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[] Anemia is a decrease in the total amount of (RBCs) or in the, or a lowered ability of the blood to carry. When anemia comes on slowly, the symptoms are often vague and may include, weakness, or a poor ability to exercise. Anemia that comes on quickly often has greater symptoms, which may include confusion,, loss of consciousness, or increased thirst. Anemia must be significant before a person becomes noticeably.
Available at guidelines/arboviruses.pdf. Bassert JM, Thomas J, editors: McCurnin's clinical textbook for veterinary technicians, ed 8, St Louis, 2013, Elsevier. Binns S, et al. Lavoie JP, Hinchcliff K, editors: The 5-minute veterinary consult equine, ed 2, Ames, Iowa, 2011, Blackwell. Providing Continuing Education to the Veterinary Profession for over 30 years, Veterinary Association Management is the nation's leading provider of continuing.
Additional symptoms may occur depending on the underlying cause. The three main types of anemia are due to, decreased red blood cell production, and increased red blood cell breakdown. Adobe Indesign Cs6 Full Crack Fshare. Causes of blood loss include and, among others. Causes of decreased production include, a,, and a number of.
Causes of increased breakdown include a number of genetic conditions such as, infections like, and certain autoimmune diseases. It can also be classified based on the and.
If the cells are small, it is. If they are large, it is while if they are normal sized, it is. Diagnosis in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dL), while in women, it must be less than 120 to 130 g/L (12 to 13 g/dL). Further testing is then required to determine the cause. Certain groups of individuals, such as pregnant women, benefit from the use of for prevention., without determining the specific cause, is not recommended. The use of is typically based on a person's signs and symptoms.
In those without symptoms, they are not recommended unless hemoglobin levels are less than 60 to 80 g/L (6 to 8 g/dL). These recommendations may also apply to some people with acute bleeding.
Are only recommended in those with severe anemia. Anemia is the most common blood disorder, affecting about a third of the global population. Affects nearly 1 billion people. In 2013, anemia due to iron deficiency resulted in about 183,000 deaths – down from 213,000 deaths in 1990. It is more common in women than men, during pregnancy, and in children and the elderly. Anemia increases costs of medical care and lowers a person's productivity through a decreased ability to work.
The name is derived from: ἀναιμία anaimia, meaning 'lack of blood', from ἀν- an-, 'not' and αἷμα haima, 'blood'. The hand of a person with severe anemia (on the left) compared to one without (on the right) Anemia goes undetected in many people and symptoms can be minor. The symptoms can be related to an underlying cause or the anemia itself. Most commonly, people with anemia report feelings of or, and sometimes poor concentration. They may also report on exertion. In very severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing. The patient may have symptoms related to this, such as, (if pre-existing heart disease is present), intermittent of the legs, and symptoms of.
On examination, the signs exhibited may include (, lining, and ), but this is not a reliable sign. There may be signs of specific causes of anemia, e.g., (in iron deficiency), (when anemia results from abnormal break down of red blood cells — in hemolytic anemia), bone deformities (found in major) or (seen in ). In severe anemia, there may be signs of a: (a fast heart rate),,, and (enlargement). There may be signs of., 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. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced academic performance in children of school age. Is more common in those with.
[ ] Causes [ ]. Figure shows normal red blood cells flowing freely in a blood vessel. The inset image shows a cross-section of a normal red blood cell with normal hemoglobin. The causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (), blood loss and fluid overload (). 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. (See ) Impaired production [ ] • Disturbance of proliferation and differentiation of stem cells • • affects all kinds of.
Is a hereditary disorder or defect featuring aplastic anemia and various other abnormalities. • Anemia of by insufficient production • Anemia of [ ]. • Disturbance of proliferation and maturation of • is a form of due to deficiency dependent on impaired absorption of vitamin B 12. Lack of dietary B 12 causes non-pernicious megaloblastic anemia • Anemia of, as with vitamin B 12, causes •, by diminished erythropoietin response to declining hematocrit levels, combined with blood loss from laboratory testing, generally occurs in premature infants at two to six weeks of age.
•, resulting in deficient heme synthesis •, causing deficient globin synthesis •, causing ineffective erythropoiesis • Anemia of (also causing stem cell dysfunction) • Other mechanisms of impaired RBC production • or is a severe type of anemia resulting from the replacement of bone marrow by other materials, such as malignant tumors or granulomas. • • anemia of Increased destruction [ ]. • Intrinsic (intracorpuscular) abnormalities cause premature destruction.
All of these, except, are hereditary. • is a hereditary defect that results in defects in the RBC cell membrane, causing the erythrocytes to be sequestered and destroyed by the. • is another defect in membrane skeleton proteins. •, causing defects in membrane lipids • Enzyme deficiencies • and deficiencies, causing defect • and deficiency, causing increased • • • Hemoglobinopathies causing unstable hemoglobins • • Extrinsic (extracorpuscular) abnormalities • -mediated • is caused by autoimmune attack against red blood cells, primarily by IgG. It is the most common of the diseases. It can be, that is, without any known cause, drug-associated or secondary to another disease such as, or a malignancy, such as.
• is primarily mediated by IgM. It can be idiopathic or result from an underlying condition. •, one of the causes of • to • Mechanical trauma to red blood cells •, including and • Infections, including • [ ] • [ ] Blood loss [ ] • from frequent blood sampling for laboratory testing, combined with insufficient RBC production • or, causing acute blood loss • Gastrointestinal tract lesions, causing either acute bleeds (e.g.
Variceal lesions, ) or chronic blood loss (e.g. ) • Gynecologic disturbances, also generally causing chronic blood loss • From, mostly among young women or older women who have • Infection by intestinal feeding on blood, such as and the whipworm. The roots of the words anemia and ischemia both refer to the basic idea of 'lack of blood', but anemia and are not the same thing in modern medical terminology. The word anemia used alone implies effects from blood that either is too scarce (e.g., blood loss) or is dysfunctional in its oxygen-supplying ability (due to whatever type of hemoglobin or erythrocyte problem).
In contrast, the word ischemia refers solely to the lack of blood (poor ). Thus ischemia in a body part can cause localized anemic effects within those tissues. Fluid overload [ ] Fluid overload () causes decreased hemoglobin concentration and apparent anemia: • General causes of include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space. Intestinal inflammation [ ] Certain gastrointestinal disorders can cause anemia. The mechanisms involved are multifactorial and not limited to malabsorption but mainly related to chronic intestinal inflammation, which causes dysregulation of that leads to decreased access of iron to the circulation. • Gluten-related disorders: untreated and. Anemia can be the only manifestation of celiac disease, in absence of gastrointestinal or any other symptoms.
Diagnosis [ ]. Peripheral blood smear microscopy of a patient with Definitions [ ] There are a number of definitions of anemia; provide comparison and contrast of them. A strict but broad definition is an absolute decrease in red blood cell mass, however, a broader definition is a lowered ability of the blood to carry. An is a decrease in whole-blood concentration of more than 2 below the of an age- and sex-matched. It is difficult to directly measure RBC mass, so the (amount of RBCs) or the (Hb) in the are often used instead to indirectly estimate the value. Hemotocrit; however, is concentration dependent and is therefore not completely accurate. For example, during pregnancy a woman's RBC mass is normal but because of an increase in blood volume the hemoglobin and hematocrit are diluted and thus decreased.
Another example would be bleeding where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit initially remains normal until fluids shift from other areas of the body to the intravascular space. The anemia is also classified by severity into mild (110 g/L to normal), moderate (80 g/L to 110 g/L), and severe anemia (less than 80 g/L) in adult males and adult non pregnant females. Different values are used in pregnancy and children. Testing [ ] Anemia is typically diagnosed on a complete blood count.
Apart from reporting the number of and the level, the also measure the size of the red blood cells by, which is an important tool in distinguishing between the causes of anemia. Examination of a stained using a 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, and ) are measured, allowing others (, and ) to be calculated, and compared to values adjusted for age and sex.
Some counters estimate hematocrit from direct measurements. [ ] WHO's Hemoglobin thresholds used to define anemia (1 g/dL = 0.6206 mmol/L) Age or gender group Hb threshold (g/dl) Hb threshold (mmol/l) Children (0.5–5.0 yrs) 11.0 6.8 Children (5–12 yrs) 11.5 7.1 Teens (12–15 yrs) 12.0 7.4 Women, non-pregnant (>15yrs) 12.0 7.4 Women, pregnant 11.0 6.8 Men (>15yrs) 13.0 8.1 Reticulocyte counts, and the 'kinetic' approach to anemia, have become more common than in the past in the large medical centers of the United States and some other wealthy nations, in part because some automatic counters now have the capacity to include reticulocyte counts. A count is a quantitative measure of the 's production of new red blood cells. The is a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a 'normal' reticulocyte count actually may reflect an inadequate response.
If an automated count is not available, a reticulocyte count can be done manually following special staining of the blood film. In manual examination, activity of the bone marrow can also be gauged qualitatively by subtle changes in the numbers and the morphology of young RBCs by examination under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation of can help assess whether the bone marrow will be able to compensate for the loss, and at what rate.
When the cause is not obvious, clinicians use other tests, such as:,,,,,,, tests (e.g. ) although the tests will depend on the clinical hypothesis that is being investigated.
When the diagnosis remains difficult, a allows direct examination of the precursors to red cells, although is rarely used as is painful, invasive and is hence reserved for cases where severe pathology needs to be determined or excluded. [ ] 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 (MCV).
If the cells are smaller than normal (under 80 ), the anemia is said to be; if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified as. This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of. 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 (a cause of macrocytosis) where the net result can be normocytic cells. [ ] Production vs. Destruction or loss [ ] The 'kinetic' approach to anemia yields arguably the most clinically relevant classification of anemia.
This classification depends on evaluation of several hematological parameters, particularly the blood (precursor of mature RBCs) count. This then yields the classification of defects by decreased RBC production versus increased RBC destruction or loss. Clinical signs of loss or destruction include abnormal with signs of hemolysis; elevated suggesting cell destruction; or clinical signs of bleeding, such as guaiac-positive stool, radiographic findings, or frank bleeding. [ ] The following is a simplified schematic of this approach: [ ] * For instance, sickle cell anemia with superimposed iron deficiency; chronic gastric bleeding with B 12 and folate deficiency; and other instances of anemia with more than one cause.
** Confirm by repeating reticulocyte count: ongoing combination of low reticulocyte production index, normal MCV and hemolysis or loss may be seen in bone marrow failure or anemia of chronic disease, with superimposed or related hemolysis or blood loss. Here is a schematic representation of how to consider anemia with MCV as the starting point.
• synthesis defect • (microcytosis is not always present) • (more commonly presenting as normocytic anemia) • synthesis defect • Alpha-, and beta- • HbE syndrome • HbC syndrome • Various other unstable hemoglobin diseases • defect • Hereditary sideroblastic anemia • Acquired sideroblastic anemia, including • Reversible sideroblastic anemia Iron deficiency anemia is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope.
• Iron deficiency anemia is due to insufficient dietary intake or absorption of to meet the body's needs. Infants, toddlers, and pregnant women have higher than average needs. Increased iron intake is also needed to offset blood losses due to digestive tract issues, frequent blood donations,.
Iron is an essential part of hemoglobin, and low iron levels result in decreased incorporation of hemoglobin into red blood cells. In the United States, 12% of all women of childbearing age have iron deficiency, compared with only 2% of adult men. The incidence is as high as 20% among African American and Mexican American women. Studies have shown iron deficiency without anemia causes poor school performance and lower in teenage girls, although this may be due to socioeconomic factors. Iron deficiency is the most prevalent deficiency state on a worldwide basis.
It is sometimes the cause of abnormal fissuring of the angular (corner) sections of the lips (). • In the United States, the most common cause of iron deficiency is bleeding or blood loss, usually from the., and should be performed to identify bleeding lesions. In older men and women, the chances are higher that bleeding from the gastrointestinal tract could be due to. • Worldwide, the most common cause of iron deficiency anemia is parasitic infestation (,, and ).
The (mean cell volume divided by the RBC count) predicts whether microcytic anemia may be due to iron deficiency or thallasemia, although it requires confirmation. [ ] Macrocytic [ ]. Main article: •, the most common cause of macrocytic anemia, is due to a deficiency of either,, or both. Deficiency in folate or vitamin B 12 can be due either to inadequate intake.
Folate deficiency normally does not produce neurological symptoms, while B 12 deficiency does. • is caused by a lack of, which is required to absorb vitamin B 12 from food. A lack of intrinsic factor may arise from an condition targeting the (atrophic gastritis) that produce intrinsic factor or against intrinsic factor itself. These lead to poor absorption of vitamin B 12. • Macrocytic anemia can also be caused by removal of the functional portion of the stomach, such as during surgery, leading to reduced vitamin B 12/folate absorption. Therefore, one must always be aware of anemia following this procedure. • • commonly causes a, although not specifically anemia.
Other types of can also cause macrocytosis. • Drugs such as,, and other substances may inhibit such as Macrocytic anemia can be further divided into 'megaloblastic anemia' or 'nonmegaloblastic macrocytic anemia'.
The cause of megaloblastic anemia is primarily a failure of DNA synthesis with preserved RNA synthesis, which results in restricted cell division of the progenitor cells. The megaloblastic anemias often present with neutrophil hypersegmentation (six to 10 lobes). The nonmegaloblastic macrocytic anemias have different etiologies (i.e. Unimpaired DNA globin synthesis,) which occur, for example, in alcoholism.
In addition to the nonspecific symptoms of anemia, specific features of vitamin B 12 deficiency include and with resulting balance difficulties from posterior column spinal cord pathology. Other features may include a smooth, red tongue and. The treatment for vitamin B 12-deficient anemia was first devised by, who bled dogs to make them anemic, and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure the disease.
And then set about to isolate the curative substance chemically and ultimately were able to isolate the from the liver. All three shared the 1934. Driver Usb Irda Sangha Space. Normocytic [ ].
• Acute • • (bone marrow failure) • 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.
[ ] Heinz body anemia [ ] form in the cytoplasm of RBCs and appear as small dark dots under the microscope. In animals, Heinz body anemia has many causes.
It may be drug-induced, for example in cats and dogs by (paracetamol), or may be caused by eating various plants or other substances: • In and dogs after eating either raw or cooked plants from the genus, for example, or garlic. • In after ingestion of, for example, after eating minted after 1982. • In which eat dry or wilted leaves. Hyperanemia [ ] Hyperanemia is a severe form of anemia, in which the is below 10%. [ ] Refractory anemia [ ] Refractory anemia, an anemia which does not respond to, is often seen secondary to. May also be refractory as a clinical manifestation of gastrointestinal problems which disrupt or cause.
Treatments [ ] Treatments for anemia depend on cause and severity. Vitamin supplements given orally ( or vitamin B 12) or intramuscularly () will replace specific deficiencies. [ ] Oral iron [ ] Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to suffer from iron deficiency; one-third of them have the more severe form of the disorder, anemia.
Iron deficiency from nutritional causes is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of loss, such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with,,. When taking iron supplements, stomach upset or darkening of the feces are commonly experienced.
The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit. [ ] In anemias of chronic disease, associated with chemotherapy, or associated with renal disease, some clinicians prescribe or, to stimulate RBC production, although since there is also concurrent iron deficiency and inflammation present, is advised to be taken concurrently.
Injectable iron [ ] In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively) or where absorption is impeded (for example in cases of inflammation), can be used. The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases the patient has a deficit of over 1,000 mg of iron which would require several months to replace. This can be given concurrently with to ensure sufficient iron for increased rates of. [ ] Blood transfusions [ ] Blood transfusions in those without symptoms is not recommended until the hemoglobin is below 60 to 80 g/L (6 to 8 g/dL). In those with who are not actively bleeding transfusions are only recommended when the hemoglobin is below 70 to 80g/L (7 to 8 g/dL). Transfusing earlier does not improve survival.
Transfusions otherwise should only be undertaken in cases of cardiovascular instability. Erythropoiesis-stimulating agent [ ] The motive for the administration of an (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual person's needs. They should not be used for mild or moderate anemia. They are not recommended in people with unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with. Hyperbaric oxygen [ ] Treatment of exceptional blood loss (anemia) is recognized as an indication for (HBO) by the. The use of HBO is indicated when delivery to tissue is not sufficient in patients who cannot be given for or reasons.
HBO may be used for medical reasons when threat of incompatibility or concern for are factors. The beliefs of some religions (ex: ) may require they use the HBO method. A 2005 review of the use of HBO in severe anemia found all publications reported positive results. Epidemiology [ ] A moderate degree of affected approximately 610 million people worldwide or 8.8% of the population.
It is slightly more common in females (9.9%) than males (7.8%). Mild iron deficiency anemia affects another 375 million. History [ ] Evidence of anemia goes back more than 4000 years.
References [ ].