Symptoms of low hct: 8 Anemia Symptoms, Treatment, Causes, Iron Deficiency & Types

10.05.197330.08.2021 by alexxlab

Содержание

9 common nutrient deficiencies in the U.S.

Although most of us are aware of the benefits of eating a balanced diet, nearly 10% of people in the U.S. have nutrient deficiencies. Failing to get key nutrients can lead to a variety of health problems, including fatigue, night blindness, osteoporosis, high blood pressure, and even acne.

If you’re experiencing the above symptoms and have ruled out other health conditions, you may suffer from a nutrient deficiency. Preventing and detecting the most common ones—including calcium, essential fatty acids, folic acid, iron, magnesium, and vitamins A, B12, C, and D—can be achieved through monitoring and adjusting your diet, considering dietary supplements, and having a conversation with your healthcare provider if you suspect you have a vitamin or mineral deficiency.

What is a nutrient deficiency, and how do I know if I have one?

“A nutrient deficiency occurs when a body doesn’t get the necessary amount of nutrients it needs (a nutrient being a substance that is essential for growth, development, or the maintenance of life),” says Michael Jay Nusbaum, MD, the medical and surgical director at Nusbaum Medical Centers in New Jersey.

Many people have vitamin deficiencies but never realize it. Those who maintain a poor diet, eat poor quality food, or fail to take supplements are most at risk. In many cases, symptoms lead to a patient getting testing, which reveals the deficiency.

Once a nutritional deficiency is detected, it’s treated by providing the nutrients needed in the diet either through food, supplements, or both. In some severe deficiency cases, IV infusions may be necessary to replenish what is missing, according to Dr. Nusbaum.

9 common nutrient deficiencies

In the U.S., calcium, essential fatty acids, folic acid, iron, magnesium, and vitamins A, B12, C, and D are some of the most common nutrient deficiencies.

1. Calcium

Calcium’s main reputation comes from being an important building block for strong bones. But the essential mineral is also key for nerve and muscle function and heart health. Because calcium is stored in the bones and withdrawn when we don’t consume enough, a calcium deficiency leaves bones weak and more likely to break.

Nearly 70% of Americans fail to meet the recommended daily intake for calcium, which is due to either inadequate intake of calcium-rich foods or to poor absorption. Additionally, caffeinated beverages, alcohol, soda, dark leafy greens, beans and whole grains can decrease the body’s absorption of calcium. Signs of a calcium deficiency include mottled teeth, weak fingernails, or a numbness/tingling in the fingers or muscle cramps.

2. Essential fatty acids

“Essential fatty acid deficiencies occur when omega-3 consumption is too low, but symptoms can also appear if omega-6 fatty acid intake from processed foods is too high,” says Paul Kriegler, RD, the nutritional products program manager at Life Time. Symptoms include scaly skin, brittle or cracking nails, and acne.

3. Folic acid

Folic acid, one of the many B vitamins, plays a role in maintaining healthy red blood cells and is particularly important during pregnancy, as women with low folic acid stores have a greater chance of having a baby with a neural tube defect (such as spina bifida). Outside of pregnancy, folic acid helps prevent anemia and heart disease.

Those who don’t consume enough fruits and vegetables (or who overcook their veggies) are at the greatest risk of developing a folate deficiency. People who consume high amounts of alcohol or who take certain medications (such as phenytoin, methotrexate, sulfasalazine, triamterene, trimethoprim-sulfamethoxazole, and barbiturates) have an increased risk of developing a folic acid deficiency. Symptoms may be similar to those caused by an iron deficiency, including fatigue, lethargy, hair loss, and shortness of breath.

RELATED: 3 types of medications that could have a vitamin interaction

4. Iron

“Iron deficiencies can occur multiple ways: inadequate consumption of iron-rich foods, poor iron absorption, or iron loss through excess blood loss or during developmental stages in life such as adolescence, pregnancy, or breastfeeding,” Kriegler says. Other people who have an increased risk of developing an iron deficiency include those with certain stomach or intestinal conditions that either cause bleeding or reduce the absorption of iron from food.

Iron deficiency anemia can cause general fatigue, headaches, dizziness, shortness of breath, muscle weakness, pale skin color, and chest pain. In pregnant women, iron levels should be routinely checked, as expectant mothers are at an increased risk of developing this condition.

5. Magnesium

Magnesium is an essential mineral that affects hundreds of metabolic reactions within the body, including regulating muscle and nerve function. “Many Americans don’t consistently consume adequate amounts of magnesium and most multivitamin supplements contain insufficient amounts of magnesium because it’s a bulky mineral that takes up a large volume of space in the formula, so it’s often recommended as an additional, stand-alone supplement,” notes Kriegler. Symptoms of a magnesium deficiency include muscle cramps, abnormal heart rhythms, unexplained numbness or tingling, and high blood pressure.

6. Vitamin A

Vitamin A is essential in the replacement of skin cells and for maintaining optimal vision and a healthy immune system. For this reason, those with a vitamin A deficiency are at an increased risk of acquiring a severe infection. As children are prone to infections, it’s crucial that those under the age of 5 get enough vitamin A in their diets or through supplements. In adults, one of the key warning signs of a vitamin A deficiency is night blindness.

7. Vitamin B12

One of the eight types of B vitamins, vitamin B12 helps to form red blood cells, enhances neurological function, and provides building blocks for DNA. Those most at risk for a vitamin B12 deficiency are vegans, people with intestinal problems that limit vitamin absorption, older adults, and those taking long-term heartburn medication. Symptoms of vitamin B12 deficiency are similar to those of anemia, including weakness, pale skin, shortness of breath, and mood changes.

8. Vitamin C

Vitamin C acts as an antioxidant within the body, helping to prevent damage inflicted by free radicals. Vitamin C also helps in hormone and amino acid formation; it also helps with the absorption of iron. The most commonly known effect of a vitamin C deficiency is scurvy, a fatal-if-untreated disease that causes inflamed and bleeding gums, easy bruising, weakness, fatigue, rashes, and difficulty healing wounds. While scurvy is uncommon today, proper vitamin C intake is still crucial for optimal health, as vitamin C regulates collagen production.

9. Vitamin D

Vitamin D is unique in that most vitamin D can be produced in our bodies when exposed to adequate amounts of UVB radiation from sunlight. Vitamin D’s key role is to regulate calcium absorption. Those with a vitamin D deficiency are unable to absorb that calcium and in turn strengthen bones. However, vitamin D has several other important roles for overall health, including supporting bone health, cardiovascular health, testosterone, and immune function.

The NIH says that “35% of adults in the United States are vitamin D deficient.” Try to get 10-15 minutes of mid-day sun exposure of the face, hands, and arms without protective sunscreen may be enough to maintain healthy vitamin D levels, depending on the time of year, latitude, and skin pigmentation characteristics. Remember, if your skin is starting to turn pink, you’ve gotten too much sun.

RELATED: How much vitamin D should I take?

How to prevent nutrient deficiencies

“The simplest way to prevent nutrient deficiencies is to eat a wholesome, nutrient-dense diet based on an abundance of produce (seven-plus servings per day) and ample protein, plus supplementing your diet every day with a high quality multivitamin, vitamin D, and omega-3 fish oil,” says Kriegler. If you’re concerned about a nutrient deficiency, there are a few steps you can take:

Get tested

Your healthcare provider can order a blood test to evaluate your essential nutrient levels if you’re exhibiting symptoms of a deficiency. An individual blood test can be conducted to assess a specific nutrient deficiency. However, a comprehensive nutrition panel is the most effective way to measure your overall health according to levels of vitamins, nutrients, and enzymes. Overnight fasting may be recommended to enhance the accuracy of results.

Evaluate your diet

Getting nutrients from your diet while avoiding processed foods, fast foods, and sugars is the ideal way to avoid a nutrient deficiency. Food sources include:

Calcium: Dairy products (milk, yogurt, or cheese), sardines, calcium-fortified orange juice, and dark green leafy vegetables
Folic acid: Eggs, leafy green vegetables, fruits, and dried beans and peas
Essential fatty acids: Cold water fish, flaxseed, and olive oil
Iron: Fortified dairy products, fatty fish, egg yolks, red meat, poultry, fish, and beans or legumes
Magnesium: Pumpkin seeds, leafy green vegetables, beans, legumes, and whole grains
Vitamin A: Spinach, chard, sweet potatoes, squash, pumpkins, carrots, mangoes, papayas, eggs and milk
Vitamin B12: Meat, fish, poultry, eggs, and dairy products
Vitamin C: Citrus fruits, broccoli, cantaloupe, cauliflower, kiwi, sweet potatoes, tomatoes, kale, bell peppers, and strawberries
Vitamin D: Fatty fish, beef liver, egg yolks, or a number of fortified foods (however, it’s almost impossible to achieve optimal vitamin D levels solely through diet, notes Kriegler)

Consider supplements

Even with a healthy diet, it can be difficult to achieve an optimal balance of nutrients. Supplements containing essential nutrients are available either alone, or in multivitamin formulas; your healthcare provider or pharmacist can help you determine the right balance of supplements.

Low hemoglobin count Causes – Mayo Clinic

Normally low hemoglobin counts

A slightly low hemoglobin count isn’t always a sign of illness — it can be normal for some people. Women with menstrual periods and pregnant women commonly have low hemoglobin counts.

Low hemoglobin counts associated with diseases and conditions

A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red blood cells. This can occur if:

Your body produces fewer red blood cells than usual
Your body destroys red blood cells faster than they can be produced
You have blood loss

Diseases and conditions that cause your body to produce fewer red blood cells than normal include:

Aplastic anemia
Cancer
Certain medications, such as antiretroviral drugs for HIV infection and chemotherapy drugs for cancer and other conditions
Chronic kidney disease
Cirrhosis
Hodgkin’s lymphoma (Hodgkin’s disease)
Hypothyroidism (underactive thyroid)
Inflammatory bowel disease (IBD)
Iron deficiency anemia
Lead poisoning
Leukemia
Multiple myeloma
Myelodysplastic syndromes
Non-Hodgkin’s lymphoma
Rheumatoid arthritis
Vitamin deficiency anemia

Diseases and conditions that cause your body to destroy red blood cells faster than they can be made include:

Enlarged spleen (splenomegaly)
Hemolysis
Porphyria
Sickle cell anemia
Thalassemia

A low hemoglobin count can also be due to blood loss, which can occur because of:

Bleeding in your digestive tract, such as from ulcers, cancers or hemorrhoids
Frequent blood donation
Menorrhagia (heavy menstrual bleeding) (heavy menstrual bleeding-although even normal menstrual bleeding may cause a slightly low hemoglobin count)

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

Definition
When to see a doctor

Sept. 22, 2020

Show references

Hemoglobin. Lab Tests Online. https://labtestsonline.org/tests/hemoglobin. Accessed March 6, 2020.
McPherson RA, et al. Erythrocytic disorders. In: Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Elsevier Inc.; 2017. https://www.clinicalkey.com. Accessed March 6, 2020.
Leung LLK. Approach to the adult with anemia. https://www.uptodate.com/contents/search. Accessed March 6, 2020.
Low red blood cell counts (anemia). American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/anemia.html. Accessed March 6, 2020.
Donors deferred for low hemoglobin. American Red Cross. https://www.redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-blood-donation/donors-deferred-forlowhemoglobin. html. Accessed March 20, 2020.

Low Blood Counts – Hematology Oncology Associates of Fredericksburg

Overview

A reduced number of blood cells in circulation is a common side effect of chemotherapy. Blood is composed of three basic blood cell types: red blood cells, white blood cells, and platelets. Blood cells are produced in the bone marrow and regularly released into circulation. Chemotherapy destroys rapidly dividing cells, a characteristic of cancer cells. However, bone marrow cells also divide rapidly and are frequently damaged by chemotherapy. The best way to treat low blood counts is to prevent them before they occur. This can be accomplished with the administration of blood cell growth factors. In some circumstances, blood transfusions may also be necessary.

What are low blood counts?

A blood count is a measurement of the number of blood cells an individual has in circulation based on laboratory evaluation of a blood sample. Blood is composed of three basic blood cell types: red blood cells, white blood cells, and platelets. You should have billions of these blood cells circulating throughout your body. However, certain circumstances may cause you to have fewer cells than is considered normal, a condition which is called “low blood counts”. The laboratory test that is conducted to measure the number of blood cells is called a complete blood count, or CBC.

What causes low blood counts?

The most common reason cancer patients experience low blood counts is as a side effect of chemotherapy. Chemotherapy involves the use of drugs to destroy cancer cells. Chemotherapy works by destroying cells that grow rapidly, a characteristic of cancer cells. Unfortunately, chemotherapy also affects normal cells that grow rapidly, such as cells in the bone marrow that produce red blood cells, white blood cells, and platelets.

What are the symptoms of low blood counts?

Your symptoms will depend on which types of blood cells are low. Common symptoms of the different types of low blood cell counts are listed in table 1.

Table 1: Common symptoms of low blood counts

Low red blood cells	Low white blood cells	Low platelets





Dizziness or lightheadedness

Why is it important to monitor blood counts?

It is important to monitor for low blood cell count because this condition may:

Increase your risk of unpleasant and sometimes life-threatening side effects, such as fatigue, infection, and/or bleeding.
Disrupt delivery of your cancer treatment, resulting in a change to the planned dose and time.

How are low blood counts diagnosed?

A test called the complete blood count (CBC) is used to determine whether your blood counts are low. The CBC measures the levels of the three basic blood cells: red, white, and platelets.

In the United States, the CBC is typically reported in the format shown below. If your blood counts fall outside of the normal range, which is shown in the “Reference interval” column, their values will be reported in the “Flag” column with an ‘L’ for low and an ‘H’ for high. The example CBC below shows that white blood cells, red blood cells, and platelets are all low.

CBC WITH DIFFERENTIAL
Test	Result	Flag	Units	Reference Interval
White Blood Count		1. 5 L	x 10-3/mL	4.0-10.5
Red Blood Count		3.50 L	x 10-6/mL	4.70-6.10
Hemoglobin		10.8 L	g/dL	14.0-18.0
Hematocrit		31.1 L	%	42.0-52.0
Platelets	302		x 10-3/mL	140-415
Polys		23 L	%	45-76
Lymphs		68 H	%	17-44
Monocytes	7		%	3-10
Eos	2		%	0-4
Basos	>		%	0.2
Polys (absolute)		.34 L	x 10-3/mL	1.8-7.8
Lymphs (absolute)	1.0		x 10-3/mL	0.7-4.5
Monocytes (absolute)	0. 1		x 10-3/mL	0.1-1.0
Eos (absolute)	0.1		x 10-3/mL	0.0-0.4
Basos (absolute)	0.0		x 10-3/mL	0.0-0.2

Result column: The result column shows counts that fall within the normal range.

Flag column: The flag column shows counts that are lower (“L”) or higher (“H”) than the normal range.

Reference interval (or reference range) column: The reference interval shows the normal range for each measurement for the lab performing the test. Different labs may use different reference intervals.

White blood cells: White blood cells help protect individuals from infections. The above CBC report shows that the patient’s total white cell count is 1.5, which is lower than the normal range of 4.0-10.5. The low white cell count increases the risk of infection.

Differential: This portion of the CBC shows the counts for the 5 main kinds of white cells, either as percentages (the first 5 counts), or as the absolute number of cells (the second 5 counts).

Absolute neutrophil count: Neutrophils are the main white blood cell for fighting or preventing bacterial or fungal infections. In the CBC report, neutrophils may be referred to as polymorphonuclear cells (polys or PMNs) or neutrophils. The absolute neutrophil count (ANC) is a measure of the total number of neutrophils present in the blood. When the ANC is less than 1,000, the risk of infection increases. The ANC can be calculated by multiplying the total WBC by the percent of polymorphonuclear cells. For example, this patient’s ANC is 0.34, which equals (WBC) 1.5 x 23%.

Red blood cells: Red blood cells carry oxygen from the lungs to the rest of the body. The above CBC report indicates that the patient has a red cell count of 3. 5, which is lower than the normal range of 4.70-6.10, and therefore, shown in the flag column.

Hemoglobin (Hb or Hgb): Hemoglobin is a protein in the red cell that carries oxygen. The above CBC report indicates that the patient’s Hb count is 10.8, which is below the normal range of 14.0-18.0. The hematocrit (HCT), another way of measuring the amount of Hb, is also low. This means that the patient has mild anemia and may be starting to notice symptoms.

These three ranges will vary depending on age and gender. For women, they will be lower than those shown here. For example, the Hb reference interval for a woman is 12.0-16.0.

Platelets: Platelets are the cells that form blood clots that stop bleeding. The above CBC report indicates that the platelet count for this patient is normal.

What are the treatments for low blood counts?

The best treatment for low blood counts is to prevent them before they occur. This can be accomplished with the administration of blood cell growth factors. Blood cell growth factors are substances produced by the body that stimulate the cells in the bone marrow to produce more red blood cells, white blood cells, or platelets. These factors have also been produced in a laboratory and are approved by the Food and Drug Administration (FDA) for the treatment of cancer patients with low blood counts.

Low red blood cell counts: Erythropoietin is a blood cell growth factor that selectively increases production of red blood cells. Clinical trials have demonstrated that erythropoietin is safe and effective in reversing anemia in cancer patients. Erythropoietin has been proven to effectively:

Increase hematocrit
Decrease the need for blood transfusions
Reverse fatigue
Improve overall sense of well-being

Erythropoietin is FDA-approved for the treatment of anemia in patients with nonmyeloid cancers (cancers that do not involve blood cells), whose anemia is a result of chemotherapy.

Treatment with erythropoietin causes a gradual increase in red blood cell production. The body uses iron in red blood cell production. Thus, supplemental iron may be required to adequately support erythropoietin-stimulated erythropoiesis. Virtually all patients receiving erythropoietin therapy will eventually require supplemental iron therapy.

Currently, there are two commercially available forms of erythropoietin for use in patients, epoetin alfa (Epogen^® or Procrit^®) and darbepoetin alfa (Aranesp^®). Both are manufactured in the same facility in the same manner. Epogen^® and Procrit^® have been in use for many years. Aranesp^® is a unique, longer-acting form of erythropoietin and is more convenient because it allows patients to receive fewer injections than with Epogen^® or Procrit^®.12 The most common side effects seen in clinical trials with Aranesp^® were fatigue, edema, nausea, vomiting, diarrhea, fever and shortness of breath. No important differences in side effects were seen between groups treated with Aranesp^® and groups treated with the existing anemia treatment, Epogen^®.

Low white blood cell count: The blood cell growth factors approved by the FDA for the prevention of chemotherapy-induced neutropenia are Neupogen^® (filgrastim) and Neulasta^® (pegfilgrastim). Multiple clinical trials have shown that Neulasta^® and Neupogen^® reduce the severity and duration of low white blood cell counts associated with many kinds of chemotherapy regimens. By increasing white blood cell counts, Neupogen^® has been shown to decrease a patient’s risk of fever and admission to the hospital. The drawback of Neupogen^®, however, is that it must be administered daily. In two clinical trials, a single dose of Neulasta^® has been proven to be as effective as an average of 11 daily injections of Neupogen^® for the management of neutropenia. 3,4 The most common side effect you may experience with Neulasta^® is aching in the bones. If this happens, it can usually be relieved with a non-aspirin pain reliever, such as acetaminophen. It is also possible to have an allergic reaction to Neulasta^®.

Low platelet count: The blood cell growth factor approved by the FDA for the prevention of low platelet count is called Neumega^®. Clinical studies have shown that Neumega^® prevents thrombocytopenia and decreases the need for platelet transfusions in patients at high risk for developing a low platelet count. Neumega^® has been reported to cause palpitations, fluid retention and diarrhea as well as other side effects in some patients.

Transfusions: In some cases, low blood counts may be so severe that you may need to undergo a blood transfusion. Red blood cells and platelets are often transfused. Sources for transfusional blood include blood banks or your own blood that you had stored for future use before undergoing treatment. Transfusions may be associated with complications, including allergic reactions that may range from mild to life-threatening. In general, it is better to prevent low blood counts than to treat them once they occur.

References

1 Glaspy JA, Jadeja J, Justice G. Optimizing the management of anemia in patients with cancer: A randomized, active-controlled study investigating the dosing of darbepoetin alfa abstract. Proceedings of the American Society of Clinical Oncology 38th annual meeting; May 18-21, 2002. Abstract 1446.

2 Kotasek D, Albertson M, Mackey J. Randomized, double-blind, placebo-controlled, dose-finding study of darbepoetin alfa administered once every 3 (Q3W) or 4 (Q4W) weeks in patients with solid tumors abstract. Proceedings of the American Society of Clinical Oncology 38th annual meeting; May 18-21, 2002. Abstract 1421.

3 Vose J, Crump M, Lazarus H. Randomized, multicenter, open-label study of pegfilgrastim compared with daily filgrastim after chemotherapy for lymphoma. Journal of Clinical Oncology. 2003;21: 514-519.

4 Green M, Koelbl H, Baselga J. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Annals of Oncology. 2003:14:29-35.

Understanding the Complete Blood Count (CBC)

The CBC – providing information about your health

The human body is primarily made up of water and cells. Many of the cells group together to form the skin, muscles, bones and organs, such as the heart, lungs, kidneys, etc. Such cells are stationary, staying in one place within the body. Some very special and important cells, however, move throughout the body by traveling (circulating) in the blood. These circulating cells provide oxygen to all of the stationary cells in the body, help fight infection throughout the body, and help stop bleeding after an injury. Information about these cells can provide important clues about the overall health of the body.

The complete blood count, or CBC, is a lab test that provides information about these circulating cells. First, a sample of your blood is collected and sent to the lab. A lab instrument then automatically counts the number of each type of circulating cell. If results from the automated instrument are outside specified limits, a medical technologist will examine the cells closely so complete information about the cells can be provided.

Results from the CBC test can help:

Provide basic information about your health
Detect a health condition before you have any symptoms
Confirm that a health condition exists
Identify the causes of your symptoms
Find out if your medicine is working
Rule out a disease
Establish a baseline that can be used for comparison with future test results

Reporting and interpreting the results

Your CBC test results are usually reported along with a reference range of expected or desired values to help guide your doctor in interpreting them. Reference ranges reflect the numeric values found in healthy people; however, a small number of healthy people (5%) have values that are higher or lower than the ones shown in the reference range. Thus, values higher or lower than those in the reference range might or might not indicate a medical condition.

In addition to the reference range, your doctor will consider other factors when interpreting your CBC test results. These factors include your personal and family medical history, results from a physical exam, and other test results. Your doctor will also consider factors that might cause an incorrect test result such as improper sample collection or handling. Therefore, it’s important that you talk with your doctor about the meaning of your test results.

This brochure includes a brief description of the items included in the CBC test report. The descriptions can help you understand your results so you can have a more meaningful discussion with your doctor. Additionally, items in the CBC are summarized in the table at the end of this brochure for quick reference.

Red Blood Cells (RBCs) – transporting oxygen throughout the body

RBCs play a vital role in transporting oxygen from the lungs to the rest of the body. These oval-shaped cells contain hemoglobin, the protein that binds oxygen while it is being carried to all the stationary cells in the body (cells in the skin, muscle, bone and organs). The chemical process that converts the nutrients found in food into energy requires oxygen. All the stationary cells require energy to function; thus, they need oxygen and are dependent on the RBCs to transport it.

More about hemoglobin

Hemoglobin (Hb or Hgb) is an iron-rich protein that carries oxygen and makes the blood red. Since hemoglobin is contained only in the RBCs, a low number of RBCs leads to low levels of hemoglobin. However, if there is something wrong with the RBCs, hemoglobin levels can be low even when the RBC count (i.e. number of RBCs) is within the reference range. So a CBC test report includes the number of RBCs, the amount of hemoglobin, and other measurements related to the RBCs.

Other RBC measurements

The hematocrit reflects the amount of space in the blood that is occupied by RBCs. Hematocrit measurements are affected by the number of RBCs and by the size of the RBCs.

The mean corpuscle (cell) volume (MCV) is a measurement of the average size of the RBCs. Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher MCV.

The mean corpuscular hemoglobin (MCH) reflects the average amount of hemoglobin in a person’s RBCs. RBCs with more hemoglobin result in a higher MCH and vice versa.

The mean corpuscular hemoglobin concentration (MCHC) is a measurement of the average amount of hemoglobin in the RBCs compared to the average size of the RBCs. Put another way, the MCHC is the ratio of the MCH to the MCV.

The red cell distribution width (RDW) reflects the degree of variation in size of the RBCs. Not all the RBCs are the same size; some are larger and some are smaller. The RDW measurement is affected by the size of the smallest RBC and the size of the largest RBC.

What this means to me and my doctor

In patients with anemia, hemoglobin levels are low and the patient may be frequently tired and have little energy. This is because there is not enough hemoglobin to carry oxygen to the stationary tissues; thus, there is not enough oxygen available to convert nutrients into energy. The RBC count, hematocrit level, MCV, MCH and MCHC might also be low in patients with anemia.

Low RBC counts, hemoglobin and hematocrit levels can be caused by other things too, such as a lot of bleeding or malnutrition (not enough nutrients in the food eaten). Kidney disease, liver disease (cirrhosis), cancer, and medications used to treat cancer can also cause low levels.

An increased RBC count and increased levels of hemoglobin and hematocrit may be caused by dehydration (not enough water in the body) or by some diseases (see table).

White Blood Cells (WBCs) – defending your body

WBCs help the body fight illness or infection. As part of the immune system, they recognize and fight things that are foreign to (not part of) the body. The number of WBCs (WBC count) is lower than the number of RBCs; however, the WBCs are larger in size RBCs. There are 5 types of WBCs; each type plays a different role in protecting the body from invaders.

What this means to me and my doctor

The WBC count may increase when you have an infection caused by bacteria, viruses, fungi, or parasites. The WBC count can also increase in patients with leukemia, a cancer of the blood. Thus, doctors use the WBC count to help determine if a patient has an infection or leukemia. When the WBC count is increased, the type of WBC can help differentiate between a bacterial infection, viral infection or leukemia. Doctors also use the WBC count to monitor various types of illness, since it may decrease in response to therapy during recovery from an illness. A low WBC count can mean you are at risk of getting an infection since you have fewer WBCs to fight infection.

Types of WBCs

Neutrophils are cells that protect the body from bacterial infections. They move toward bacteria and then swallow them up so the bacteria cannot harm the body.
Lymphocytes are cells that protect the body against viruses, bacteria, and fungi. One type of lymphocyte (B-cell) produces antibodies that attack and destroy the bacteria and viruses. Another type of lymphocyte (T-cell) can directly attack viruses and bacteria and can stimulate the B-cells to produce antibodies.
Monocytes are cells that consume dead or damaged cells. They are the “clean-up crew”.
Eosinophils are cells that kill parasites and contribute to allergic reactions.
Basophils are cells that release histamines during allergic reactions.

The differential – visualizing the cells

When performing a differential, a medical technologist looks at the various cells under a microscope. A differential provides information about the relative numbers (that is, the percentage) of each type of WBC. Such information helps the doctor determine whether an illness is caused by a bacteria, a virus, or leukemia. A differential can be used to monitor patients with allergies and to determine how a patient is recovering from an illness or responding to therapy.

In addition to the cell types listed previously, certain cell types that don’t normally appear in the blood can be reported in the differential. These cells include promyelocytes, metamyelocytes, blasts, etc. Presence of any of these cells indicates a need for follow-up with your doctor.

Finally, the differential can provide information about the appearance of RBCs, since the cells are visualized under a microscope. The appearance of RBCs helps differentiate the various types of anemia.

Platelets – helping to clot blood

Platelets are the smallest blood cells. They are an important part of blood clotting. These small cells clump together and form a sticky mass that helps the blood to clot. Blood clots help your body handle injury by stopping or preventing bleeding. Blood clots can also cause problems, however, when they occur within the blood vessels or the heart; such clots cause a blockage known as thrombosis.

Platelet Counts – assessing your body’s ability to clot blood

A CBC includes the number of platelets and the mean platelet volume (MPV). MPV is a measurement of the average size of the platelets. A higher MPV roughly indicates better platelet function. Some medical conditions are associated with a high MPV and some are associated with a low MPV. Thus, the MPV can sometimes be helpful in telling apart different disorders.

A decreased number of platelets (thrombocytopenia) is associated with bleeding. Some causes include certain rare inherited disorders, leukemia, autoimmune disorders (e.g., rheumatoid arthritis or lupus) and medications. A falsely low platelet count, which is not associated with bleeding, can be caused by a rare error in blood sample collection: instead of staying in a liquid form, the sample clots (becomes solid), thus using up the platelets.

An increased platelet count is less common and is associated with clotting disorders such as thrombocythemia. Platelet counts can also be increased in some cancers and following infections or other medical conditions.

Aspirin can decrease the platelet function, so it’s important to consult with your doctor when taking large amounts of aspirin or when taking aspirin for an extended period of time. Many over-the-counter medications contain aspirin, which may be listed as acetylsalicylic acid, salicylate, or 2-(acetyloxy) benzoic acid.

Table: Items included in a CBC Test Report

←Back

What to Know About Anemia and Pancreatic Cancer – Pancreatic Cancer Action Network

It’s important for pancreatic cancer patients to maintain healthy red blood cell counts.

Editor’s note: This week’s Friday Fix focuses on anemia, a condition when your red blood cell count is too low.

When you get your blood drawn at a doctor’s office or lab, you often receive complete blood count, or CBC, results. CBC tests check for several levels within your body that can indicate when something isn’t right.

For example, high white blood cell counts can signify that your body is fighting off an infection. When levels are too low, they could indicate a weakened or compromised immune system. Chemotherapy and other cancer treatments can impact pancreatic cancer patients’ white blood counts.

CBC tests also provide information about your red blood cells, which function to carry oxygen throughout your body.

When red blood cell counts drop too low, it causes a condition called anemia.

Chronic diseases like pancreatic cancer, or inflammation like pancreatitis, can cause anemia. And chemotherapy or radiation therapy can also cause or worsen anemia.

If you or a loved one is experiencing new or worsening fatigue or muscle weakness, these could be symptoms of anemia. Contact your healthcare team to determine if bloodwork and other testing might be necessary.

“Patients who experience anemia due to pancreatic cancer or its treatment may require a blood transfusion, depending upon its severity,” said Jeannine Mills, MS, RD, CSO, LD, a clinical oncology dietitian at the Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center and member of the Pancreatic Cancer Action Network’s (PanCAN) Scientific & Medical Advisory Board.

Another kind of anemia is caused by low iron levels.

“Iron-deficiency anemia may be a result of blood loss or even an inability to absorb iron, known as malabsorption, following surgery,” Mills said. “Iron is used by the body to make hemoglobin, which then carries oxygen from the lungs to other parts of the body via red blood cells. Iron is also used to make myoglobin, which provides oxygen to muscles.

“Iron is needed for growth and development as well as to make some hormones.”

When patients experience iron-deficiency anemia, they may need oral or intravenous (IV) iron supplementation to restore healthy levels. Foods high in iron can help, too.

“Some seafood, like shellfish and anchovies, are a good source of iron,” Mills said. “Red meat and poultry are rich in iron, too. Some plant-based iron-rich foods include greens, like spinach, and beans, like lentils – but plant-based sources may not be as well absorbed as ‘heme’ sources of iron like meat or poultry.”

She added, “Try to include a source of vitamin C when consuming any food containing iron to improve absorption.”

If your iron levels are low enough to necessitate supplementation with oral pills or IV iron, your healthcare team will monitor you to determine how much iron you need to be given, and for how long.

“It is important to talk with your care team before you elect to take iron supplements of any kind,” Mills noted.

Contact PanCAN’s Patient Central to learn more about pancreatic cancer patient’s dietary and nutritional needs and for other free, personalized information and resources about the disease.

Symptoms, Causes & Treatment of Anemia in Dogs | Huntersville Vet

What is anemia in dogs?

If your dog has anemia, the disease could indicate that your pet is suffering from an underlying illness or condition.

Anemia happens when your pet’s body does not produce enough haemoglobin or red blood cells, or when your dog suffers severe blood loss as a result of conditions such as stomach ulcers or cancer. A serious injury or accident can also lead to anemia.

What are the different types of anemia?

Blood Loss Anemia

If your dog is suffering from severe blood loss due to a bleeding disorder, injury or surgery, this can result in blood loss anemia. Internal bleeding due to parasites, cancer, ulcers or other health conditions can also be the culprit.

Aplastic or Non-Regenerative Anemia

Dogs can develop aplastic or non-regenerative anemia as a result of insufficient production of red blood cells. Bone marrow disease, kidney disease, exposure to toxins, parvovirus, chemotherapy drugs and other certain medications can also cause this form of anemia.

Methemoglobinemia

In dogs, certain genetic disorders can lead to too much methemoglobin in the blood and result in methemoglobinemia. This condition could also be due to exposure to toxins, including some medications meant for exclusively human use, such as benzocaine, acetaminophen or ibuprofen.

Hemolytic Anemia

The breakdown or destruction of red blood cells in your dog’s body can lead to hemolytic anemia. This form of anemia often results from immune-mediated hemolytic anemia (IMHA), or the non-immune mediated form of the condition (caused by toxins, parasites, low phosphorus levels or hereditary disease).

What are symptoms of anemia in dogs?

If your dog is suffering from anemia, you may notice one or more symptoms, which will vary depending on the underlying cause of your dog’s condition.

Pale gums, eyes or ears
Weakness or lethargy
Black stools
Fast pulse or rapid breathing

Swelling of the jaw or face
Vomiting
Loss of appetite
Weight loss

What causes anemia in dogs?

Numerous conditions can result in your dog developing anemia. A few of the most common causes of anemia in dogs include:

Chronic diseases that suppress red blood cell production
Cushing’s disease
Infectious diseases (including canine distemper)
Bleeding from the intestines
Medications which interfere with production of red blood cells
Severe blood loss due to injury or accident

Blood loss caused by parasites
Poisons or toxins
Cancer
Tick-borne diseases such as Lyme disease
Poor nutrition
Bone marrow disease
Kidney disease
Hypothyroidism

How is anemia in dogs treated?

If your dog is diagnosed with anemia, your veterinarian will recommend a treatment based on what’s causing the condition. Some treatments that your vet recommends could include:

Intravenous fluids
Deworming or parasite medications
Gastrointestinal medication
Chemotherapy
Surgery

Change in existing medications
Antibiotics or immunosuppressive drugs
Blood transfusion
Bone marrow transfusion
Potassium phosphate supplements

Depending on the availability of effective treatment for the underlying illness, the prognosis for dogs with anemia may vary. Sadly, anemia can be an indication of a very serious or fatal condition such as an autoimmune condition, poisoning or cancer.

If your pet is displaying signs of anemia, contact your veterinarian as soon as possible to schedule an examination.

Can I prevent my dog from developing anemia?

Whenever possible, take measures to prevent anemia by preventing the conditions that cause it. Keep substances that are toxic to dogs (such as human food and medications) far away from your curious pup, and provide him with a healthy diet. These actions may help prevent your dog from developing anemia.

Protect your dog against worms, fleas and ticks with year-round parasite prevention medications, and you’ll eliminate another potential cause.

If you’ve got a breed of dog that’s susceptible to developing anemia (Shih Tzus, Labrador Retrievers, American Cocker Spaniels, and Miniature Schnauzers), regularly scheduled wellness exams – every six months – at your primary care veterinarian may help to detect early signs of anemia, so your dog can receive a diagnosis and get treatment before the condition gets more severe.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet’s condition, please make an appointment with your vet.

Is your dog showing symptoms of anemia? At LakeCross Veterinary Hospital, our Huntersville vets can diagnose and treat a wide range of conditions. Book an appointment today.

Polycythaemia | nidirect

Polycythaemia, or erythrocytosis, means having a high concentration of red blood cells in your blood. See your GP if you have persistent symptoms of polycythaemia. You should also get emergency medical help if you think you or someone you’re with is having a heart attack or stroke.

Symptoms of polycythaemia

A high concentration of red blood cells in your blood makes the blood thicker and less able to travel through blood vessels and organs.

Many of the symptoms of polycythaemia are caused by this sluggish flow of blood.

Mild cases of polycythaemia may not cause any problems, but some people with polycythaemia can experience:

discomfort in the chest or tummy (abdomen)
muscle ache and weakness
tiredness
headaches – may be experienced as a sense of ‘fullness’ in the head and neck
dizziness
tinnitus – hearing sounds that come from inside your head, when there is no sound externally
blurred vision (or temporary loss of vision in one or both eyes)
paraesthesia – an abnormal sensation such as tingling, tickling, pricking, numbness or burning, with no clear physical cause
periods of confusion
bleeding problems – such as nosebleeds, heavy periods and bruising
itchy skin – especially after a bath or shower – this is the result of white blood cells (levels of which can also be high) releasing the chemical histamine
red skin – particularly in the fingers, palms, heels or toes
gout – which can cause joint pain, stiffness and swelling

You should make an appointment to see your GP if you have persistent symptoms of polycythaemia.

When to get immediate medical advice

The slow blood flow associated with polycythaemia can also cause blood clots.

These can be serious because they may put you at risk of life-threatening problems such as:

In some cases, a blood clot – known as deep vein thrombosis (DVT) – may form in your leg, before moving elsewhere in your body.

Signs of DVT or a pulmonary embolism can include:

If you experience any of the above symptoms, seek medical help immediately.

You should also seek emergency medical help if you think that you or someone you are with is having a heart attack or stroke.

Causes of polycythaemia

Polycythaemia can be divided into several different types, depending on the underlying cause of the condition. In some cases, an underlying cause can’t be identified.

Apparent polycythaemia

’Apparent polycythaemia’ is where your red cell count is normal, but you have a reduced amount of a fluid called plasma in your blood, making it thicker.

The condition is often caused by being overweight, smoking, drinking too much alcohol or taking certain medications – such as diuretics for high blood pressure.

A similar condition that’s sometimes called ’relative polycythaemia’ can also occur as a result of dehydration.

Apparent polycythaemia may improve if the underlying cause is identified and managed. Stopping smoking or reducing your alcohol intake, for example, may help.

Absolute polycythaemia

‘Absolute polycythaemia’ is where your body produces too many red blood cells. There are two main types:

primary polycythaemia – there’s a problem in the cells produced by the bone marrow that become red blood cells; the most common type is known as polycythaemia vera (PV)
secondary polycythaemia – too many red blood cells are produced as the result of an underlying condition

Both PV and secondary polycythaemia are described in more detail below.

Polycythaemia vera (PV)

PV is a rare condition usually caused by a fault in the JAK2 gene. The condition causes the bone marrow cells to produce too many red blood cells.

The affected bone marrow cells can also develop into other cells found in the blood. This means that people with PV may also have abnormally high numbers of both platelets (thrombocytosis) and white bloods cells (leukocytosis).

Although caused by a genetic fault, PV isn’t usually inherited. Most cases develop later in life, with 60 the average age of diagnosis.

Secondary polycythaemia

Secondary polycythaemia is where an underlying condition causes more erythropoietin to be produced.

This is a hormone produced by the kidneys that stimulates the bone marrow cells to produce red blood cells.

Conditions that can cause secondary polycythaemia include:

How polycythaemia is diagnosed

Polycythaemia can be diagnosed by carrying out a blood test to check:

the number of red blood cells in your blood (red blood cell count)
the amount of space the red blood cells take up in the blood (haematocrit level)

A high concentration of red blood cells suggests you have polycythaemia.

Your GP may have ordered a blood test because you reported some of the above symptoms or complications.

But polycythaemia is sometimes only discovered during a routine blood test for another reason.

Your GP may refer you to a haematologist (a specialist in conditions affecting the blood) for more tests, to confirm the diagnosis and to work out the underlying cause.

These may include a blood test to look for the faulty JAK2 gene and an ultrasound scan of your abdomen to look for problems in your kidneys.

Treating polycythaemia

Treatment for polycythaemia aims to prevent symptoms and complications (such as blood clots), and treat any underlying causes.

Treatment can include:

regular removal of blood to reduce the amount of red blood cells in your body
medication to reduce the production of red blood cells
medication to prevent blood clots

The health professional looking after your care will discuss the most appropriate treatment option with you.

Treating and preventing other conditions

Some people may also need treatment for any other symptoms or complications of polycythaemia they have, or for any underlying cause of the condition.

For example, you may be given medication to help relieve itching, manage COPD or treat gout.

Lifestyle changes

As well as improving some cases of apparent polycythaemia, making healthy lifestyle changes can also reduce your risk of potentially serious blood clots for people with all types of polycythaemia.

Having polycythaemia means you’re already at high risk of a blood clot, and being overweight or smoking only increases this risk.

Outlook

The outlook for polycythaemia largely depends on the underlying cause.

Many cases are mild and may not lead to any further complications. Some cases – particularly cases of PV – can be more serious and require long-term treatment.

If well controlled, polycythaemia shouldn’t affect your life expectancy, and you should be able to live a normal life.

People with PV can have a slightly lower life expectancy than normal due to the increased risk of problems, such as heart attacks and strokes.

PV can also sometimes cause scarring of the bone marrow (myelofibrosis). This can eventually lead to you having too few blood cells. In some rare cases, the condition can develop into a type of cancer called acute myeloid leukaemia (AML).

If you have polycythaemia, it’s important to take any medication you’re prescribed. It is also important to keep an eye out for signs of possible blood clots to help reduce your risk of serious complications.

TREATMENT OF ANEMIA IN CHILDREN WITH WILMS TUMOR – Oncology

INTRODUCTION

Anemia is often detected in patients with tumors even before chemotherapy (CT) is used. The mechanisms of anemia development, as a rule, are complex and completely unexplored [5, 7]. It is assumed that the causes of this disease may be nutritional quality, side effects of therapy, bone marrow damage, bleeding and hypersplenism [20]. In many patients, anemia develops gradually and is similar to that observed in a number of chronic diseases [20].

RBC transfusions increase the risk of infection, allergic reactions, alloimmunization and iron overload. These factors can have a negative impact on the results of treatment [17]. The effectiveness of erythropoietin (EPO) has been confirmed in adult patients with various forms of tumors [7]. The treatment results are satisfactory, the drug is well tolerated with minimal side effects [6]. Patients sometimes reported increased blood pressure, flushing, headache, and, in rare cases, deep venous thrombosis [13].The data of a number of studies indicate the successful use of EPO in children with tumor diseases [8, 18]. The authors present preliminary results of treatment for anemia in children with Wilms tumor with recombinant human erythropoietin (rHuEPO).

OBJECT AND METHODS OF RESEARCH

The studies were carried out under the supervision of the Ethics Commission of the Medical Academy (proto

col TKEBN / 260/97) with the participation of 13 children with Wilms tumor (7 girls and 6 boys) who were admitted to the clinic (Gdansk Medical Academy, Department of Pediatrics, Hematology, Oncology and Endocrinology).The average age of the patients was 6 (from 7–12 to 71–74 months) years. The stage of the disease and the degree of malignancy of the nephroblastoma were established in all patients. Children were divided into 2 groups, depending on the level of epoetin (6 IU / ml were considered as the dividing line).

Group 1 (9 patients) received standard CT and erythrocyte mass (PRB) treatment. Group 2 (4 patients) – standard chemotherapy and rHuEPO treatment (Eprex, Cilag, Switzerland) 3 times a week at a dose of 150 IU / kg. Before chemotherapy, after removal of the kidney and during the period of auxiliary chemotherapy, all patients underwent analyzes of standard morphological parameters of blood and the concentration of iron, transferrin, ferritin, creatinine and erythropoietin in accordance with the recommendations of the International Society of Pediatric Oncology SIOP 9201 …

The chemotherapy protocol was adopted by the Polish pediatric

group for the treatment of solid neoplasms [10]. All children over 6 months of age with nephroblastoma without distant metastases underwent 4 weeks of preoperative chemotherapy: ActinomycinD (ACTD) – at a dose of 15 μg / kg; Vincristine (VCR) – at a dose of 1.5 mg / m2. Patients with tumor grade IV received 6-week preoperative chemotherapy according to the following scheme: ActinomycinD (ACTD) – at a dose of 15 μg / k; Vincristine (VCR) – at a dose of 1.5 mg / m2; Epirubicine (EPI) – 50 mg / m2.

Patients with low-grade tumor (I) underwent postoperative 4-week CT (ACTD + VCR). Patients with tumors of medium malignancy – postoperative 18-week CT (ACTD + VCR).

Patients with tumors of low and moderate malignancy (II N) received postoperative 27-week CT (ACTD + VCR + EPI).

Patients with tumors of low and medium malignancy (II N + and III) underwent postoperative 27-week CT (ACTD + VCR + EPI) in combination with radiotherapy.In high-grade tumors, postoperative 34-week CT with etoposide, carboplatin, isophosphamide, and epiadriamycin in combination with radiotherapy.

For grade IV, postoperative treatment was performed in the same way as for neoplasms II N +; at grade V – chemotherapy, prescribed individually, depending on the general condition, age and histological structure of the tumor.

To determine the level of endogenous erythropoietin in the blood serum, blood samples were taken at 8 am.The erythropoietin level was measured using a standard ELISA kit (“Quantikine IVD Epo, DEP00”) by the double antibody sandwich method (wavelength 450 nm). The analysis of the percentage of leukocytes in peripheral blood (WBC), the level of hemoglobin (Hb), erythrocytes (RBC), hematocrit (Ht), platelet (PLT) and reticulocyte (RTC) were carried out using CELLDYN 3200 or

CELLDYN 4000 “. The iron level in the blood serum

was determined by colorimetric analysis (“Hitachi 917”).The concentration of transferrin and ferritin in blood serum was measured using standard kits from ABBOTT (No. 7D6830, No. B7A58P). In the determination of ferritin, a microparticle enzyme immunoassay (MEIA) was used. Serum creatinine concentration was determined using a standard kit (“ABBOTT”, no. S7D6420). The test is based on an enzymatic kinetic reaction. The concentration of nitrogen in the blood serum, urea in the blood was measured using a standard kit (“ABBOTT”, no. 7D7520). The test is also based on an enzymatic kinetic reaction.

Anemia was diagnosed when the content of

Hb <11 g / dl, severe anemia - with Hb <10 g / dl. In the presence of anemia, erythrocyte transfusion was performed. Complications of chemotherapy were recorded in the compared groups.

The fact of infection was documented when the presence of pathogenic bacteria with clinical signs of infection was confirmed.

RESULTS AND DISCUSSION

In patients of both groups, approximately the same average values of hemoglobin content, the number of erythrocytes, reticulocytes and platelets before and after nephrectomy were determined (Table 1).1). Treatment for anemia was successfully controlled in both groups during the entire period of chemotherapy. During concomitant therapy, no signs of bleeding were detected.

Table 1 The content of hemoglobin (Hb), the number of erythrocytes (RBC), reticulocytes and platelets (PLT) in children with Wilms tumor

Parameter	Patient group
Parameter	1st 2
Hb, g / l	9.42 / 9.66 *	10.28 / 10.43
RBC, 106 / μl	3.94 / 3.68	4.04 / 4.19
Reticulocytes, ‰	18.98 / 14.97	23.92 / 25.99
PLT, 103 / μl	404.13 / 354.08	305 , 02 / 245.25

* Numerator – indicator before nephrectomy, denominator – after.

There were no differences in the concentration of iron, transferrin and serum ferritin between the compared groups (Table 2).

Table 2 Level of iron, transferrin and ferritin

in blood serum of children with Wilms tumor

Iron,

Parameter	Patient group
Parameter	1st for	2nd
	40.58 / 57.13 *	59.62 / 59.12 *
Transferrin, mg / L	2.57 / 2.32	2.82 / 2.75
Ferritin, ng / ml	81.29 / 112.71	133.85 / 132.37

* Numerator – indicator before nephrectomy, denominator – after.

The average volume of erythrocyte mass transfused to patients in group 1 was 246 ml. In group 2, patients did not need blood replacement. In the same group, during concomitant treatment, the concentration of epoetin increased by 4 times (from 5.05 before treatment to 21.975 IU / ml – by the end of therapy) (Table 3). No adverse effects of rHuEPO treatment were noted.

Table 3 Erythropoietin content (EPO 1 – before chemotherapy, EPO 2 – after preoperative chemotherapy, EPO 3 – after postoperative chemotherapy)

in blood serum

65 1st

Parameter	Patient group
Parameter	2nd
EPO 1, IU / ml	66.12	5.05
EPO 2, IU / ml	43.49	9.05
EPO 3 , IU / ml	54.11	21.98

The incidence of nephroblastoma is about 8 cases per million in children under 15 years of age [15].Most children with Wilms tumor go to the doctor if there is a tumor-like mass in the abdominal cavity. Treatment for nephroblastoma includes chemotherapy followed by surgical treatment and postoperative chemotherapy according to the SIOP 9201 protocol. Patients with nephroblastoma often suffer from tumor-related anemia, which typically occurs for many reasons. A low hemoglobin (Hb) content can occur in a tumor disease, and on the other hand, it can be the result of CT complications [14].

Anemia is a frequent complication in cancer patients. This condition is characterized by a sharp deterioration in the quality of life of patients, a high level of fatigue, shortness of breath, palpitations, dizziness and decreased cognitive function [13, 14]. Anemia negatively affects treatment outcomes, quality of life and median survival [6]. The compensatory effects of anemia include intense oxygen dissociation, increased cardiac output and respiratory rate, or other metabolic important mechanisms that improve tissue oxygenation [8].

Traditionally, treatment for anemia has consisted of RBC transfusion. In accordance with the guidelines for the treatment of anemia published in 2003 by the US National Comprehensive Cancer Network (NCCN), the use of rHuEPO is recommended when the Hb content is <11 g / dl and is mandatory when the fall is <10 g / dl [8]. Erythromass transfusions are associated with a high risk of infection and the development of potential immunodeficiency [13]. The frequency of negative effects during erythrocyte mass transfusion reaches 20% [8].Since 1980, rHuEPO has become an alternative to conventional treatment for anemia.

Is there any reason for treating erythropoietin in patients with normal or elevated endogenous erythropoietin levels? In this study, children with Wilms tumor were treated with PRB or rHuEPO based on baseline EPO levels (dividing line set at 6 IU / ml). Determined a persistent high level of EPO in children treated with PRB, despite the presence of anemia.On the other hand, in patients taking rHuEPO, during the period of therapy, the EPO level did not reach the values in group 1, despite the obvious effect of the treatment. There is evidence that in cancer patients, the EPO level is not always associated with the degree of anemia [9]. Excessive production of inflammatory cytokines has been shown to delay anemia-stimulated EPO production. Similar results were obtained by other authors [3, 5, 16]. The question of the use of erythropoietin in patients with neoplastic diseases should not be based solely on the EPO level, but mainly on the symptoms associated with anemia.rHuEpo should not be used in life-threatening acute bleeding due to the relatively slow response to cytokine treatment.

Treatment with erythropoietin, taken 3 times a week (TIW) or once a week (QW), causes a sharp and predictable increase in hemoglobin and hematocrit levels in adult patients with tumors [13, 20, 21].

There are several EPO prescription and dosage regimens. EPO, administered at a dose of 150–300 IU / kg by subcutaneous injection (TIW), significantly reduces the need for transfusion, as shown by the results of a double randomized control study [12].There is also evidence of a commonly used protocol of 1 weekly continuous dose of 40,000 IU EPO [16]. The results of clinical trials in patients with neoplasms have shown similar efficacy for the two EPO regimens [1, 4, 9]. Similar results were obtained in children with cancer, but not in the group of patients with Wilms tumor [11, 18, 20].

Children with nephroblastoma, who were observed

by the authors of this work, took 150 IU / kg 3 times a week.This scheme is based on the EPO half-life data, pharmacokinetics and therapeutic experience obtained by other researchers [2, 6, 11, 20].

The results of this group of patients showed a high efficacy of EPO in children with Wilms’ tumor. In patients who underwent erythrocyte mass transfusions during chemotherapy (group 1), there was a higher incidence of infectious complications compared to group 2 who received rHuEPO treatment. The aim of the study is to control anemia during chemotherapy in nephroblastoma and use rHuEPO.During the chemotherapy period, successful treatment with this drug was noted without the need for red blood cell transfusion. Similar results were obtained by the Epoetin Alfa study group [6]. The authors did not note any negative effects when taking EPO. Due to the small number of patient groups, the statistical analysis of the results of these studies seems to be incorrect.

Patients treated with rHuEpo had a number of advantages

, since they did not need RBC transfusions requiring a clinical regimen.In addition, treatment for anemia in this group of children is continuous, in contrast to intensive care in children who received PRB. The EPO effect is due to the natural response to compensate for the low Hb concentration. Given the efficacy of rHuEpo, a study in a larger population group could show its benefits in treating anemia in children with Wilms’ tumor.

THANKS

We express our gratitude to Ms. Yustyna Hirsch for her help in translating the article into Russian.

REFERENCES

Aapro M, Bajetta E, Freund M,
et al. Is there a possible sur vival benefit to increasing hemoglobin levels with epoietin alfa dur ing chemotherapy? Eur J Cancer 2004; 2 (Suppl 2): 20-8.
Beck MN, Beck D. Recombinant Erythropoietin in acute chemotherapyinduced anemia of children with cancer. Med Ped Oncol 1995; 25: 17-21.
Bolonaki I, Stiakaki E, Lydaki E,
et al. Treatment with re combinant human erythropoietin in children with malignances. Pediatr Hematol Oncol 1996; 13: 111-21.
Chudek J, Więcek A, Kokot F,
et al. Stężenie erytropoetyny w surowicy kobiet z guzami macicy lub jajnika. Przegl Lek 1998; 55: 47-50.
Csaki C, Ferencz T, Schuler D, Borsi JD. Recombinant human erythropoietin in the prevention of chemotherapyinduced anemia in children with malignant solid tumors. Eur J Cancer 1998; 34 (3): 364-7.
Dowd MD, Morgan ER, Langman CB, Murphy S. Serum erythropoietin levels in children with leukaemia.Med Pediatr On col, 1997; 28: 259-67.
Falkson CI, Keren-Rosenberg S, Uys A,
et al. Recombinant Human erythropoietin in the treatment of cancerrelated anemia. Oncology 1994; 51: 497-501.
Ferrario E, Ferrari L, Bidoli P,
et al. Treatment of cancer related anemia with epoetin alfa: a review. Cancer Treat Rev 2004; 30: 563-75.
Green DM, D’Angio GJ, Beckwith JB,
et al. Wilms tumor.Ca Cancer J Clin 1996; 46: 46-63.
Iconomou G, Koutras A, Rigopoulos A,
et al. Effect of re combinant human erythropoietin on quality of life in cancer patients receiving chemotherapy: Results of a randomized, controlled trial. J Pain Symp Man 2003; 25 (6): 512-8.
Kaczorowska-Hać B, Balcerska A. Endogennous erythropoietin levels in children with malignancies disorders. Acta Haematol Polonica 2003; 34 (2): 231-7.
Kettelhack C, Schoter D, Matthias D, Schlag PM.Serum Erythropoietin levels in patients with solid tumors. Eur J Cancer 1994; 30: 1289–91.
Leon P, Jimenez M, Barona P, Sierrasesumaga L. Recombinant human erythropoietin for the treatment of anemia in children with solid malignant tumors. Med Pediatr Oncol 1998; 30: 110-6.
Littlewood TJ, Bajetta E, Nortier JW,
et al. Effects of epoie tin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, doubleblind, placebocontrolled trial.J Clin Oncol 2001; 19: 2875-82.
MacMillan ML, Freedman MH. Recombinant human erythropoietin in children with cancer. J Pediatr Hem Oncol 1998; 20 (3): 187-9.
Miller CB, Jones RJ, Piantadosi S,
et al. Decreased eryth ropoietin response in patients with the anemia of cancer. N Engl J Med 1990; 322: 1682–92.
Mohanddas K, Aledort L. Transfusion requirements, risk and costs for patients with malignancy. Transfusion 1995; 35: 427-30.
Piroso E, Erslev AJ, Caro J. Inappropriate increase in erythropoietin titers during chemotherapy. Am J Haematol 1989; 32: 248-54.
Sawicz-Birkowska K. Leczenie nerczaka u dzieci. Zalecenia Polskiej Grupy Pediatrycznej ds. leczenia guzów litych. Wrocław, (Protokół 9201) 1995.
Shilling RF. Anemia of chronic disease a minsomer edito ral. Ann Intern Med, 1991; 115: 572-3.
Siena S, Secondino S, Giannetta L, Carminati O, Pedrazzoli P.Optimizing management of neutropenia and anemia in cancer chemotherapy – advances in cytokine therapy. Critical Rev Oncol / Hematol 2003; 48S: S39-S47.

90,000 Iron deficiency anemia in athletes

Determined by low levels of iron in the blood, iron deficiency occurs in approximately 50 percent of female athletes and slightly less frequently in men. If untreated, iron deficiency can develop into iron deficiency anemia (IDA), which impairs the aerobic processes of the body, brain and muscle metabolism, impairs performance and endurance, and weakens the immune system.

Iron is a key element in aerobic exercise and directly affects the performance of the athlete, it is an element that is responsible for the production of hemoglobin and myoglobin. Its main function is to carry oxygen from the lungs to the tissues, and from the tissues to the lungs, it carries carbon dioxide. It also traps and stores oxygen in your muscles to keep them active when swimming, pedaling, running, or just shopping. Without iron, oxygen entering the body is useless.Simply put, when your iron levels are too low, your ability to move actively, and sometimes just move, is severely impaired.

Signs and symptoms

A short test for triathletes to find out if they suffer from low blood iron levels. When the body struggles to normalize hemoglobin levels during iron deficiency, lactic acid begins to build up in the oxygen-deprived muscles. As lactic acid builds up, the athlete becomes more sluggish, prone to premature fatigue during exercise, may experience muscle burning, shortness of breath, and decreased motivation to exercise.Chronic fatigue is the most common symptom, but other symptoms include an increase in the rate of perceived exertion (RPE), nausea, tinnitus, flashing »Before the eyes, frequent infections, respiratory problems, inability to think clearly, pale and haggard appearance. All of these symptoms should not be ignored. Constant exercise requires you to be healthy, enduring, and mentally strong, so don’t let iron deficiency weigh you down.

What Causes Low Iron?

Although inadequate dietary iron intake is the most common cause of iron deficiency anemia, there are a number of other factors that affect iron stores outside of athletes:

malnutrition: vegetarian, vegan, low protein diets,
heavy menstrual bleeding,
disease, gastrointestinal tract or injury,
strenuous endurance training that can increase iron loss through sweat,
gastrointestinal bleeding, decrease iron absorption,
frequent use of aspirin or nonsteroidal anti-inflammatory drugs,
training at high altitudes.

Monitoring of iron reserves

Chronic iron deficiency is an indicator that the body is under extreme stress. Long runs, extremely intense workouts, unbalanced / unhealthy diets, living under constant stress, inadequate sleep, lack of recovery time can all contribute to repeated depletion of iron stores. Very often, runners find that they have low or low ferritin levels, but normal hemoglobin values.Iron deficiency without anemia (i.e. low ferritin) has been noted to also affect endurance and performance. If you notice signs of iron deficiency, or iron deficiency anemia, see your doctor urgently. Periodically, it is necessary to monitor the state of the blood, indicators of hemoglobin, hematocrit, serum ferritin, serum iron, transferrin saturation, the general ability to bind iron, reticulocytes. It should be remembered that serum ferritin (a marker of iron levels in the body) may be falsely elevated within 72 hours of a long, strenuous workout or marathon, or if the body is fighting infection or experiencing inflammation.

Sports anemia – a decrease in the number of red blood cells or the level of hemoglobin in the blood 90 150

Endurance training increases blood volume, which dilutes the hemoglobin and hematocrit in the blood, making it artificially low when iron levels are actually within normal limits. Sports anemia is common when an athlete returns to training after a period of inactivity or when there is a dramatic increase in training intensity.After the body gets used to the training load, hemoglobin and hematocrit will return to normal levels.

Increase your iron consumption

Animal products such as red meat, dark poultry and seafood contain the most beneficial (absorbable) forms of iron (heme). While plant foods provide non-heme iron, this form is more difficult to absorb. However, consuming foods rich in vitamin C in the same diet can increase the absorption of iron from a non-heme source.For example, if you eat spinach salad, add strawberries or tangerine chunks to boost your vitamin C. Consider combining heme and non-heme iron sources, such as beans with dark turkey or beef. Include a small amount of red meat in your diet with pasta, soups, salads and sandwiches.

In addition, it is important to understand that coffee, acids in tea, and calcium-rich foods inhibit the absorption of heme iron. Bran or grains that are high in fiber (containing phytates and oxalates) can also inhibit the absorption of non-heme iron.

Recommended intake of iron

Men / women ages 9-13: 8 mg / day

Men ages 14-18: 11 mg / day

Women ages 14-18: 15 mg / day

Men ages 18-50: 8 mg / day

Women ages 18-50: 18 mg / day

Additional sources of iron

If you have a serious iron deficiency and are prescribed ferrous sulfate and ferrous gluconate supplements as a source of iron, check your dosage and dosage guidelines before increasing your iron regimen, as iron supplements can cause side effects such as constipation, diarrhea, and nausea and dark stools.Make sure you follow the recommendations exactly, as excess iron supplementation can have adverse health effects.

A few guidelines when consuming iron:

remember to add vitamin C to food,
avoid iron intake with milk, coffee, tea, and foods high in fiber and antibiotics,
drink plenty of fluids daily,
iron supplements should be taken at the same time of day each day for best results.

90,000 Autoimmune hemolytic anemia in dogs: symptoms and treatment

Contents of article

It is no secret to anyone what an important role blood plays in the body of all mammals. The quality and quantity of this priceless liquid directly affects the general condition of a person or animal and its life expectancy.

In this article, we will look at what happens if anemia occurs in dogs, as well as how and how it is treated. Possession of such information gives the owners the opportunity to track the pathology of their pets in the early stages and seek help from doctors in time.

Varieties of anemia

Anemia is also called anemia, but this does not mean that the volume of blood decreases with the disease. The amount of blood in this pathology remains unchanged, but its qualitative composition changes. This is expressed in a decrease in the amount of hemoglobin and is most often accompanied by a decrease in the number of red blood cells in the blood.

If you remember that the role of hemoglobin is to deliver oxygen to the cells of the body and remove carbon dioxide from them, then it becomes clear how important it is for a dog’s blood to have a normal amount of this protein.

Anemia has a classification and is divided into several types:

Massive bleeding after trauma or surgery causes a decrease in the number of red blood cells in the dog’s body, resulting in post-hemorrhagic anemia.
When exposed to certain substances or microorganisms, the destruction of red blood cells occurs and this is the cause of hemolytic anemia.
Hypoplastic and aplastic anemia develops when the dog’s body does not have enough of its own resources for the formation of red blood cells.
If a dog has regenerative anemia, then his body can restore the lost volume of red blood cells; in non-regenerative anemia, this recovery does not occur.

The cause of non-regenerative anemia, as well as post-hemorrhagic, can be severe bleeding, after which the dog needs a lot of effort to heal the wound and replenish the supply of red blood cells.

The problem is that after an injury or an operation, the animal sometimes loses its appetite and, accordingly, a sufficient amount of nutrients ceases to enter its body.The dog does not have enough iron in order to “build” new blood cells, and such a type of disease occurs as hypochromic, that is, low-color anemia.

Any of these conditions are dangerous to dogs and should be treated under the supervision of an experienced veterinarian.

What causes the disease?

The reasons why anemia occurs are quite varied, but it makes sense to consider the most common of them:

Endoparasite contamination.Worms not only “suck” many useful substances from the animal, but also poison its blood with toxins, as a result of which the breakdown of red blood cells can occur. In addition, parasites in the intestines literally “bite off” pieces of mucous tissue, injuring it and causing microbleeding. It would seem that this cannot greatly harm the health of the dog, but if thousands of worms live in its intestinal tract, then this becomes a serious threat to the health of the dog.
Tick bites, after which blood parasitic microorganisms “settle” in the blood.They multiply very quickly and use the protein found in erythrocytes – hemoglobin as food. After the number of parasites reaches a critical mass, anemia in dogs manifests itself in an acute form.
Poisoning with hemolytic poisons that cause hemolysis. This is one of the most dangerous types of anemia, in which the death of an animal can occur very quickly, since it is not always possible to quickly find the causes of the pathology.
Autoimmune hemolytic anemia in dogs is extremely rare.It is caused by the fact that some genetic disease gives the body a command to destroy its own red blood cells.

Less common causes of anemia include tumors affecting the red blood brain, infectious diseases, chronic kidney disease, exposure to radiation and long-term use of toxic drugs.

Manifestations of the disease

Signs of anemia are associated with the fact that the supply of oxygen to cells in the dog’s body is impaired.It should be appreciated that the symptoms of anemia are often mistaken for other diseases, such as heartworm disease, and the treatment of dogs is described here. With the manifestation of anemia, the owner can observe such symptoms of the disease in the pet as:

Lethargy and depression.
Rapid fatigability, decreased activity.
Bad mood, lethargy.
Sleepiness.
Decreased appetite.
Pallor of the mucous membranes and minor hemorrhages on them.
Arrhythmia and increased heart rate.
Temperature rise.
Traces of blood in feces and urine.
Shallow and rapid breathing.
Increase in the volume of the abdomen.

However, the presence of such signs does not allow an accurate diagnosis, since anemia has symptoms similar to other pathologies, and therefore the treatment of the dog should begin with instrumental studies.

Making a diagnosis

The main diagnostic method for determining anemia is a clinical blood test.On the basis of this study alone, it is already possible to identify anemia. It is more difficult to understand what caused the pathology, so the veterinarian may prescribe:

urinalysis;
fecal occult blood test;
x-rays;
Ultrasound of the abdominal organs;
tests for genetic diseases;
endoscopy;
tests for the presence of parasites in the blood.

Despite a wide range of studies, sometimes it is not possible to determine the exact cause of anemia in a dog.

Treatment

Tactics for treating anemia in dogs are developed by a veterinarian based on information about what caused this pathological condition:

Intravenous infusion of various drugs to increase the total circulating blood volume.
Hemotransfusion of various blood components (erythrocytes, platelets, plasma) or whole blood transfusion.
Bone marrow transfusion.
A course of antibiotic therapy if infections are the cause of anemia.
The use of antiparasitic agents.
If the disease is immune-mediated, then corticosteroids that reduce immunity, such as prednisone, are prescribed.
Course intake of vitamin K1, which improves blood clotting.
Use of preparations containing iron, potassium, vitamins.
In case of anemia, dogs are recommended a special diet with a large amount of meat, liver and other foods rich in B vitamins and iron.
Surgery is used in severe cases.

Proper treatment, balanced nutrition and good care will help your pet recover in a month and a half, and in case of chronic anemia, therapy will be prescribed on an ongoing basis.

Prevention and feeding of a dog with anemia

There are no preventive measures that would help to completely protect the dog from anemia, but it is recommended to follow the classic rules for the prevention of diseases:

Timely vaccinate.
See your veterinarian regularly.
Make sure that the dog does not come into contact with poisonous substances.
Coordinate any medications with your doctor.
Pay special attention to the diet. You need to feed the dog in a balanced way, i.e. include in the menu foods rich in vitamins and minerals. For these purposes, meat, buckwheat and liver, which contain a lot of iron, are well suited. When choosing a commercial feed, carefully study its composition and give preference to feed made from waste meat, as they contain more nutrients.
Make sure your pet eats regularly, at least 3 times a day. If your dog has a poor appetite, you can try to feed him often and in small portions, as well as try to find the food that he likes.
If necessary, you can correct the lack of nutrients with food additives. Pregnant and lactating bitches, who often have low hemoglobin levels, are advised to give B vitamins and iron tablets. A doctor in a veterinary clinic will help you choose the right drug and calculate the dosage.

A dog with anemia can live a long and fulfilling life if treatment is started on time and the recommendations of the attending physician are strictly followed.

See also: Brucellosis – symptoms in dogs.

Interesting topics

90,000 Anemia in the elderly | Grinfeld E.S.

Anemia is a very common disease in various populations around the world. According to the definition of the World Health Organization, men with hemoglobin less than 13.0 g / dl and women with hemoglobin less than 12 g / dl suffer from anemia.

Based on these standards, it is estimated that about 4% of men and 8% of women living in the United States meet this definition. Among patients who visit hospitals for medical care, this percentage is significantly higher. This is especially noticeable among middle-aged and elderly patients, where this figure ranges between 8 and 44%.
In most cases, anemia is a manifestation of some other disease. Therefore, even if the anemia is minor and the patient does not experience symptoms, research into its causes is absolutely necessary in order to identify the underlying disease causing it.
Anemia among older people has been repeatedly interpreted as a normal phenomenon associated with aging of the body. Actually this is not true. In most healthy elderly people, hemoglobin and hematocrit remain within the normal range. Another reason is the fact that 80 percent of older people with anemia can be diagnosed with the cause.
This article will discuss the four types of anemia that are most common among older people living in the United States.
Symptomatology of anemias
First of all, it should be noted that the symptoms of anemia are not specific to this or that type of anemia. They represent a compensatory response to tissue hypoxia and usually develop when hemoglobin falls below 7 gm / dl, although symptoms may occur in patients with higher hemoglobin levels. This usually occurs against the background of chronic diseases of the heart and lungs, as well as in cases where anemia develops very quickly (such as the result of bleeding).
The most common complaints of patients with anemia are weakness, increased drowsiness, headache, shortness of breath, increased drowsiness. Patients with coronary heart disease may experience chest pain, loss of consciousness. Also, patients may complain of dizziness, tinnitus, loss of libido, flickering of dots in the eyes.
As a rule, these symptoms appear gradually due to the physiological ability of the body to adapt to new conditions. In many cases, these symptoms are not perceived as something that deserves special attention, and are “attributed” to the aging organism.
The most important element in the diagnosis of a disease, including anemia, is the collection of anamnesis and examination of the patient. Much attention is paid to this in Western medicine, despite the availability of laboratory tests.
Collecting anamnesis, the patient needs to be asked a number of questions, the answers to which can serve as an essential clue to establishing the correct diagnosis. For example, jaundice and dark urine in a patient who does not have liver disease may suggest hemolysis underlying anemia.Weight loss can be caused by the presence of a malignant tumor. Paresthesias in the hands and feet of the feet occur when vitamin B12 and folic acid are deficient.
It is very important to ask the patient about possible contact with chemicals such as insecticides, solvents, paints. Many chemicals can have a significant effect on the process of hematopoiesis by suppressing the bone marrow.
When gathering information about a potential source of bleeding leading to anemia, it is very important to inquire about changes in bowel movements and the presence of blood in the stool.Black, tar-like stool is an indicator of bleeding from the gastrointestinal tract, which may be based on gastric ulcer or duodenal ulcer, as well as erosive esophagitis. The presence of bright red blood in the stool is most often associated with hemorrhoids, diverticulosis, or colon tumors. The interpretation of the test results used for the initial diagnosis of anemia is presented in Table 1.
Anemia of chronic diseases
Anemia of chronic disease is most common among older Americans.Numerous diseases lead to this condition. Among them, the most common are infections, tumors, autoimmune diseases, and chronic kidney disease.
The pathogenesis is based on a combination of several factors. Firstly, the life of erythrocytes is slightly reduced, and secondly, there is a sequestration of iron in the cells of the reticuloendothelial system, which cannot be efficiently utilized by the body, and, finally, an insufficiently high level of erythropoietin relative to the degree of anemia.
A blood smear test usually reveals normal red blood cells. Only in some cases is hypochromia observed. Microcytosis occurs in about a third of patients.
The concentration of iron in serum, transferrin and iron-binding capacity of blood serum (YSS) are quite low in most patients. At the same time, the concentration of ferritin, which is an indirect indicator of inflammation, remains normal or elevated.
The main distinguishing feature of ACD from iron deficiency anemia is the normal stores of iron in the body, which can be confirmed by a bone marrow biopsy.
It is believed that all these changes occur under the influence of cytokines such as interleukin-1, tumor necrotic factor, interferons alpha, beta and gamma.
In recent years, another neurotransmitter has been discovered that is involved in iron metabolism, called hepcidin. In the presence of an inflammatory process, the concentration of hepcidin can increase by 100 times. hepcidin is secreted in response to increased liver iron stores. In this case, hepcidin blocks the absorption of iron from the gastrointestinal tract and stimulates the capture of iron molecules by macrophages, which are part of the reticuloendothelial system.
It should be noted that the anemia of chronic disease is usually not severe. Its degree correlates with the severity of the chronic disease causing it.
Only in rare enough cases does hemoglobin drop significantly below 10 g per dl (100 g per L).
Treatment of ACD should begin with the identification and treatment of the underlying disease that caused this condition. Iron supplements are not effective for the treatment of ACD. Synthetic erythropoietin is the main treatment used today.Its main task is to replace endogenous erythropoietin, which is insufficiently produced in people with ACD. In this regard, it would be useful to measure the concentration of endogenous erythropoietin before starting treatment. If it exceeds 500 mU / ml, the likelihood of effective use of synthetic erythropoietin is low.
In other cases, subcutaneous injections of erythropoietin at a dosage of 100–150 U / kg are recommended three times a week. In recent years, weekly subcutaneous injections at a dose of 40,000 U have been increasingly practiced.If hemoglobin does not rise after 12 weeks of treatment, erythropoietin injections should be discontinued. Darbepoetin-alfa is a long-acting drug. It can be used at a dosage of 100 µg or 200 µg once every two weeks.
Iron deficiency anemia
Iron deficiency anemia occurs when the body’s need for iron exceeds the intake of iron in the diet. A person should consume at least 1 g of iron per day in order to counterbalance its natural loss by the body.As the body’s iron stores decrease, anemia develops.
Iron deficiency anemia is the second most common in middle-aged and older people in the United States. The most common cause of this condition is directly related to bleeding from the gastrointestinal tract. In the vast majority of cases, this bleeding is very slow, almost imperceptible to the naked eye. The most common causes of this bleeding are gastritis, gastric and duodenal ulcers, diverticulosis, bowel angiodysplasia, and colon cancers.
In the United States, a fairly large percentage of ulcers and gastritis are caused by the use of non-steroidal anti-inflammatory drugs, which can be obtained without a prescription. Elderly people often abuse these drugs, which they use as pain relievers to treat musculoskeletal conditions (eg, osteoarthritis). Less often, chronic bleeding from the genitourinary system, hemophthisis, and blood clotting diseases can become the cause of anemia.
Undoubtedly, iron deficiency anemia can result from inadequate intake of iron in the diet.In America, as in other countries of the world, a large number of older people have a fairly uniform diet for one reason or another, and therefore it usually takes several years before clinical symptoms appear.
Treatment
Iron tablets are used as the primary treatment for iron deficiency anemia. It should be noted that the reaction of the bone marrow to the iron obtained from these preparations has its limits. It was found that the bone marrow does not respond with more rapid formation of red blood cells and the synthesis of hemoglobin to a dose of iron in excess of 20 mg per day.It should be borne in mind that the absorption of iron in the jejunum is influenced by a number of factors. Among the factors that increase the absorption of iron, ascorbic acid can be distinguished. Substances such as calcium, cellulose, as well as food products such as tea, coffee and wine slow down this process. In addition to this, it should be borne in mind that the process of absorption of iron is directly related to the degree of its deficiency in the body. In a healthy adult, only 5 to 10 percent of dietary iron will be assimilated.At the same time, this figure can increase 3-5 times in the case of a significant lack of iron in the body.
There are practically two types of iron preparations – ferrous gluconate, which is usually available in two dosages (300 and 325 mg), and ferrous sulfate in the most common dosage of 325 mg. To achieve the result, these drugs should be taken 3-4 times a day.
An increase in hemoglobin levels of 1 g per dL (10 g per L) should be expected every 2–3 weeks of regular medication use.At the same time, the full restoration of iron stores in the body can take up to four months after the hemoglobin has returned to normal.
The second way to replenish iron stores in the body is parenteral administration using intravenous infusion. In cases of malabsorption, intolerance to tablets of iron, chronic bleeding from the gastrointestinal tract, which cannot be localized or eliminated, these drugs take on a primary role.
Until recently, iron dextran was the only drug in this group. Using this drug, it was possible to enter into the body in large doses (from 200 to 500 mg) at a time. The most serious side effect of this drug was anaphylactic shock in a very small percentage of patients (0.61%). The more frequent complications, along with headaches, were muscle and joint pain, which usually occurred in the first 48 hours after using the drug. Nonsteroidal anti-inflammatory drugs have been very effective in relieving these symptoms.
In the period 1999-2000, two new drugs for intravenous iron administration appeared on the American market: Sodium ferric gluconate and iron sucrose, which are significantly safer than their predecessors. When using them, the risk of anaphylaxis is estimated in hundredths of a percent. The first drug is administered at a dose of 125 mg per week for 8 weeks. The second one is administered in a dose of 200 mg, 5 doses in total for two weeks.
Blood transfusion is also a treatment for anemia, including iron deficiency.Usually this method is used to treat patients with pronounced symptoms such as shortness of breath, severe weakness. In the presence of coronary artery disease, some experts advise blood transfusions even for asymptomatic patients if their hemoglobin is below 10 g per dL (100 g per L). There is no generally accepted point of view on this issue yet. In our opinion, this is not necessary at all, provided that the patient is feeling well.
Anemia associated with
with vitamin B12 deficiency
Vitamin B12 deficiency is found in 5-10% of older adults, but in fact, vitamin B12 deficiency is much more common in this population.And only about 60% of people with low levels of this vitamin develop anemia.
There are several features of this condition that create significant difficulties in establishing a diagnosis.
First, neurological symptoms can develop much earlier than anemia. Speaking of neurological symptoms, it is necessary to mention sensory disorders (especially vibration and body position), hyporeflexia, muscle weakness. As vitamin B12 deficiency develops, ataxia, spasticity, and sensory disturbances in the form of “socks and gloves” may also develop.
Second, there is significant microscopic variation among patients with vitamin B12 deficiency. The classical description of macrocytes and megaloblasts is not always what we see in real life under a microscope. Often there are cases when this anemia is normocytic and even microcytic.
Third, the level of vitamin B12 in the blood plasma does not reflect the potential deficiency of this vitamin in the tissues. Approximately one third of patients with vitamin B12 levels in the lower range of normal suffer from anemia and neurological symptoms.Serum methylmalonic acid and homocysteine levels are a more reliable indicator of vitamin B12 deficiency. Vitamin B12 is a cofactor in the metabolism of these substances. Therefore, if it is insufficient, the level of these compounds in the blood is increased. At the same time, the normal concentration of methylmalonic acid and homocysteine practically excludes vitamin B12 deficiency.
Causes of vitamin B12 deficiency
The most common cause is decreased intestinal absorption of vitamin B12.Pernicious anemia is a striking illustration of this phenomenon. In the case of pernicious anemia, there is an autoimmune destruction of the parietal cells of the stomach, which produce intrinsic factor, which is an integral part of the absorption of vitamin B12.
Reduced absorption of this vitamin has also been observed in patients undergoing gastric resection (10 to 30%).
In patients with diseases of the small intestine, such as increased bacterial growth in the small intestine, this condition is also not uncommon.
Deficiency of vitamin B12 as a result of inadequate dietary intake is extremely rare these days and is observed mainly in vegetarians.
In the recent past, the Schilling test was used to diagnose vitamin B12 deficiency. At the present time, it has lost its clinical significance and is practically not used. High doses of vitamin B12 correct deficiencies, whatever the cause.
Treatment
Deficiency of vitamin B12 is treated by replenishing its reserves in the body.For this, a tablet form is used at a dose of 1000 to 2000 mg or intramuscular injections of the drug. In the case of intramuscular injections, the usual dose is 1000 mg per day for 7 days, then once a month. The effectiveness of treatment is determined by the increase in the number of reticulocytes in the blood. This usually occurs one week after starting treatment.
Failure anemia
folic acid
In contrast to vitamin B12 deficiency, folate deficiency is usually the result of inadequate intake in the diet.The human body has sufficient reserves of folic acid for only 4-6 months.
Classical anemia associated with folic acid deficiency is macrocytic. However, in about a quarter of patients with folate deficiency, normocytic anemia is present.
In 90% of patients with folate deficiency, homocysteine levels are elevated. At the same time, the level of methylmalonic acid remains normal, which is an essential factor in the differential diagnosis with anemia caused by vitamin B12 deficiency.
Interestingly, when folate deficiency anemia is treated, vitamin B12 deficiency anemia is improved. However, there is no improvement in the neurological symptoms associated with vitamin B12 deficiency. The treatment of this anemia is quite simple – folic acid 1 mg per day.
Figure 1 shows an algorithm that will help systematize the process of establishing the correct diagnosis in patients with anemia

References
1.Smith, D. (2000, October 1). Anemia in the Elderly. American Family Physician. Retrieved September 15, 2008, from http://www.aafp.org/afp/AFPprinter/20001001/1565.html
2. Johnson, L.E. (2007, April). Vitamin B12. The Merck Manual Online Medical Library. Retrieved September 13, 2008, from http://www.merckmedicus.com/pp/us/hcp/framemm.jsp?pg=www. merck. com / mmpe / index.html
3. Conrad, M.E. (2008, March 11). Anemia. eMedicine. Retrieved September 15, 2008, from http: //www.emedicine.com / MED / topic132.htm
4. Killip, S., Bennett, J.M., & Chambers, M.D. (2007, March 1). Iron Deficiency Anemia. American Family Physician. Retrieved September 14, 2008, from http://www.aafp.org/afp/20070301/671.html

90,000 Anemia, not pneumonia: COVID-19 cheated everyone? – Search

04/22/20

Recently, information appeared on the network that the cause of death of patients with coronavirus is not pneumonia at all, but anemia. The video, in which an American nurse talks about it, has received almost 2 million views on YouTube.In short, the essence is as follows: the insidious virus deceived everyone, treatment protocols need to be revised. It is pointless to connect patients to mechanical ventilation.

Weights were added to the nurse’s statements by the latest studies by Chinese scientists, who note a decrease in hemoglobin levels in most severe patients with COVID-19. “Poisk” asked for a comment to an infectious disease specialist, advisor to the director for science of the Central Research Institute of Epidemiology of Rospotrebnadzor, Academician of the Russian Academy of Sciences Viktor Maleev.According to him, anemia can be the cause of the initial serious condition, and not its consequence.

“If the patient initially has anemia, then the body will have a much harder time fighting the infection,” explains the scientist. – The number of red blood cells is reduced, hemoglobin is low, the body does not have enough oxygen. The heart begins to work hard and the body simply cannot withstand such a load. But COVID-19 will not be able to cause anemia, it simply will not have time. The decay of red blood cells in the spleen takes 120 days, the coronavirus develops much faster. “

However, there is still a certain grain of truth in the words of the American nurse. According to Maleev, the coronavirus is indeed capable of infecting the porphyrin nucleus of hemoglobin, which contains iron. It is hemoglobin that is responsible for capturing oxygen from the lungs. And if the oxygen level in the blood drops for this reason, then the ventilator really will not help. But in this case, doctors use extracorporeal membrane oxygenation, ECMO, delivering oxygen to the patient not through the lungs, but directly into the blood.