Main symptoms and syndromes of patients with different variants of anemia

1. Main symptoms and syndromes of patients with different variants of anemia

2. Anemia -is the decreasing of hemoglobin and red blood cells amount in the unit of blood volume From data of WHO:a hematocrit less than 40 in men and 37 in women, or hemoglobin less than 130 g/l in men and less than 120 g/l in women.

3. Actuality of theme: • Anemia is very often met in 20% women of the developed countries and in 50% women of the non-developed countries; • More than 50% patients with chronic diseases and tumors; • Considerably worsens quality of life and capacity.

4. Clinical classification of anemia is based on morphological prinsiple - determination of mean corpuscular volume (MCV) of red blood cells MСV- is determined by automatic laboratory analyzers or by such formula: MСV = (hematocrit x10) / amount of RBC (in mln/l).

5. Normocytic anemia • (MCV - 80-100) • A loss or destruction of RBC is increased • - Acute bleeding • - Hemolytic anemia • - Hypersplenism • Decreasing of RBC synthesis • - Deficiency anemia (iron, vitamin В12, folic acid) • - Renal insufficiency • - Anemia, caused by chronic diseases • - Endocrine dysfunctions • Pathology of bone marrow (for example, action of medications, infection, aplastic anemia, myelodysplastic syndrome, plural mieloma and other infiltrative diseases).

6. Microcytic anemia (MCV less than 80) • - Iron-deficiency anemia • - Thalassemia • - Anemia, caused by chronic diseases • Sideroblastosis • Hereditary anemia • Lead poisoning • Deficit of copper, poisoning by zinc

7. Makrocytic anemia (MCV more than 100 fl) - Megaloblastic anemia (vitamin В12 or folic acid deficiency ) - Toxic effect of chemotherapeutic agents (methotrexate) or other medications (zidovudine (AZT), phenytoin) - Pathology of bone marrow - Chronic abuse by alcohol (toxic effect) - Liver disease

8. Depends on the level of hemoglobin in the blood anemia is divided on: - light degree (Hb 110-90 g/l), - middle degree (Hb 89-70 g/l), - severe degree (Hb less than 69 g/l). Depends on the size of RBC and their saturation by hemoglobin (from data of colour index - CI) anemia is divided on: - Normocytic normochromic anemia: colour of RBC is normal and CI is 0,86-1,1; - Microcytic anemia (can be hypo- or normochromic): microcytosis , anizopoykilocytosis, hypochromia, CI < 0,7; - Makrocytic anemia : makrocytosis, even megalocytosis, CI > 1,1.

9. ANEMIA CAUSES • External bleeding: Loss of blood through heavy menstrual bleeding, wounds, as well as stomach ulcers can cause anemia. • Iron deficiency: The bone marrow needs iron to make red blood cells. • Anemia of chronic disease: Any long-term medical condition can lead to anemia. • Kidney disease: The kidneys help the bone marrow to make red blood cells. • Pregnancy: Water weight gain during pregnancy dilutes the red blood cells. • Poor nutrition: Vitamins and minerals are required to make red blood cells. • Alcoholism. • Uncommon causes of anemia: bleeding disorders, liver disease, thalassemia, infection, cancer, arthritis, enzyme deficiency, sickle cell disease, hypothyroidism, toxins, or hereditary conditions.

10. Signs and symptoms Signs of anemia may include the following: • Black and tarry stools (sticky and foul smelling) • Maroon, or visibly bloody stools • Rapid heart rate • Rapid breathing • Pale or cold skin • Yellow skin called jaundice • Low blood pressure • Heart murmur • Enlargement of the spleen Symptoms of anemia may include the following: • Fatigue • Trouble breathing • Chest pain • Abdominal pain • Weight loss • Weakness • Dizziness and passing out, especially upon standing

13. Diagnosis • The only way to diagnose anemia is with a blood test. Generally, a full blood count is done. Apart from reporting the amount of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells, which is an important tool in distinguishing between the causes. • Occasionally, other tests are required to further distinguish the cause for anemia. These are discussed with the differential diagnosis (below). The doctor may also decide to take some other screening blood tests that might identify the cause of fatigue; glucoselevels, ESR, ferritin, renal functiontests andelectrolytes may be part of such a workup.

14. Lab tests for anemia may include the following: • Complete blood count - Determines the severity of the anemia and is almost always the first test ordered • Stool guaiac - Tests for blood in stool • Peripheral blood smear - Looks at the red blood cells under a microscope • Iron level - Low iron is one of the most common causes of anemia • Transferrin level - Looks at a protein that carries iron around the body • Ferritin - Looks at the total iron available in the body • Folate - A vitamin needed to produce red blood cells, which is low in people with poor eating habits

15. Vitamin B12 - A vitamin needed to produce red blood cells, low in people with poor eating habits • Bilirubin - Useful to determine if the red blood cells are being destroyed within the body • Lead level - Lead toxicity used to be one of the more common causes of anemia • Hemoglobin electrophoresis - Sometimes used when a person has a family history of anemia • Reticulocyte count - A measure of new red blood cells produced by the bone marrow • Liver function tests - Uncommon tests to determine how the liver is working • Bone marrow biopsy - One of the last tests done; looks at production of red blood cells

20. Thank you for attention!