytic anemia
condition after removal of the spleen
condition after removal of the spleen
drugs (estrogens, drugs that reduce the activity of the thyroid gland)
ulcerative colitis
Lymphocytes
Lymphocytes – the second largest fraction of leukocytes.Lymphocytes play a key role in humoral (through antibodies) and cellular (realized by direct contact of the destroyed cell and lymphocyte) immunity. Different types of lymphocytes circulate in the blood – helpers, suppressors and killers. Each type of white blood cell is involved in the formation of an immune response at a certain stage.
Norms of lymphocytes in children and adults
age Indicator in%
Newborns 15 – 35
up to 2 weeks 22 – 55
From 2 weeks to 1 year 45 – 70
From 1 year to 2 years 37 – 60
From 2 to 5 years 33 – 55
From 6 to 7 years old 30 – 50
From 8 to 9 years old 30 – 50
From 9 to 11 years old 30 – 46
From 12 to 15 years old 30 – 45
From 16 years old and adults 20 – 40 90 144 Reasons increased lymphocytes (lymphocytosis)
Viral infections: infectious mononucleosis, viral hepatitis, cytomegalovirus infection, herpes infection, rubella
Toxoplasmosis
ARVI
Diseases of the blood system: acute lymphocytic leukemia, chronic lymphocytic leukemia, lymphosarcoma – Franklin’s disease, heavy chain disease
Poisoning with tetrachloroethane, lead, arsenic, carbon disulfide
Application of drugs: levodopa, phenytoin, valproic acid, narcotic painkillers
Leukemia
Causes of a decrease in lymphocytes (lymphopenia)
Tuberculosis
Lymphogranulomatosis
Lymphogranulomatosis
Systemic redness
Systemic anemia diseases;
AIDS
Radiotherapy;
Chemotherapy
Glucocorticoid use
Platelets
Platelets are small, nuclear-free cells.The main function of this blood component is to participate in blood coagulation. Inside the platelets, most of the clotting factors are contained, which are released into the blood when necessary (damage to the vessel wall). Due to this property, the damaged vessel is clogged with a forming thrombus and the bleeding stops.
Norms of blood platelets
Norm of blood platelets
180 – 320 × 109 cells / l
Reasons for an increase in platelets
(thrombocytosis, platelet count more than 320 × 109 cells / l)
removal of the spleen
inflammatory processes (exacerbation of rheumatism, osteomyelitis, abscess, tuberculosis )
different types of anemias (after blood loss, iron deficiency, hemolytic)
after surgery
cancer of various localization
physical fatigue
erythremia
Decreased platelet count
(thrombocytopenia – less than 180 × 109 cells / l)
congenital blood diseases (hemophilia)
idiopathic autoimmune thrombocytopenic purpura
drug thrombocytopenia
systemic lupus erythematosus
infections (viral and bacterial infections, rickettsiosis, malaria, toxoplasmosis)
aplastic anemia
paroxysmal nocturnal hemoglobinuria (autoimmune hemoglobinuria)
Evans syndrome DIC syndrome (disseminated intravascular coagulation)
Blood transfusion
In preterm infants
with hemolytic disease of newborns
heart failure
renal vein thrombosis
ESR erythrocyte sedimentation rate
Erythrocyte sedimentation rate (ESR) – to assess the blood separation rate (ESR) – on plasma and erythrocytes.
The essence of the study: erythrocytes are heavier than plasma and leukocytes, therefore, under the influence of gravity, they sink to the bottom of the test tube. In healthy people, erythrocyte membranes have a negative charge and repel each other, which slows down the rate of sedimentation. But during illness, a number of changes occur in the blood:
The content of fibrinogen increases, as well as alpha and gamma globulins and C-reactive protein. They accumulate on the surface of erythrocytes and cause them to stick together in the form of coin columns;
The concentration of albumin decreases, which prevents the adhesion of red blood cells;
The electrolyte balance of the blood is disturbed.This leads to a change in the charge of red blood cells, because of which they stop repelling.
As a result, the red blood cells stick together. Clusters are heavier than individual erythrocytes, they sink to the bottom faster, as a result of which the erythrocyte sedimentation rate increases.
There are four groups of diseases that cause increased ESR:
infections
malignant tumors
rheumatological (systemic) diseases
kidney diseases
What you need to know about ESR
The definition is not a specific analysis.ESR can increase in numerous diseases that cause quantitative and qualitative changes in plasma proteins.
In 2% of patients (even with serious diseases), the ESR level remains normal.
ESR does not increase from the first hours, but on the 2nd day of the disease.
After illness, ESR remains elevated for several weeks, sometimes months. This indicates recovery.
Sometimes the ESR rises to 100 mm / h in healthy people.
ESR rises after eating up to 25 mm / hour, so tests must be taken on an empty stomach.
If the temperature in the laboratory is above 24 degrees, then the process of adhesion of erythrocytes is disrupted and the ESR decreases.
ESR – an integral part of the general blood test.
The essence of the method for determining the erythrocyte sedimentation rate?
The World Health Organization (WHO) recommends the Westergren method. It is used by modern laboratories to determine ESR. But in municipal clinics and hospitals, the Panchenkov method is traditionally used.
Westergren’s method. Mix 2 ml of venous blood and 0.5 ml of sodium citrate, an anticoagulant that prevents blood clotting.The mixture is collected in a thin cylindrical tube to a level of 200 mm. The tube is vertically placed in a rack. An hour later, the distance from the upper border of the plasma to the level of erythrocytes is measured in millimeters. Automatic ESR counters are often used. The unit of measurement of ESR is mm / hour.
Panchenkov’s method. Capillary blood from a finger is examined. In a glass pipette with a diameter of 1 mm, a solution of sodium citrate is taken up to the mark of 50 mm. It is blown into a test tube. After that, 2 times with a pipette, take blood and blow it into a test tube to sodium citrate.Thus, the ratio of anticoagulant to blood is 1: 4. This mixture is drawn into a glass capillary to a level of 100 mm and is set in an upright position. The results are evaluated after one hour, as with the Westergren method.
ESR standards
Westergren’s method, norm: Panchenkov’s method, norm:
children 0-16 years old – 2-10 mm / hour
men under 50 years old – up to 15 mm / hour
men over 50 years old – up to 20 mm / hour
women up to 50 years old – up to 20 mm / hour
women over 50 years old – up to 30 mm / hour
children 0-12 months – 2-10 mm / hour
children 1-16 years old – 2-12 mm / hour
men – 1-10 mm / hour
women – 2-15 mm / hour
Determination according to Westergren is considered a more sensitive technique, therefore the level of ESR is slightly higher than in the study by Panchenkov’s method.
Reasons for increased ESR
Reasons for decreased ESR
Physiological (not related to disease) fluctuations in ESR
Menstrual cycle. ESR rises sharply before menstrual bleeding and decreases to normal during menstruation. This is associated with a change in the hormonal and protein composition of the blood at different periods of the cycle.
Pregnancy. ESR increases from the 5th week of pregnancy to the 4th week after delivery. The maximum level of ESR reaches 3-5 days after the birth of the child, which is associated with injuries during childbirth.In normal pregnancy, the erythrocyte sedimentation rate can reach 40 mm / h.
Physiological (not associated with disease) fluctuations in ESR
Newborns. In infants, ESR is low due to a decrease in fibrinogen levels and a large number of red blood cells in the blood.
Infections and inflammation (bacterial, viral and fungal)
infections of the upper and lower respiratory tract: tonsillitis, tracheitis, bronchitis, pneumonia
otitis media: otitis, sinusitis, tonsillitis
dental diseases: stomatitis, dental granulomas
cardiovascular diseases vascular system: phlebitis, myocardial infarction, acute pericarditis
urinary tract infections: cystitis, urethritis
inflammatory diseases of the pelvic organs: adnexitis, prostatitis, salpingitis, endometritis
inflammatory diseases of the gastrointestinal tract: cholecystitis, colitis, pancreatitis, abscesses
peptic ulcer and
peptic ulcer disease144 tuberculosis
connective tissue diseases: collagenoses
viral hepatitis
systemic fungal infections
Reasons for a decrease in ESR:
recovery from a recent viral infection
astheno-neurotic syndrome, exhaustion of the nervous system: fatigue, lethargy, headaches
cachexia – extreme
long-term use of glucocorticoids, which led to inhibition of the anterior lobe of the pituitary gland
hyperglycemia – high blood sugar
blood clotting disorders
severe traumatic brain injury and concussion.
Malignant tumors
malignant tumors of any localization
oncological diseases of the blood
Rheumatological (autoimmune) diseases
rheumatism
rheumatoid arthritis
hemorrhagic vasculitis
systemic scleroderma
systemic lupus erythematosus
anti-inflammatory drugs diclofenac, nemid
sulfanilamide drugs – sulfasalazine, salazopyrine
immunosuppressants – penicillamine
hormonal drugs – tamoxifen, nolvadex
vitamin B12
Kidney disease
pyelonephritis
chronic glomerulonephritis
cerebral insufficiency
nephritis
nephritis after cerebral insufficiency
nephritis
neurotic wounds
burns
Medicines that can cause increased ESR:
morphine hydrochloride
dextran
methyldopa
vitamin D
It must be remembered that uncomplicated viral infections do not cause an increase in ESR.This diagnostic sign helps to determine that the disease is caused by bacteria. Therefore, with an increase in ESR, antibiotics are often prescribed.
Slow erythrocyte sedimentation rate is 1-4 mm / h. This reaction occurs when the level of fibrinogen, which is responsible for blood clotting, decreases. And also with an increase in the negative charge of erythrocytes as a result of changes in the electrolyte balance of the blood.
It should be noted that taking these drugs can cause a falsely low ESR result in bacterial infections and rheumatoid diseases.
What is a general urine test for?
It shows how the entire urinary system works, which includes the kidneys, ureters, bladder and urinary tract. In this case, the total amount of secretions is not too important. The general analysis of urine provides for the determination of color, relative density, urine reaction, the presence of protein, sugar, salts in it. Microscopy of the sediment is also carried out to determine the number of erythrocytes, leukocytes and other elements. The general analysis of urine includes the determination of its acid-base state.Normally, urine is acidic, but sometimes people eat foods that contain a lot of alkaline salts, such as sorrel. Drinks also come in both acidic and alkaline varieties. Therefore, it is important to find out if the kidneys do a good job of keeping the urine acidic.

A urinalysis can be used to determine if the kidneys are performing their function, i.e. whether they are able to sufficiently filter metabolic products harmful to the body from the blood and, conversely, whether they do not remove substances that are necessary and useful for the body. This is evidenced by the density or specific gravity of urine.The more substances dissolved in urine, the higher its density and vice versa. The density of urine depends on many reasons: on the nature of the diet, on what a person ate during the day and before going to bed, whether he got up to use the toilet at night, etc.
The kidneys work most actively after 2-3 o’clock in the morning. A general analysis of urine is collected from the night, because it is concentrated in the body precisely at night. And what is collected in the urine overnight will have a very significant effect later on the results of the analysis. Before collecting urine, it is imperative to wash the external genitals with warm water so that microbes and dead cells from their surface do not spoil the picture.For urine analysis, there must be at least 100 ml. Women must not donate urine three days before, during and after menstruation: the discharge that gets into it will give an absolutely wrong result.
What disease is indicated by the presence of protein or glucose in the urine?
According to the analysis, it is determined whether there is protein, glucose in the urine and, if they are, then very approximately within what limits the protein or glucose content is. In principle, neither one nor the other should be in the urine. The presence of protein or glucose in the urine is a sign of illness.If the kidneys are leaking protein, then their function is impaired. And glucose can indicate diabetes mellitus or urinary diabetes, when blood sugar is normal, but it appears in the urine.
The functional unit of the kidney is the nephron. It consists of a glomerulus and tubules, and after the nephron there is a section that is responsible for the reabsorption of glucose. If something does not work in this area, as well as during excessive physical exertion or when a person has eaten too much sweets, blood sugar does not seem to rise, and its excess is excreted in the urine.
After examining the liquid part of the urine, the sediment is examined, which is separated using a centrifuge. The sediment is very important for diagnosis because it contains cells excreted in the urine. It is important to know what kind of cells are there and in what quantity. For this, cells of different types are counted in the field of view of the microscope.
Most importantly, urinalysis informs the doctor about the possible presence of an infection in the urinary tract, as evidenced by an increased white blood cell count. Erythrocytes should not be at all, sometimes they are only in women due to the peculiarities of their physiology.From which cells of the epithelium (cylinders of different types) prevail, it is possible to determine in which place the inflammation occurs.
What are biochemical tests for?
Biochemical analyzes allow us to evaluate the work of many internal organs: liver, pancreas, kidneys, they also give an idea of ​​the characteristics of lipid metabolism (it is directly related to atherosclerosis), protein and carbohydrate (glucose) metabolism. Biochemical analyzes can reveal cardiological, urological, gastroenterological, gynecological, ENT diseases, etc.Currently, without these tests, serious cases will not be diagnosed by any clinician in most areas of medicine. In addition, biochemical analysis shows which trace elements are lacking in the body. This is mainly a biochemical blood test, but there are a number of studies that are carried out in urine, complementing a general blood test.

Biochemical blood test allows you to judge the metabolism, the functioning of the kidneys, liver, pancreas and heart. For example, bilirubin is elevated with jaundice.If they do not cope with the work of the kidneys, the level of urea and creatinine rises. Total protein decreases with inflammation and high fever.
Rules for taking biochemical blood tests
Biochemistry should be taken strictly on an empty stomach, otherwise most of the indicators will creep up. The period of abstinence from food should be 8 – 12 hours. The last crumb can be taken in your mouth at 19 o’clock, and after that you can only drink pure water. One or two days before the tests, you should not drink alcohol, eat fried food.If you have not specifically discussed with the doctor the intake of the medicines prescribed for you, which maintain your condition at a certain level, then you need to take the medicine with clean water. You should be aware that a cigarette smoked within an hour before a laboratory test can distort its results. Please note that test results also depend on body position. If a person stands during blood sampling or stood a few minutes before, then almost all indicators (total protein, cholesterol, creatinine, calcium, alkaline phosphatase) increase.Therefore, it is advisable to spend half an hour before the analysis lying or sitting.
How often do you need to get tested?
According to doctors, even if there is no visible deterioration in well-being, it is recommended to take a general blood and urine test on a regular basis, about once a year. Of course, if you feel any discomfort, you should not postpone your visit to the doctor for a year. In the presence of chronic diseases, it is better to discuss the frequency of repeated consultations and examinations with your doctor.
Regular glucose tests are strongly recommended for everyone in old age.It is necessary to donate “blood for sugar” in the morning strictly on an empty stomach. In front of him, you can not only eat, but also drink, chew gum, smoke and take medicine.
A very important test – for total cholesterol, as well as for the content of low density lipoproteins (the so-called “bad” cholesterol) and high density (“good” cholesterol). Their ratio is called the “coefficient of atherogenicity”. If it is very tall, it is hard for the heart to work, the blood vessels are clogged, the blood is viscous, viscous. This is atherosclerosis – the situation before the catastrophe.In this case, doctors choose therapy to improve lipid (fat) metabolism.

90,000 which means, what is the norm, the reasons for the increase and decrease in erythrocytes

Erythrocytes are the most numerous type of human blood cells (every fourth cell in the body is an erythrocyte) [1]. Several million red blood cells are destroyed in the human body every second. And the same amount is synthesized in the bone marrow to replenish the reserves of red blood cells in the vessels.These small, but very important cells are not only vital for each of us, but can also tell a lot about the state of health. Therefore, the study of the level of erythrocytes (as part of a general clinical blood test) is an important diagnostic procedure that should be regularly taken by both adults and children.

Functions of erythrocytes

The main function of erythrocytes is the transfer of oxygen, which is carried out thanks to hemoglobin – a special protein in their composition. In addition, red blood cells are involved in the transport of nutrients, immune responses, and help maintain acid-base balance.

Erythrocytes are very small in size – one hundredth of a millimeter in diameter [2]. These cells are similar to elastic discs with a depression in the middle, thanks to which they are able to curl, easily penetrating even the thinnest – thinner than a human hair – vessels of the body.

This is interesting!

Human erythrocytes, like all mammals, do not have a nucleus [3]. On this basis, they can be distinguished from the red blood cells of other animals, such as birds or frogs, by examining a blood sample under a microscope.

Erythrocytes are formed in the human red bone marrow. Before entering the vascular bed, cells go through several stages of development, during which they change shape, size and composition. Normally, in the analysis of blood taken from a finger or from a vein, no varieties of red blood cells are found except for mature cells (they are called normocytes) and young forms (reticulocytes). The content of the latter in the body of healthy people is about 1% [4].

The level of red blood cells in the blood of healthy people

Normally, the content of red blood cells in the blood of adult men is 4.3 × 10 ¹² – 5.7 × 10 ¹² cells / l.In women, this indicator is slightly less – 3.8 × 10 ¹² – 5.1 × 10 ¹² cells / l [5]. As for children, the norms of erythrocytes differ depending on the age of the child [6].

In the first two weeks, the content of red blood cells in the blood is 3.9 × 10 ¹² – 5.9 × 10 ¹² cells / l. The norm of erythrocytes in a one-month-old baby is 3.5 × 10 ¹² – 5.1 × 10 ¹² cells / l. In two to four months – 3.6 × 10 ¹² – 4.8 × 10 ¹² cells / l.Up to six months – 3.8 × 10 ¹² – 4.6 × 10 ¹² cells / l. Up to a year – 3.9 × 10 ¹² – 4.7 × 10 ¹² cells / l (before this age, the norm for reticulocytes is 0.2–2.8%). From one year to nine years, the content of erythrocytes ranges from 3.9 × 10 ¹² – 4.5 × 10 ¹² cells / l. The normal number of erythrocytes in the blood in children under 12 years of age is approximately 4.2 × 10 ¹² – 4.6 × 10 ¹² cells / L, regardless of the sex of the child [7].

As the child grows up, the norms of red blood cells in the blood begin to differ depending on his gender. Thus, in adolescent girls 12–18 years old, the healthy indicator is 3.8 × 10 ¹² – 5.1 × 10 ¹² cells / l. For boys 12-15 years old – 4.1 × 10 ¹² – 5.2 × 10 ¹² cells / l, and from 15 to 18 years old – 4.2 × 10 ¹² – 5.6 × 10 ^{1290,720 cells / l. This is due to the characteristics of the growth and development of boys and girls.}

Compared to middle-aged people, the number of red blood cells in the blood of the elderly gradually decreases.The normal indicator is 3.8 × 10 ¹² – 5.3 × 10 ¹² for women and 3.8 × 10 ¹² – 5.8 × 10 ¹² for men.

Another category for which there is a separate standard is pregnant women. The fact is that in the process of intrauterine development of the child, the volume of circulating blood in the expectant mother increases due to the liquid part (plasma), while the number of formed elements grows more slowly [8]. Therefore, the normal content of erythrocytes in the blood of pregnant women is considered to be 3.5 × 10 ¹² – 5.6 × 10 ¹² cells / l.The number of reticulocytes during this period should not differ from the normal values ​​for an adult (about 1%).

Elevated erythrocytes in the blood: the reasons for the deviation

It would seem that the more red blood cells we have in our blood, the better. However, such a judgment is erroneous, because an excess of cells thickens the blood and violates its properties. In addition, erythrocytosis (as in medicine they call an increased content of red blood cells) is a symptom of some serious diseases.

Why are the erythrocytes in the blood test increased?

The simplest and most common explanation is dehydration of the body, which is provoked not only by fever, but also by fever, vomiting, diarrhea (that is, precisely those symptoms that often become the reason for going to the hospital and taking a general blood test).

Other, less probable causes of erythrocytosis include tumors of the kidneys or endocrine glands, as well as an excess of steroid hormones in the body (they are prescribed for certain diseases).The content of red blood cells in the blood also rises in situations associated with a lack of oxygen: for example, if a person recently returned from a hike in the mountains or if he suffers from diseases of the lungs (such as COPD) and heart, in which the process of oxygen transport is disrupted. Such pathologies include chronic bronchitis, bronchial asthma and heart defects. Smoking can also cause a decrease in oxygen and, consequently, an increase in the production of red blood cells [9].

Important to know!

It is extremely rare that the number of red blood cells in the blood increases due to a hereditary disease called polycythemia vera (Vakez disease).In fact, it is a type of blood cancer in which the bone marrow begins to produce too many cells. Vakez disease occurs in one in 100,000 people, mainly in old age [10]. It is impossible to cure it, but the fulfillment of the doctor’s prescriptions allows patients with polycythemia vera to suppress the manifestations of the disease for many years.

In , there are many possible reasons for the increase in reticulocytes. If the blood test was preceded by bleeding or treatment of anemia, then reticulocytosis is a good sign that indicates the restoration of red blood cell reserves in the vascular bed [11].If there are no obvious reasons for the growth of reticulocytes, it is imperative to consult a hematologist: this situation may indicate a hereditary blood disease or a tumor.

Low red blood cell count: Causes

Erythropenia is a low red blood cell count.

Why are the erythrocytes in the blood test lowered?

• Acute blood loss (with trauma or during surgery) [12].
• Chronic blood loss (heavy menstruation in women or latent bleeding – with stomach or duodenal ulcers, hemorrhoids, bowel cancer and other diseases).
• Insufficient intake of iron from food (it is necessary for the synthesis of hemoglobin) [13].
• Poor absorption or deficiency of vitamin B in food ₁₂ and folic acid.
• Chronic kidney failure, as it is in the kidneys that the hormone that stimulates the formation of red blood cells, erythropoietin, is synthesized [14].
• Excessive fluid intake or the introduction of an excess amount of saline solution intravenously through a dropper [15].
• Red blood cell destruction too quickly due to a transfusion error, inherited diseases (such as sickle cell anemia), heavy metal or other poisoning, and in patients with an artificial heart valve.

The content of reticulocytes in the blood often decreases as a result of alcohol abuse (it impairs the functioning of the kidneys and bone marrow), with anemia and the presence of metastases of malignant tumors in the bone marrow.

Other pathologies of erythrocytes

In addition to the quantitative content of erythrocytes and reticulocytes in the blood, it is important to pay attention to other parameters of a detailed blood test related to the state of red blood cells. Here are the main ones:

• Form of erythrocytes . In some pathologies, doctors notice a change in the appearance of cells. For example, due to Minkowski-Shoffard disease, ovalocytosis or sickle cell anemia, erythrocytes instead of flattened ones become round (spherocytosis), oval (elliptocytosis) or take the shape of a sickle.In rare cases, small outgrowths of the same (acanthocytosis) or different (echiocytosis) sizes are found on the cell surface. The cause of such changes is the pathology of the liver, stomach or genetic disorders.
• Hemoglobin level . Hemoglobin is a pigment that is part of erythrocytes, due to which gas exchange occurs in the body [16]. An increase and decrease in its content in the blood is most often interconnected with the number of red blood cells, but sometimes these indicators change independently of each other.Normal indicators of hemoglobin concentration are 132-173 g / l for men, 117-155 g / l for women, 152-235 g / l for newborns, 90-166 g / l for one-month-old infants [17]. The norm of hemoglobin in the blood of children from six months to 12 years is 110–140 g / l, and by the age of majority these values ​​are close to the “adult” indicators. In pregnant women, the level of hemoglobin in the blood should be at least 110–140 g / l. A lack of hemoglobin is called anemia – this disease can be caused by a deficiency of iron or vitamins in the body, as well as acute or chronic blood loss [18].And the reasons for the increase in hemoglobin in the blood, as a rule, coincide with the causes of erythropenia.
• The erythrocyte sedimentation rate (ESR) often increases with inflammatory processes in the body, and decreases with chronic circulatory disorders. Normal ESR in men is 1-10 mm / h, in women 2-15 mm / h. In newborns, ESR should correspond to a value of 2-4 mm / h, in babies under one year old – 2-4 mm / h, up to five years – 5-11 mm / h, up to 14 years – 4-13 mm / h. After this age, ESR in children approaches the “adult” indicators, taking into account gender.The ESR rate in pregnant women increases every month, starting from the fourth. In the first trimester, it is 15 mm / h, in the second – 25 mm / h, in the third – 40 mm / h, and three months after delivery, its values ​​return to their original values.

Erythrocyte indices . Other parameters of the state of erythrocytes are reflected in the indicators designated in the analysis as erythrocyte indices. The most informative of them are MCV (average volume of red blood cells), MCH (average hemoglobin content in red blood cells), MCHC (average concentration of hemoglobin in red blood cells) and RDW 9000 coefficient of the average volume of erythrocytes).Deviations from the normal values ​​of these indicators help the doctor to clarify the cause of the anemia if there are abnormalities in the standard parameters of the blood test.

• The norm for MCV in adults is 80-100 fl (femtoliters).
• The norm of MCH in adult women and men is 27–35 pg (picograms), in infants under one month old – 27–33 pg, up to four months – 25–29 pg, up to three years old – 22–32 pg, up to 14 years old – 25–35 pg.
• The MCHC norm in people over 17 years old is 300-380 g / l, in infants up to one month – 316-375 g / l, up to four months – 306-324 g / l, up to three years – 307-380 g / l, up to 10 years old – 336–344 g / l.
• The norm of RDW-CV in adults is 11.5-14.5%.

Despite the variety of blood parameters that characterize erythrocytes, there is no point in memorizing the meaning of each of them and extremely worried about possible deviations in the absence of any symptoms. There are many physiological conditions that explain changes in red blood cell counts that a competent doctor will be able to distinguish from pathology.

All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

Hematocrit – Blood test – Decoding of analyzes online

Synonyms : hematocrit, HCT, Ht, Crit, packed cell volume, PCV

What is hematocrit?

Hematocrit is the part (%) of the total blood volume, which is made up of erythrocytes, that is, it is the ratio of erythrocytes to blood plasma.

Decipher “Biochemical blood test”
Decipher “General urine test”

Red blood cells carry oxygen throughout the body.Having too many or too few red blood cells in your blood can be a sign of certain medical conditions.

The hematocrit value is often used to assess the severity of anemia, due to which it can drop to 15-25%. Hematocrit should not be assessed immediately after transfusion or blood loss, as this may cause a falsely high or falsely low result.

Units

Hematocrit (Ht) is expressed as a percentage (%) of the total blood volume or in liters per liter (l / l) – the corresponding proportion of formed elements in 1 liter of blood (480 ml of cells in 1 liter of blood = 0.48 liter / liter = 48%).

Under normal conditions, there is a linear relationship between hematocrit and hemoglobin concentration.

Norm of hematocrit

Normal hematocrit values ​​may differ slightly depending on age, gender, pregnancy, place of residence, and the use of different diagnostic methods.

The following hematocrit values ​​are generally considered normal:
90,003 90,072 90,073 Adult Male: 42-54% 90,074

• Adult women: 38-46% (due to physiological menstrual blood loss, the hematocrit rate in women is lower than in men)

For residents of highlands, hematocrit norms increase with increasing altitude at which people live.This is a consequence of the lower concentration of oxygen in the atmosphere, which is why more red blood cells are needed to provide the body with the necessary amount of oxygen.

Hematocrit can be decreased or increased due to various reasons. But it should be remembered that its level in some cases may be estimated incorrectly (with blood loss, with transfusion, in the mountains). According to research, moving from supine to sitting position can cause clinically significant increases in hemoglobin, hematocrit, and red blood cell count.

Norm of hematocrit during pregnancy

Blood volume increases during pregnancy. But the volume of plasma increases more than the volume of red blood cells, which leads to relative anemia. There is a physiological decrease in the number of red blood cells (RBC), as well as the level of hemoglobin (Hb) and hematocrit (Hct). Different laboratories may have different hematocrit reference values. Below is the approximate blood hematocrit during pregnancy.

In the first trimester of pregnancy, the normal hematocrit is 31-41%.By 6-12 weeks, blood plasma volume has already increased by approximately 10-15%. The blood liquefies, and the concentration of cells in it decreases. Therefore, in a pregnant woman, a slight decrease in hematocrit and hemoglobin is allowed by the end of the first / middle of the second month of pregnancy. If the indicator falls below normal, then we can talk about the manifestation of anemia.

In the second trimester, the volume of circulating blood is steadily increasing. The risk of developing iron deficiency anemia increases during this period.Therefore, obstetricians-gynecologists attach particular importance to the mandatory regular observation of the expectant mother and hematocrit indicators. The reference hematocrit values ​​in the second trimester are 30-39%.

The hematocrit reaches its lowest level in the third trimester. From 30 to 34 weeks of pregnancy, the fastest rate of increase in the volume of circulating blood is observed, after which this volume changes slightly before delivery. The peak of the decrease in hematocrit reaches 33 weeks. A hematocrit below normal (28-40%) should be considered abnormal.

Hematocrit values ​​above normal during pregnancy are also referred to as pathological.

Norm of hematocrit in children

In newborns and especially premature babies, high hematocrit values ​​are normal. If the hematocrit level in the analysis of blood from a vein exceeds 65%, then polycythemia (an increased level of red blood cells) is diagnosed. Closer to three months of age, the hematocrit drops. The reference hematocrit values ​​are approximately 30-44%, depending on the age of the child.

Decreased or increased hematocrit in a child with minor deviations from the norm, most often, is caused by the influence of external factors. If these deviations are significant, then it is necessary to look for the reasons for this condition.

Hematocrit above normal

A high hematocrit may reflect an absolute increase in the number of red blood cells or a decrease in plasma volume. An increase in hematocrit means that the blood thickens, which means that the risk of blood clots increases.This causes oxygen deficiency of the organ in which the thrombus has formed, and, accordingly, a violation of its functions (stroke, heart attack).

Reasons for an increase in the level of hematocrit:

• Dehydration (with burns, diarrhea, taking diuretics). With sufficient fluid intake, the hematocrit returns to normal.
• Diseases of the heart and lungs. The body tries to compensate for the lack of oxygen in the blood by producing more red blood cells.
• Smoking, living high above sea level (compensation for a decrease in oxygen levels in the body)
• Neoplasms in the kidneys, accompanied by increased production of erythropoietin.
• Polycythemia vera (polycythemia vera) is a rare disease that causes abnormal production of red blood cells.

High hematocrit during pregnancy

An increased hematocrit in pregnant women signals a thickening of the blood, increasing the load on the cardiovascular system and increasing the likelihood of blood clots.

High hematocrit may be a sign of preeclampsia (gestosis).

High hematocrit in a child

If, when determining the results of a blood test, the hematocrit is very high (more than 65%) in a newborn child, it means that the baby was in a state of hypoxia. That is, the baby experienced oxygen deficiency during the prenatal period or during childbirth. The future development of the baby depends on the duration of the hypoxia period, because during oxygen starvation, the blood supply to the brain is disrupted.

At an older age, the causes of an increase can be the same pathological conditions as in adults.

Hematocrit below normal

A low hematocrit reflects a low circulating red blood cell count and is an indication of a reduced ability to carry oxygen. In this condition, patients have shortness of breath, constant feeling of fatigue, heart palpitations, pale skin color, hair loss. With a decrease in hematocrit, anemia is diagnosed.

Causes of low hematocrit:

• Significant blood loss (due to trauma, chronic bleeding).
• Deficiency of nutrients in the body (iron, folic acid, vitamins B12, B6).
• Increased destruction of red blood cells (hemolytic anemia, sickle cell anemia).
• Disorders in the functioning of the bone marrow (aplastic anemia, cancer, chemotherapy).
• Kidney disease resulting in decreased production of erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow.

Low hematocrit during pregnancy

A slight decrease in hematocrit due to increased blood volume is normal during pregnancy. With a decrease in hematocrit below the reference values, one speaks of anemia.

Iron deficiency anemia is the cause of decreased hematocrit during pregnancy in 90% of cases. The state of health of a pregnant woman with a low hematocrit worsens, since the cells of all organs experience oxygen starvation (hypoxia), the alkaline balance is disturbed.Fatigue, weakness, headache, heart palpitations, and shortness of breath may occur. The heart and blood vessels work under increased load, the work of other organs and systems is disrupted.

Low hematocrit in a child

A decrease in hematocrit in children may be due to improper diet (lack of nutrients), and is also observed with a significant growth spurt. These changes can be easily corrected.

Acquired types of anemia, especially iron deficiency anemia, are more common in children over 1 year of age and adolescents.In term infants under 6 months of age, iron deficiency is an unlikely cause of anemia.

Hematocrit is below normal – what does it mean, how to determine the indicator and what to do next?

A blood test helps to assess not only the work of the organs of the hematopoietic system, but also the state of the body as a whole. Among the parameters taken into account in the analysis, the leading position is occupied by the concentration of erythrocytes – hematocrit, as doctors call it.

What is hematocrit in a blood test?

Patients, receiving the test results on their hands, seeing the hematocrit indicator, what kind of parameter it is and what it is responsible for, do not know.This term is usually used to denote the ratio of the volumetric amount of formed elements to a unit volume of whole blood. The indicator is expressed as a percentage, less often as a decimal fraction with a two-digit value after the decimal point. Often, experts refer to it as the hematocrit indicator. To calculate the hematocrit, the number of erythrocytes is compared with the plasma volume, then multiplied by 0.01 (for conversion to percent).

What is hematocrit responsible for?

From the above it follows that hematocrit is a quantitative indicator.The hematocrit number is a reflection of the cellular composition of the blood circulating in the human body. It does not depend on factors affecting the synthesis of intracellular hemoglobin. At the same time, the value is actively used by doctors with suspicion of latent diseases, anemia. The analysis is often prescribed after surgery and during pregnancy. This is done to eliminate the risk of losing a large blood volume.

The value of hematocrit is a primary indicator in the diagnosis of pathologies.Deviation from existing standards becomes an indication for further comprehensive examination of the patient. To find out why the hematocrit is below normal, what this means, more than one examination is required. Among the indications for the analysis are:

• varicose veins;

90,073 autoimmune diseases;

• liver pathology;
• high risk of bleeding.

Hematocrit – norm

Studies conducted by doctors have shown that the hematocrit value changes with the age of the patient.In addition, due to the peculiarities of physiology, the values ​​are lower in girls than in men. Given this feature, when decoding the analysis for hematocrit, the norm in women is set lower. Among the determining factors during the assessment of the result is the age of the patient. The hematocrit in the blood changes as follows:

1. Children:

• newborns – 35–65;

90,073 up to 1 year – 32–40;

90,073 1–11 years old – 32–41;

90,073 girls 12-17 years old – 35-45;

90,073 boys 12-17 – 34-44.

2. Adults:

• women 18–45 years old – 39–50;

90,073 men 18–45 years old – 34–45;

90,073 women over 45 – 40-50;

90,073 women after 45 years – 35–46.

Lowered hematocrit – what does it mean?

Deviation of values ​​from existing standards is an indication for further examination of the patient. To find out why the hematocrit is lowered, what does this mean in a woman, hardware research methods are prescribed:

• Ultrasound of the pelvic organs;
• Ultrasound of the liver;
• examination of the organs of the gastrointestinal tract.

To find out why the hematocrit is below the established norm, what does this mean, doctors take into account the time of the analysis. During menstruation and a few days after its end, the hematocrit level in girls decreases. The hematocrit is lower than normal during pregnancy, which a woman often does not know about at a short time.

Hematocrit is lowered – reasons

When the hematocrit is lowered, what is this violation and what is it connected with – only a specialist can determine. The analysis is deciphered exclusively by doctors who have information about the general condition of the patient’s body, his diseases and chronic pathologies.Among the disorders and conditions accompanied by a decrease in hematocrit:

1. Aplastic anemia – provoked by congenital and hereditary diseases, toxic damage to the bone marrow.
2. Hemolysis – resolution of blood cells in case of congenital anomalies of erythrocytes, a decrease in their elasticity, diseases of the spleen.
3. Hyperhydration – the introduction of a large amount of fluid into the body during infusion.
4. An increase in the volume of proteins and salts in plasma, which leads to a relative decrease in the concentration of blood cells.
5. Pregnancy.

Low hematocrit – symptoms

The fact that the hematocrit is low can be suspected by a number of characteristic signs. Most of them have no specificity, so patients often do not attach importance to them. Among the main symptoms of a decrease in hematocrit in the body:

• general malaise – a decrease in the concentration of red blood cells leads to a decrease in the volume of oxygen delivered by blood cells to organs and tissues;

• permanent fatigue;
• the appearance of a feeling of lack of air;
• pallor of the skin;
• tachycardia;

90,073 hair loss;

• frequent headaches.

Why is low hematocrit dangerous?

Reduced hematocrit in the blood indicates insufficient production of red blood cells – erythrocytes. These shaped elements are responsible for the delivery of oxygen and some nutrients to the organs and tissues of the body. A decrease in their concentration is fraught with the development of chronic hypoxia – constant oxygen starvation. This phenomenon negatively affects the functioning of the brain. Memory impairment, decreased ability to concentrate, and mental activity are directly related to cerebral hypoxia.

Hematocrit below normal (which means – indicated above) is the cause of the development of anemia. As a result, there is a violation of the processes of hematopoiesis. Such patients are more likely to suffer from colds and infectious diseases, constantly experience weakness and fatigue. Other negative consequences of low hematocrit include:

• heart disease;
• disruption of the liver;
• deterioration of kidney function (toxins are poorly excreted from the body, intoxication is possible).

How to increase hematocrit?

Before increasing the hematocrit in the blood, starting therapy for the deviation, doctors carry out a comprehensive diagnosis. Establishing the direct cause of the violation is the main task of specialists. Often, the exclusion of the factor provoking a decrease in hematocrit leads to the normalization of the indicator. Among the main areas of treatment for this disorder:

• therapy with iron-containing drugs – Sorbifer, Maltofer, Ferritab;
• enrichment of the diet with foods containing iron: meat, eggs, nuts, liver, pomegranate;
• reduction of physical activity on the body;
• Frequent walks in the fresh air.

Lowered hematocrit during pregnancy

Hematocrit always decreases during pregnancy. This phenomenon is physiological in nature. As gestation develops, plasma volume increases, resulting in fewer erythrocytes per unit volume of blood. The drop in the indicator begins from about the 4th week of pregnancy. At the same time, the maximum minimum is recorded at 32–34 weeks – 31–35%. In this way, the body prepares for possible blood loss during childbirth. A decrease in the indicator below 30% increases the risk of developing fetal hypoxia.With a hematocrit of 14-25%, the pregnant woman is hospitalized and constantly monitored.

90,000 Anemia in cardiovascular diseases

S.P. Sidoruk, E.B. Petrova, N.P. Mitkovskaya

Hospital, Al-Ahsa, Saudi Arabia, Belarusian State Medical University

Anemia often occurs in patients with pathology of the cardiovascular system: it can be observed in a third of patients with congestive heart failure and in 10-20% of patients with coronary heart disease (IHD).The causes of anemia in heart disease are multifactorial and may include chronic inflammation, absolute or functional iron deficiency, insufficient production and activity of erythropoietin, hemodelution, and renal dysfunction. Hemodynamic and non-hemodynamic changes due to anemia in the presence of concomitant chronic heart disease contribute to an increase in the incidence of cardiovascular complications. Anemia is an independent risk factor for poor outcome in cardiovascular disease and is likely both a mediator and a marker of poor prognosis.Treatment for anemia in patients with cardiovascular disease may include erythropoietins, blood transfusions, and iron supplementation.

keywords: anemia, cardiovascular diseases, ischemic heart disease, arterial hypertension, iron deficiency, carboskimaltose

For citation: Sidoruk S.P., Petrova E.B., Mitkovskaya N.P. Anemia in cardiovascular diseases. Emergency cardiology and cardiovascular risks, 2017, Vol.1, no. 1, pp. 38-45.

Introduction

Cardiovascular diseases are the leading cause of death worldwide. Many patients with cardiovascular disease suffer from anemia as a result of acute or chronic comorbid conditions. According to the criteria of the World Health Organization, the term “anemia” is disclosed as a condition in which, according to gender, a decrease in the concentration of hemoglobin in the blood is observed: in women – less than 120 g / l and less than 130 g / l in men.Anemia is an important problem in practical health care, as it affects the quality of life, mortality and is a common reason for seeking medical attention.

Worldwide, 1.62 billion people suffer from anemia, which is 24.8% of the total population of the planet. Children of preschool age are most often susceptible to anemia (47%), and least of all – men (12.7%). In half of the cases, iron deficiency is the cause of anemia [1]. Iron deficiency not only disrupts the formation of red blood cells, but also impairs cellular functions associated with muscle metabolism, affects the function of mitochondria, neurotransmitters, DNA synthesis and the immune system [2].The incidence of anemia increases with age, which makes it a frequent companion of cardiovascular accidents. Analysis of the literature has demonstrated that anemia is an independent predictor of cardiovascular disease and adverse outcomes [3].

Effect of anemia on the cardiovascular system

To assess the pathological effect of a decrease in the concentration of hemoglobin in the blood on cardiovascular risks, it is necessary to consider the physiological response of the body to anemia.The main factors responsible for gas exchange are: blood flow intensity and distribution, oxygen consumption by cells, blood oxygenation. Hypoxia in anemia is compensated by a cascade of hemodynamic and hemodynamically unassociated mechanisms, such as activation of erythropoietin production, increased tissue oxygen utilization. The realization of the main hemodynamic factors is achieved by increasing the contractile ability of the myocardium, reducing the afterload, increasing the preload, and the realization of positive foreign and chronotropic effects.Increased nitric oxide production, hypoxia-induced vasodilation, and a decrease in blood viscosity cause a decrease in vascular resistance and lead to a decrease in afterload. Chronic anemia stimulates angiogenesis and the formation of new small vessels. The development of collaterals and microvasculature contributes to a decrease in post-exercise. Increased venous return (preload) and left ventricular blood filling contribute to an increase in end-diastolic volume and left ventricular ejection fraction.With short-term anemia, these changes are reversible, with chronicity of the process, they lead to remodeling with the formation of essential hypertrophy of the left ventricular myocardium, as in other forms of volume overload.

The increase in cardiac output, in turn, contributes to the development of arterial remodeling of the central vessels of the elastic type, such as the aorta and common carotid arteries, by increasing the lumen and compensatory thickening of the intima-media complex. As a result, an increase in systolic pressure and inertia, a large mass of blood enters the dilated arterial system.The activation of the sympathetic nervous system enhances the contractility of the left ventricle and increases the heart rate. In the presence of chronic heart disease, these additional effects mediated by anemia contribute to an increase in the incidence of cardiovascular complications [4].

Anemia with arterial hypertension

Normochromic anemia is a common finding in patients with arterial hypertension (AH), and is more common in uncontrolled hypertension.Low hemoglobin levels are associated with poor blood pressure control and are an indicator of increased cardiovascular risk [5]. According to the literature, patients with hypertension with concomitant anemia have higher mean daily, nocturnal and insufficient reduction in nighttime systolic blood pressure compared with those with normal hemoglobin levels. In patients with anemia, there is also a tendency to an increase in the mean daily values ​​of diastolic blood pressure [6].In patients with isolated systolic hypertension and left ventricular hypertrophy with a concomitant decrease in hemoglobin levels, an increase in cardiovascular mortality and the incidence of acute cerebrovascular accidents is observed [7].

Changes in the electrocardiogram in case of anemia

Electrocardiographic repolarization changes (ST segment depression, T wave inversion, prolongation of the QT interval) are common in patients with anemia, both at rest and during exercise [8].It was found that hemoglobin levels strongly correlate with changes in the electrocardiogram [9].

Prolongation of the QT interval is a predictor of ventricular arrhythmias and sudden death. Hypoxia and impaired oxygen delivery in patients with anemia can cause impaired myocardial repolarization. According to the studies, anemia, macrocytosis and anisocytosis correlate with prolongation of the QT interval in patients with arterial hypertension and can be taken into account in assessing the risk of sudden death [10].Low iron levels in otherwise healthy children correlate negatively with QT and QTc intervals and may indicate an additional risk of arrhythmia [11].

Mehta et al. demonstrated significant and reproducible ST segment depression in patients with iron deficiency anemia during exercise tests. These electrophysiological changes disappeared after treatment with iron preparations even before the normalization of the hemoglobin level, which can be explained by the effect of iron at the tissue level [12].

Anemia in coronary heart disease

Myocardial ischemia is determined by the severity of the mismatch between the oxygen demand of cardiomyocytes and the possibilities of its delivery. The determining factors affecting the interest of the myocardium in oxygen are: heart rate, myocardial contractility and heart wall tension. The factors that determine the delivery of oxygen to the heart are the oxygen content in the blood and the intensity of the coronary blood flow.An increase in oxygen delivery to the myocardium in response to an increase in consumption occurs by a decrease in the resistance of the coronary bed. Extraction of oxygen by cardiomyocytes even at rest is about 90% [13]. In patients without coronary pathology, even a significant decrease in oxygen content in the coronary blood flow can be compensated for by peripheral vasodilation. In coronary stenosis, this mechanism is limited. According to the literature, in animals with anemia in acute myocardial infarction, the infarction zone increased, the pumping function of the heart and the survival rate decreased.Blood transfusion to animals with anemia up to a hemoglobin level of 100 g / l reduced the infarction zone and improved the contractile capacity of the myocardium. At the same time, blood transfusion up to a hemoglobin level of 120 g / l was associated with an increase in the infarction zone [14].

Sabatine et al. found a U-shaped dependence of clinical events in acute coronary syndrome by the 30th day: in patients with ST-segment elevation myocardial infarction, there was an increase in mortality at hemoglobin levels below 140 g / l and above 170 g / l, while in patients with myocardial infarction without ST-segment elevation, mortality, the size of the infarction and ischemia increased when the hemoglobin level was less than 110 g / l and more than 160 g / l [15].

Anemia is a significant risk factor for coronary heart disease (CHD). Patients with coronary artery disease and concomitant anemia have a more pronounced degree of coronary disease. According to a number of publications, in patients with coronary artery disease and anemia, the level of hemoglobin, serum iron and total iron-binding capacity of the blood negatively correlate with the severity of coronary pathology [16]. In patients with coronary heart disease and concomitant anemia, there is an increase in mortality compared to the category of individuals with isolated IHD, and anemia is an independent predictor of acute ischemic myocardial injury [17].

A study by Ferreira et al. found that a hemoglobin level of less than 108 g / l was one of the strongest independent predictors of mortality by the end of the first year in acute coronary syndrome. He suggested including the hemoglobin level in the risk assessment of patients hospitalized with acute coronary syndrome, since this is an available parameter and is systematically assessed during hospitalization [18].

In the Cadilac study, anemia was common in patients referred for primary angioplasty for acute myocardial infarction.A strong correlation was demonstrated between a decrease in hemoglobin levels and the development of unfavorable outcomes, an increase in mortality. It was concluded that anemia was an independent predictor of hospital and general mortality by the end of the first year of the postinfarction period [19]. Severe anemia can lead to an imbalance between the delivery and consumption of oxygen in the myocardium, even in the absence of hemodynamically significant coronary stenosis. Bailey et al. described an example of the development of acute ST-segment elevation coronary syndrome in a patient with severe anemia in the absence of angiographically significant coronary stenosis, thrombosis, or spasm [20].

Thus, the causes of poor outcomes in patients with anemia and coronary artery disease are numerous. A decrease in the oxygen capacity of the blood, as well as the activation of the sympathetic nervous system, can increase myocardial oxygen demand and aggravate ischemia.

Anemia in heart failure

Anemia is a common concomitant pathological condition in heart failure (HF). In patients with heart failure and concomitant anemia, the following tendency can be traced: they have more pronounced symptoms of left ventricular failure, a higher frequency of hospitalizations for decompensation of chronic heart failure (CHF), women are more common among them, patients are represented by an older age group, they are more often diagnosed with sugar diabetes, concomitant renal failure and arterial hypertension [21].Anemia is a powerful predictor of readmission and poor survival in chronic heart failure [22]. The incidence of anemia increases with increasing severity of heart failure and can reach 79.1% in patients with functional class IV HF according to the classification of the New York Heart Association [23].

The etiology of anemia in heart failure is multifactorial, with multiple mechanisms responsible for the condition. Increased systemic inflammation, neurohumoral activation, malnutrition, renal dysfunction, decreased bone marrow response to a request, and the effect of taking a number of drugs contribute to its development.An increase in circulating pro-inflammatory cytokines in HF causes impaired iron mobilization, insufficient production of erythropoietin in response to activation of the renin-angiotensin-aldosterone system and a decrease in renal blood flow, and a decrease in bone marrow function. The use of angiotensin-converting enzyme inhibitors can further reduce the secretion of erythropoietin. Eating disorders due to lack of appetite, gastrointestinal malabsorption, and aspirin use can aggravate iron deficiency anemia.Hemodelution also makes an additional contribution to the development of anemia [24].

Iron deficiency

Iron deficiency (ID) is the most common cause of anemia in patients with heart failure [25,26]. Iron deficiency can also be observed at normal hemoglobin levels, and iron deficiency without anemia is detected in 46% of patients with stable heart failure [27]. JJ can be presented in absolute and functional forms. With an absolute deficiency of iron, depletion of its reserves in the body occurs, and iron deficiency anemia can be considered as the final stage of this depletion.Functional iron deficiency is associated with inadequate release from the depot in response to the needs of the bone marrow and occurs in many acute and chronic inflammatory conditions. Iron deficiency is associated with progression of symptoms of heart failure, decreased quality of life, increased mortality and hospitalizations [28-30].

Activation of the sympathetic and renin-angiotensin-aldosterone systems, chronic inflammation, absolute and functional iron deficiency, impaired formation and activity of erythropoietin, hemodelution, renal dysfunction worsen the prognosis in patients with heart failure.Probably, anemia is both a mediator and a marker of a poor prognosis in patients with heart failure.

Treatment of anemia in patients with heart disease

Treatment of anemia in heart failure and coronary heart disease may include taking erythropoietins, in the presence of iron deficiency states with or without anemia – therapy with iron preparations, in severe cases – transfusion of erythrocyte mass.

Sixteen randomized controlled trials evaluated the effect of erythropoietins in patients with heart failure.Most of these studies included patients with systolic heart failure. The obtained data, with a moderate degree of evidence, demonstrated no improvement in quality of life and exercise tolerance with treatment with erythropoietins. At the same time, data with a high degree of evidence demonstrated no reduction in mortality with treatment with erythropoietins. Among the serious side effects associated with their use, the development of vascular thrombosis was identified [31].

Although anemia is common in patients with chronic heart failure and coronary artery disease, erythropoietin treatment did not reduce mortality, the risk of cardiovascular events, or hospital admissions [31]. The American College of Physicians does not recommend the use of erythropoietins in patients with heart failure or coronary heart disease with mild to moderate anemia [31].

Blood transfusion has been suggested for the correction of severe anemia in patients with coronary heart disease, but the results of its effectiveness are conflicting.Most of the data were obtained using liberal or restrictive blood transfusion protocols. The liberal approach to blood transfusion was defined as blood transfusion with a hemoglobin level of less than 90 g / L. Restrictive transfusion strategy – transfusion with hemoglobin level less than 70 g / l. A meta-analysis of 10 studies, which included 203,665 patients with acute coronary syndrome, found that liberal transfusion was associated with an increase in overall mortality compared with restrictive blood transfusion or the management of patients without it [32].However, it should be noted that blood transfusion was associated with a significant increase in the risk of death by the 30th day only with a hematocrit of more than 25% [32].

To date, there is no consensus regarding liberal and restrictive blood transfusion tactics in patients with coronary artery disease. A number of studies with low evidence indicate that restrictive transfusion has no effect on mortality in patients with coronary heart disease compared with liberal transfusion.A number of studies based on clinical observation of patients have put forward the statement: blood transfusion has no practical benefit and can harm patients with cardiovascular pathology with a hemoglobin level of more than 100 g / l [31]. A pilot study of 110 patients with acute coronary syndrome or stable angina who underwent coronary interventions demonstrated that hemoglobin less than 100 g / L correlated with a trend towards an increase in major coronary events, including death from cardiovascular causes in patients with liberal versus restrictive strategy of blood transfusion [33].

Due to conflicting research results and a lack of robust randomized controlled trials, restrictive blood transfusion may occur in acute coronary syndrome and hospitalized patients with coronary heart disease [31, 34].

Beneficial effects of intravenous iron therapy for iron deficiency with or without anemia in patients with heart failure

Iron is a vital element for the organization of a number of vital functions in the body.It serves as a carrier of oxygen to cells and is part of important enzyme systems in various tissues. Iron-containing enzymes perform the function of transferring electrons within the cell, and their function in oxidative metabolism is the transfer of energy within the mitochondria. Another key function of iron-containing enzymes (eg, cytochrome P450) is the synthesis of steroid hormones and bile acids; neutralization of toxins in the liver; control of the effect of neurotransmitters, such as dopamine, and the serotonin systems of the brain [35].

Several studies have addressed the treatment of patients with heart disease with intravenous iron supplementation. Data from the Fair-HF study, which included patients with and without anemia, demonstrated that only 27.6% of patients receiving intravenous iron carboxymaltose had cardiovascular events compared with 50.2% of patients receiving placebo (p = 0.01). Intravenous administration of iron carboxymaltose increased the tolerance and duration of physical activity in patients with stable heart failure and chronic kidney disease (CKD), no higher than stage 3 CKD.Most of the patients included in the study had ferritin levels less than 100 mg / L [36]. This study showed that intravenous administration of 200 mg of iron carboxymaltose formulation increased the 6-minute walk test distance (317 m versus 277 m) compared to intravenous administration of saline [36]. This study, with a moderate degree of evidence, demonstrated that intravenous iron supplementation improved the quality of life in patients with anemia or iron deficiency with stable CHF and chronic kidney disease no higher than stage 3.The Fair-HF study showed that treatment with intravenous iron supplementation improved the functional class of heart failure and quality of life indicators, regardless of whether the patient had laboratory signs of anemia or not [36]. This study also demonstrated no statistically significant difference in the incidence of significant side effects between patients receiving intravenous iron carbosymaltose and the control group [36].

The aim of the CONFIRM-HF study was to investigate the long-term effect of treatment with iron carboxymaltose in patients with symptomatic heart failure and iron deficiency.The study included 304 patients with stable NYHA class II or III heart failure, left ventricular ejection fraction ≤45%, elevated natriuritic peptide levels (brain natriuretic peptide> 100 pg / ml and / or N -terminal fragment of natriuritic peptide> 400 pg / ml), iron deficiency (serum feritin level <100 ng / ml, or from 100 to 300 ng / ml if transferrin saturation <20%) and hemoglobin up to 15 g / dl.

As a result of the study, it was revealed that the treatment of stable symptomatic patients with heart failure and iron deficiency with intravenous iron carboxymaltose leads to a sustained improvement in their functional state according to the 6-minute walk test; improving the quality of life; a significant reduction in the risk of hospitalizations due to the progression of heart failure. The patients were monitored for one year. The above positive effects were observed in all subgroups, including patients with or without anemia [37].

Results of the CONFIRM-HF study compared with Fair-HF had more objective primary and endpoints, showed a longer beneficial effect of treatment with iron carboxymaltose with a good safety profile, and demonstrated a significant reduction in the risk of hospitalization due to worsening heart failure [37].

A meta-analysis of all randomized controlled trials examining the effect of intravenous iron therapy in patients with systolic heart failure and iron deficiency showed that its use in this patient population reduces the risk of combined endpoints: overall mortality and cardiovascular hospitalizations, cardiovascular mortality and hospitalization for worsening heart failure, and the risk of hospitalizations due to CHF decompensation.There was no significant effect on overall or cardiovascular mortality. At the same time, intravenous therapy with iron preparations led to an improvement in exercise tolerance, a decrease in symptoms of heart failure, and an improvement in the quality of life of patients [38].

Intravenous administration of iron carboxymaltose should be considered as a treatment in symptomatic patients with systolic heart failure and iron deficiency to reduce clinical manifestations, increase exercise tolerance and improve quality of life [39].

Conclusion

Treatment of anemia in patients with heart disease may differ significantly from treatment of anemia in the general population. However, an understanding of the evidence base and the use of clinical judgment are essential for the treatment of this population. Anemia correlates with worse prognosis in patients with cardiovascular pathology and becomes a new therapeutic target for this category of patients. The question of whether anemia is a cause or a marker of adverse outcomes and reflects only the severity of cardiovascular disease remains relevant to this day.

Conflict of interest. The authors declare that they have no conflicts of interest that could influence the results of the study or their interpretation.

Introduction. Cardiovascular disease is a significant health problem around the world and accounts for the majority of deaths annually. Many of such patients have anemia due to acute blood loss (surgery or trauma) or chronic conditions such as renal failure or cancer.

According to the World Health Organization criteria anemia is defined in cases when hemoglobin is less than 120 g / l in females and less than 30 g / l in males.It is a major health problem that increases the mortality rate, affects physical status, and demands referral to health-care professionals. Globally, anemia affects 1.62 billion people, which corresponds to 24.8% of the total population. The highest prevalence is in preschool-age children (47.4%), and the lowest prevalence is in men (12.7%). Half of the cases are due to iron deficiency [1] which affects not only red blood cell production but also cellular functions related to muscle metabolism, mitochondrial function, neurotransmitters, DNA synthesis, and the immune system [2].

Prevalence of anemia increases with the advanced age making it a common associated comorbidity in patients with cardiovascular diseases. It has been established that anemia is an independent risk factor for cardiovascular diseases (CVD) outcomes [3].

Effects of anemia on the cardiovascular system. Understanding the physiologic response to anemia is important in order to take into account the implications of this state in regards to cardiac diseases. Three main factors are responsible for oxygen delivery to organs: blood flow and its distribution; the oxygen-carrying capacity of the blood, i.e. hemoglobin concentration; and oxygen extraction. Hypoxia in anemia is compensated through several non-hemodynamic (increased erythropoietin production to stimulate erythropoiesis, increased oxygen extraction) and hemodynamic mechanisms. The main hemodynamic factors are decreased afterload, increased preload, and positive inotropic and chronotropic effects. Enhanced nitric oxide activity, hypoxia-induced vasodilatation and lower blood viscosity are responsible for reduced vascular resistance and lead to the decreased afterload.Chronic anemia stimulates angiogenesis and recruitment of new microvessels. Enhanced venous return (preload) and left ventricular (LV) filling lead to the increased LV end-diastolic volume and cardiac output. Increased cardiac output is responsible for arterial remodeling of the central elastic arteries such as the aorta and common carotid artery through arterial enlargement and compensatory arterial intima-media thickening, leading to the elevated systolic pressure and high inertia due to higher blood mass in the dilated arterial system.Activation of sympathetic activity enhances LV contractility, and the heart rate. Short-lasting anemia is reversible but in chronic anemia hemodynamic changes lead to cardiac enlargement and development of eccentric LV hypertrophy (LVH). It also occurs in other forms of the volume overload. In case of heart diseases chronic anemia contributes to a high incidence of cardiovascular complications [4].

Anemia in arterial hypertension

Normocytic anemia is common in hypertensive patients but more prevalent in uncontrolled hypertension.Lower hemoglobin is associated with poor blood pressure control, indicating a higher cardiovascular risk in uncontrolled hypertension [5]. It was noted that hypertensive patients with anemia had higher nocturnal systolic and mean blood pressure and a lower dipping status compared to the patients with normal hemoglobin levels. There was a trend for increased diastolic blood pressure [6].

In patients with isolated systolic hypertension and left ventricular hypertrophy lower hemoglobin was associated with the increased cardiovascular death or stroke [7].

Electrocardiographic changes in anemia.

Electrocardiographic (ECG) repolarization abnormalities (ST segment depression, T wave inversion, prolonged QT) are highly prevalent in anemic patients at rest and during the tests with physical loading [8]. It has been shown that the hemoglobin level is strongly correlated with ECG changes [9].

A long ECG QT interval duration is a predictor of ventricular arrhythmia and sudden cardiac death. Hypoxia and impaired oxygen supply in anemic patients may affect repolarization of the myocardium.It has been found that anemia, macrocytosis and anisocytosis are associated with prolonged QT intervals in hypertensive patients and may contribute to the risk of sudden cardiac death [10]. Low iron stores in otherwise healthy children negatively correlated with QT and QTc intervals and may indicate some risk in developing arrhythmias [11].

Mehta et al. showed significant reproducible ST depression in anemic patients with iron deficiency during the tests with physical loading. These electrophysiological changes were corrected after iron therapy, even before the rise of hemoglobin occurred, which may be explained by the effect of iron on the tissue level [12].

Anemia in Ischemic Heard Disease

Myocardial ischemia is defined as oxygen delivery that is insufficient to meet oxygen requirements. The determinants of myocardial oxygen demand are wall tension, heart rate and contractility. The determinants of myocardial oxygen delivery are arterial oxygen content and coronary arterial blood flow. The increase of oxygen delivery in response to the enhancement of oxygen demand occurs through the changes in coronary vascular resistance, as the extraction ratio of myocardium at rest is nearly 90% [13].Patients without coronary artery disease, therefore, have a tremendous ability to compensate the decrease in coronary arterial oxygen content through distal vasodilatation but in the presence of coronary stenosis this compensatory mechanism has a limited ability.

It was proved that anemic animals have the increased infarct size, decreased cardiac function and the survival rate in case of acute myocardial infarction (MI). Transfusion of fresh blood to anemic animals up to 100 g / L Hb reduced the infarct size and improved the cardiac function.However, blood transfusion up to 120 g / L Hb was associated with larger infarcts [14].

Sabatine et al. found out a U-shaped relationship with clinical events by the 30th day: in patients with ST-elevation MI; the mortality rate was higher in those with the hemoglobin levels below 140g / L or above 170g / L, while in patients with non-ST elevation acute coronary syndrome (ACS), death, infarction and ischemia increased in case when hemoglobin levels were below 110g / L or above 160 / L [15].

Anemia is a risk factor for ischemic heart disease.Patients with ischemic heard disease (IHD) and anemia have a more advanced degree of ischemic heart disease compared to patients with isolated IHD. In anemic patients with IHD the level of hemoglobin, serum iron and total iron-binding capacity negatively correlated with the severity of IHD [16]. The mortality rate in anemic patients with IHD was higher than in patients with isolated IHD [16]. Anemia was an independent predictor of acute coronary syndrome based on the hemoglobin level, while both anemia and a high hematocrit level were predictors of myocardial infarction based on hematocrit [17].

The investigations made by Ferreira et al. revealed that hemoglobin <108g / L was one of the strongest independent predictors of one-year mortality in population with acute coronary syndrome (ACS). He suggested including the hemoglobin level in risk stratification scores of patients admitted for ACS, given that it is an easy parameter to measure and is systematically assessed at admission [18].

In the Cadilac trial anemia was common in patients with AMI who underwent primary PCI and was strongly associated with the adverse outcomes and increased mortality [19].Anemia was an independent predictor of in-hospital mortality by the end of the first year [19].

Severe anemia can lead to disbalance between oxygen delivery and demand in the myocardium even in patients without coronary stenosis. Bailey D et al. reported a case of the ST segment elevation myocardial infarction (STEMI) secondary to severe anemia which occurred in the absence of angiographically significant coronary artery stenosis, thrombosis or coronary artery spasm [20].

Thus, there are a number of reasons for the worse outcomes in anemic patients with the obstructive coronary artery disease.Diminished oxygen-carrying capacity, activation of the sympathetic nervous system can increase myocardial oxygen demand and worsen ischemia.

Anemia in Heart Failure

Anemia is a very common comorbidity in chronic heart failure. Anemic patients are elderly women with more advanced symptoms and signs of heart failure, greater functional impairment and a higher hospitalization rate; they have a history of diabetes mellitus, renal insufficiency, and hypertension [21].Anemia is a powerful predictor of rehospitalization rates and survival in case of chronic heart failure [22]. The prevalence of anemia increases with the severity of heart failure (HF) and can reach 79.1% in those with Class IV according to the classification of the New York Heart Association [23].

Etiology of anemia in HF may be multifactorial and a number of potential mechanisms may be responsible for such a condition in heart failure. Neurohormonal and inflammatory activation, renal dysfunction, bone marrow hyporesponsiveness, malnutrition, drug effects contribute to its development.Increased circulating proinflammatory cytokines enable defective iron mobilization, inappropriate erythropoietin production, depressed bone marrow function. Activation of the renin-angiotensin-aldosteron system, decreased renal perfusion caused by the low blood pressure and stroke volume stimulate the release of erythropoietin but the response is blunted due to effect of the circulatory cytokines. Poor nutrition due to anorexia, gastrointestinal malabsorbtion and aspirin use may precipitate iron deficiency anemia.Hemodilution can contribute to anemia. The use of the angiotensin-converting enzyme (ACE) inhibitor therapy may reduce secretion of erythropoietin [24].

Iron deficiency (ID) is the most frequent cause of anemia in patients with HF [25, 26] and can be revealed in ∼46% of non-anemic patients with stable systolic HF [27].

Iron deficiency may exist in absolute or functional forms. Absolute iron deficiency occurs when total body iron stores become exhausted and ID anemia can be considered as the final phase of iron stores depletion; functional iron deficiency refers to inadequate iron release in response to the demands of the bone marrow.Functional iron deficiency can be seen in many acute and chronic inflammatory states. ID is associated with the worsening of symptoms in patients with heart failure, impaired life quality, the increased mortality and hospitalization level [28, 29, 30].

Activation of sympathetic and renin-angiotensin-aldosteron systems, chronic inflammation, absolute and functional iron deficiency, impaired production and activity of erythropoietin, hemodilution, renal dysfunction impair prognosis in heart failure patients.Probably, anemia acts as a mediator and a marker of a poor prognosis in HF patients.

Treatment of anemia in patients with heart diseases. Anemia treatment strategies in heart failure and CHD patients include erythropoiesis-stimulating agents (ESAs), red blood cell transfusions and iron replacement in iron deficient patients with or without anemia.

Sixteen randomized, controlled trials assessed the impact of ESAs in patients with heart disease. Most of these studies included patients with CHF and the reduced systolic function.Overall, moderate-quality evidence showed no benefit from ESAs in regard to improving exercise tolerance and duration or quality of life, and high-quality evidence showed no mortality benefit [31]. Serious harmful effects associated with the treatment include mortality and vascular thrombosis [31]. So, the damage outweighs the benefits in treatment of patients with mild to moderate anemia using ESAs. Although anemia is common in patients with CHF and CHD, treatment with ESAs did not decrease mortality, cardiovascular events or hospitalization rates [31].The American College of Physicians does not recommend using erythropoiesis-stimulating agents to patients with mild to moderate anemia and congestive heart failure or coronary heart disease [31].

Blood transfusion has been suggested to correct severe anemia in patients with coronary artery disease, but data in regard to its effectiveness are contradictory. In the majority of studies investigating different transfusion protocols, a liberal blood transfusion strategy was defined as any red blood cell transfusion at a hemoglobin level up to 90 g / L, while a restrictive blood transfusion strategy was defined as any transfusion at a hemoglobin level up to 70 g / L.A meta-analysis of 10 studies totaling 203 665 patients with acute coronary syndrome (both STEMI and NSTEMI-ACS) reported that blood transfusion or a liberal transfusion strategy was associated with the increased all-cause mortality, compared with no blood transfusion or a restrictive transfusion strategy [32]. However, a transfusion or liberal transfusion strategy was associated with a significantly higher mortality risk by the 30 ^th day only in case when a nadir hematocrit is more than 25% [32].

However, low-quality evidence data demonstrate that blood transfusion using restrictive compared with liberal transfusion protocols had no effect on mortality in patients with CHD. Observational studies suggested that transfusion is not beneficial and may be harmful for patients with heart disease and hemoglobin levels of more than 100 g / L (31). A pilot trial of 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and hemoglobin <100 g / L revealed a trend of fewer major cardiac events and deaths in patients with the liberal transfusion strategy as compared with a more restrictive strategy [33] ...

Due to inconsistent results of the studies and the lack of adequately powered RCTs restrictive red blood cell transfusion strategy may be considered in the settings of ACS and for hospitalized patients with coronary heart disease [31, 34]

Benefits of using intravenous iron injections in treatment of iron deficiency with or without anemia in HF patients.

Iron has several vital functions in the body. It serves as a carrier of oxygen to the tissues, a transport medium for electrons within cells, and an integrated part of important enzyme systems in various tissues.Several iron-containing enzymes act as electron carriers within the cell and their role in the oxidative metabolism is to transfer energy within the cell and mitochondria. Other key functions for the iron-containing enzymes (e.g. cytochrome P450) include synthesis of steroid hormones and bile acids; detoxification of foreign substances in the liver; and signal controlling in some neurotransmitters, such as the dopamine and serotonin systems in the brain [5].

Few studies addressed to intravenous iron therapy for patients with heart disease.Data from Fair-HF study, which included patients with and without anemia demonstrated, that 27.6% of patients treated with intravenous iron carboxymaltose had cardiovascular events compared with 50.2% of patients receiving placebo (p = 0.01). Moderate-quality evidence showed that intravenous iron administration increased exercise tolerance and duration in patients with stable CHF including patients with Stage 3 chronic kidney disease. FAIR-HF trial (Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure) included anemic and nonanemic patients, with the majority of them having ferritin levels less than 100 µg / L [36].This trial showed that 200 mg of intravenous ferric carboxymaltose (FCM) increased a 6-minute walk distance (313 m vs. 277 m) compared with intravenous saline [36]. Moderate-quality evidence showed that intravenous iron improved quality of life in patients with anemia or iron deficiency, stable CHF, and chronic kidney disease excluding the patients with the 4 ^th and 5 ^th stages. The FAIR-HF study showed that intravenous iron treatment improved Patient Global Assessment scores compared with control patients and the improved NYHA functional class, regardless of the anemia status (hemoglobin level ≤120 g / L) [36].This trial also showed improved life quality. [36]. There was no statistically significant difference in serious harmful effects between the intravenous iron treatment and the control groups [36].

The CONFIRM-HF trial was aimed at studying effects of long-term intravenous iron therapy in ferric carboxymaltose inpatients with symptomatic heart failure and iron deficiency. Totally 304 patients with stable ambulatory HF (class II or III according to New York Heart Association (NYHA) classification) and left ventricular ejection fraction (LVEF) ≤45%, elevated natriuretic peptides (brain natriuretic peptide> 100 pg / mL and / or N-terminal-pro-brain natriuretic peptide> 400 pg / mL), presence of ID (defined as serum ferritin level <100 ng / mL, or between 100 and 300 ng / mL if transferrin saturation was <20%) and hemoglobin ( Hb) up to15 g / L were enrolled in the study.This study showed that treatment of stable, symptomatic, 'iron-deficient HF patients with intravenous iron (FCM) results in sustainable improvement of functional capacity as measured over a 1-year period using the 6-MWT walking test, improvement in quality of life , significantly reduced risk of hospital admission due to worsening of HF during a1-year follow-up period. These favorable results were consistent across all pre-specified subgroups including patients with and without anemia [37].

The results of CONFIRM-HF compared with FAIR-HF had a more objective primary end-point, documented longer-term sustainability of beneficial effects of treatment with FCM and the acceptable safety profile (i.e. 12 months compared with 6 months or less in previous studies) and provided data on significant risk reduction of the hospitalization due to HF worsening [37].

A meta-analysis of all randomized controlled trials that investigated the effects of intravenous iron therapy in iron-deficient patients with systolic HF (also analyzed separately in anemic and non-anemic subjects) showed that intravenous iron therapy in patients with systolic HF and ID reduced the risk of the combined endpoint of all-cause death or cardiovascular hospitalization, the risk of the combined endpoint of cardiovascular death or hospitalization due to advanced HF.However there was no effect on either all-cause or cardiovascular mortality, parenteral iron therapy resulted in the improved exercise capacity (as reflected by a longer 6MWT distance) and life quality, and also in alleviation of HF symptoms (reduction in the NYHA class) [38].

Intravenous FCM should be considered in symptomatic patients with systolic heart failure and iron deficiency (serum ferritin level <100 ng / mL, or between 100 and 300 ng / mL if transferrin saturation <20%) in order to alleviate HF symptoms, and improve exercise capacity and life quality [39].

Conclusion. Management of patients with heart disease and anemia might appropriately differ from that of the general population. Hence, clinical judgment and understanding the evidence base are critical when managing these patients. Anemia is associated with worse outcomes in patients with cardiovascular diseases. However, it is uncertain if anemia is the cause or the marker of poor outcomes and thus it only reflects advanced cardiovascular disease.

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