Anemia is a condition that develops when your blood lacks enough healthy red blood cells .

1. Anemia
Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen. Symptoms of anemia like fatigue occur because organs aren t getting what they need to function properly.

Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. Women and people with chronic diseases are at increased risk of anemia. Important factors to remember are Certain forms of anemia are hereditary and infants may be affected from the time of birth.

Women in the childbearing years are particularly susceptible to iron deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during pregnancy. Older adults also may have a greater risk of developing anemia because of poor diet and other medical conditions. There are many types of anemia. All are very different in their causes and treatments. Iron deficiency anemia, the most common type, is very treatable with diet changes and iron supplements. Some forms of anemia like the anemia that develops during pregnancy are even considered normal. However, some types of anemia may present lifelong health problems.

2. Causes Anemia
There are more than 400 types of anemia, which are divided into three groups
Anemia caused by blood loss
Anemia caused by decreased or faulty red blood cell production
Anemia caused by destruction of red blood cells
Anemia Caused by Blood Loss
Red blood cells can be lost through bleeding, which can occur slowly over a long period of time, and can often go undetected. This kind of chronic bleeding commonly results from the following
Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis inflammation of the stomach, and cancer Use of nonsteroidal anti inflammatory drugs NSAIDs such as aspirinor ibuprofen, which can cause ulcers and gastritis Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies.

3. Signs and symptoms
Anemia goes undetected in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the underlying cause or the anemia itself. Most commonly, people with anemia report feelings of weakness, or fatigue, general malaise, and sometimes poor concentration. They may also report dyspnea shortness of breath on exertion. In very severe anemia, the body may compensate for the lack of oxygen carrying capability of the blood by increasing cardiac output. The patient may have symptoms related to this, such as palpitations, angina if pre existing heart disease is present, intermittent claudication of the legs, and symptoms of heart failure. On examination, the signs exhibited may include pallor pale skin, lining mucosa, conjunctiva and nail beds, but this is not a reliable sign. There may be signs of specific causes of anemia, e.g., koilonychia in iron deficiency, jaundice when anemia results from abnormal break down of red blood cells in hemolytic anemia, bone deformities found in thalassemia major or leg ulcers seen in sickle cell disease. In severe anemia, there may be signs of a hyperdynamic circulation tachycardia a fast heart rate, bounding pulse, flow murmurs, and cardiac ventricular hypertrophy enlargement. There may be signs of heart failure. Pica, the consumption of non food items such as ice, but also paper, wax, or grass, and even hair or dirt, may be a symptom of iron deficiency, although it occurs often in those who have normal levels of hemoglobin. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced scholastic performance in children of school age. Restless legs syndrome is more common in those with iron deficiency anemia.

4. Causes
Broadly, causes of anemia may be classified as impaired red blood cell RBC production, increased RBC destruction hemolytic anemias, blood loss and fluid overload hypervolemia. Several of these may interplay to cause anemia eventually. Indeed, the most common cause of anemia is blood loss, but this usually does not cause any lasting symptoms unless a relatively impaired RBC production develops, in turn most commonly by iron deficiency.See Iron deficiency anemia

5. Blood loss
Anemia of prematurity from frequent blood sampling for laboratory testing, combined with insufficient RBC production Trauma or surgery, causing acute blood loss Gastrointestinal tract lesions,causing either acute bleeds e.g. variceal lesions, peptic ulcers or chronic blood loss e.g. angiodysplasia Gynecologic disturbances,also generally causing chronic blood loss From menstruation, mostly among young women or older women who have fibroids Infection by intestinal nematodes feeding on blood, such as hookworms and the whipworm Trichuris trichiura.

6. Fluid overload
Fluid overload hypervolemia causes decreased hemoglobin concentration and apparent anemia General causes of hypervolemia include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space. Anemia of pregnancy is induced by blood volume expansion experienced in pregnancy.

7. Diagnosis
Anemia is typically diagnosed on a complete blood count. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and it is sometimes a necessity in regions of the world where automated analysis is less accessible. In modern counters, four parameters RBC count, hemoglobin concentration, MCV and RDW are measured, allowing others hematocrit, MCH and MCHC to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements.

8. Red blood cell size
In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in the mean corpuscular volume MCV. If the cells are smaller than normal under 80 fl, the anemia is said to be microcytic; if they are normal size 80 100 fl, normocytic; and if they are larger than normal over 100 fl, the anemia is classified as macrocytic. This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of iron deficiency. In clinical workup, the MCV will be one of the first pieces of information available, so even among clinicians who consider the kinetic approach more useful philosophically, morphology will remain an important element of classification and diagnosis. Limitations of MCV include cases where the underlying cause is due to a combination of factors such as iron deficiency a cause of microcytosis and vitamin B12 deficiency a cause of macrocytosis where the net result can be normocytic cells.

9. Dimorphic
A dimorphic appearance on a peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content this last feature affecting the color of the red blood cell on a stained peripheral blood smear. For example, a person recently transfused for iron deficiency would have small, pale, iron deficient red blood cells RBCs and the donor RBCs of normal size and color. Similarly, a person transfused for severe folate or vitamin B12 deficiency would have two cell populations, but, in this case, the patient s RBCs would be larger and paler than the donor s RBCs. A person with sideroblastic anemia a defect in heme synthesis, commonly caused by alcoholism, but also drugs toxins, nutritional deficiencies, a few acquired and rare congenital diseases can have a dimorphic smear from the sideroblastic anemia alone. Evidence for multiple causes appears with an elevated RBC distribution width RDW, indicating a wider than normal range of red cell sizes, also seen in common nutritional anemia.

10. Heinz body anemia
Heinz bodies form in the cytoplasm of RBCs and appear as small dark dots under the microscope. Heinz body anemia has many causes, and some forms can be drug induced. It is triggered in cats by eating onions or acetaminophen paracetamol. It can be triggered in dogs by ingesting onions or zinc, and in horses by ingesting dry red maple leaves.

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