Anemia: the types, symptoms and treatment - Research Paper Example

? Anemia: types, symptoms and treatment The vital requirement for blood and the belief that it is driving force for the existence of mankind existed since the ancient times. Several scientists have studied the properties of blood and have hence established the various functions performed by blood and its components that include red blood cells, white blood cells and blood platelets. Among the components the red blood cells, which was found in abundance, was considered to play an important role ever since it was studied in detail back in the 17th century. The history of anemia in particular dates back to early 19th century when anemia was mentioned as a clinical term in the first textbook of hematology. There have been great strides made in the field of hematology ever since and anemia in particular (Uthman, n.d). The word anemia originates from two Greek words that mean without blood. As this cannot be taken for a precise definition of the condition, scientists have defined anemia as the condition in which there is a below than normal number of red blood cells and their hemoglobin component. Hemoglobin is the principle component of red blood cells that carries oxygen from the lungs via the blood to various tissues in the body where it dislodges the oxygen and takes up carbon dioxide which is supplied back to the lungs for exhalation. As a result of decreased oxygen supplied to the tissues in anemia, the condition is generally characterized by tiredness and fatigue. In prolonged cases anemia can cause damages to the heart and other vital organs in the body. Though anemia could result due to varied reasons, the causative factors have been broadly classified based on the number of red cells as follow: decreased production of red blood cells, increased destruction or hemolysis of red cells and loss of blood (Anemia, 2008). Each of these causative factors is associated with several etiologies such as genetic, nutritional, physical, chronic and malignant conditions and infectious. Every etiological condition is associated with the corresponding signs and symptoms. Though anemia can go undetected in most cases, once it is diagnosed anemia can be effectively treated through nutritional supplementations, medications or through administration of blood. History of Anemia Blood has for long been considered as a vital requirement for life and the role played by red blood cells was determined as early as the 18th century when the Englishman, William Hewson, famously referred to as the father of hematology, stated that red blood cells are likely to play an important role owing to their abundant presence in the blood. These cells were first described as ruddy globules when they were observed under the compound microscope by naturalist Jan Swammerdam. At the onset red blood cells were not associated with any disease condition until techniques were developed to count the cells and determine the normal range in blood. In the beginning of the nineteenth century, the term anemia was coined which was used as a clinical term which referred to pallor of the skin and mucous membrane. In the year 1852 Karl Vierordt first developed a technique to count the cells in blood. When one of his students counted the cells in a patient with chlorosis, now most commonly known as iron-deficiency anemia, he found that the number of red blood cells was lower than what was present in normal individuals. Further understanding about anemia, is symptoms, diagnosis, causative factors and treatment modules by nutritional means to transfusion of blood and transplantation of bone marrow in severe cases were provided later by hematologists using modern advances in scientific technologies (Uthman, n.d). Anemia: Definition and general causes and symptoms The definition most widely followed for anemia is “anemia is a condition characterized by an abnormal decrease in the body’s total red blood cell mass (Uthman, n.d; Maakaron, 2011).” It is also referred to as a condition in which there is lower than normal levels of red blood cells and its oxygen carrying component hemoglobin. Hemoglobin is the major protein in red blood cells that serves as an oxygen carrier from the lungs to the various tissues via the blood. After dislodging the oxygen at the tissues hemoglobin picks up the carbon dioxide released from metabolism in the tissues and carries it back to the lungs for expulsion (Uthman, n.d). In anemia due to a decrease in the number of red blood cells and consequently the amount of hemoglobin, the oxygen supply to the tissues is lesser which results in the most common symptoms of tiredness and fatigue. The hemoglobin limit that determines the presence of anemia has been set to 12.5g/dl for both males and females by the World Health Organization (Maakaron, 2011). Causes There are several causative factors for anemia and there are three possible factors that are associated with each etiology. Anemia can result due to Decreased production of red blood cells by the body: When the ability of the bone marrow to produce red blood cells is diminished the number of circulating red cells is also decreased. The hormone erythropoietin produced by the kidneys stimulates the production of red blood cells by the bone marrow. However, in conditions when the hormone production is low, bone marrow is damaged, presence of low levels of protein required to make red blood cells or when the kidneys are diseased the production of red blood cells by the bone marrow is affected. In addition iron or vitamin deficiencies also hinder the optimum production of red blood cells. Such conditions are associated with a poor diet or absorption of nutrients. Increased destruction of red cells: Another condition which lowers the amount of red cells in the blood is associated with increased destruction of the cells compared to its production. Destruction of red blood cells occurs during certain hereditary conditions in which faulty genes lead to production of abnormal or lower amount of red cells that have a shorter lifespan. These cells are eventually destroyed at a higher rate and after a stage the body is unable to compensate the loss of cells through the production of new cells. Anemia due to blood loss: While the above two conditions are associated with the production of red blood cells, anemia can also occur following severe loss of blood from an accidental injury, surgery and childbirth. In healthy individuals the body is able to replace the lost red blood cells within some time, however, in case of individuals who are already anemic these episodes further decrease the amount of circulating red cells and these cases warrant immediate treatment (Anemia, 2008). General signs and symptoms The general signs and symptoms that is observed in most patients with anemia include pallor or pale skin due to reduced blood flow to the skin, tachycardia or fast heartbeat due to an increase in cardiac output, dyspnea or shortness of breath while performing exercises or other strenuous activities, the insufficient supply of oxygen to the various tissues results in fatigue and improper oxygen supply to the brain causes dizziness and fainting. In addition, anemic patients may also experience tinnitus or buzzing in the ears which is attributed to increased blood flow through the vessels surrounding the ear. Other possible symptoms include headache, reduction in vision, loss of appetite, disinterest in sex, inability to deliver at workplace, a general lack of concentration and constipation. In more severe cases, the heart is unable to pump out all the blood that is present and fluid from the blood plasma begins to move out from the capillaries and enter into the tissues. This could result in edema and when this build-up of fluid occurs in the lungs it may enter the alveoli and interfere with gaseous exchange. This condition is referred to as pulmonary edema and if left untreated it ultimately leads to the death of the individual (Anemia, 2008) (Uthman, n.d). Types of Anemia: causes, symptoms and treatment There are more than 400 different types of anemia that are known. However while some of the types occur more commonly most forms of anemia have a rare occurrence rate. The type anemia could be hereditary, acquired through iron and vitamin deficiencies or by the presence of an underlying disease or infections, or could result due to accidental blood loss due to injuries and surgeries. One of the most important etiologies associated with anemia is the hereditary conditions in which genetic variations can affect the process of erythropoiesis or red blood cell production. Genetic variations can result in either an abnormal production of red cells or may decrease its production by the body. These conditions are associated with increased destruction of red cells by the body. Types of anemia’s due to increased destruction of red blood cells Sickle cell anemia Causes Sickle cell anemia occurs due to a genetic aberration which results in the production of sickle shaped hemoglobin that causes the sickle cells to assume a similar shape. Sickle shaped red cells have a lifespan of about 10 to 20 days and are more stiffer and sticky which could block the flow of blood within the blood vessels resulting in pain and damage to the organs as the oxygen supply to the organs are affected. When individuals inherit both the copies of genes coding for sickle hemoglobin (S) they have sickle cell disease and when only one of the gene inherited codes for the sickle protein and the other codes for normal hemoglobin they have a sickle cell trait which has less severe consequences (Maakaron, 2011; WebMD, n.d). Signs and symptoms the signs and symptoms of the disease occur as early as six months of life up to which HbF hemoglobin is present in large amounts. Once the shift to the S form of hemoglobin begins the problems associated with the disease become evident. The major symptoms of the disease include pain in various body parts depending on where the vaso-occlusive crisis occurs due to impaired circulation within the blood vessels containing sickle cells. Pain can occur in any part of the body but it is more pronounced in the abdomen, bones, joints and soft tissue. As the bone marrow function decreases with age pain is felt in the vertebral region especially in the lumbar area. Chronic and hemolytic anemia is a common symptom along with aplastic crisis in which RBC progenitors in the bone marrow is infected with Parvovirus B-19 that impairs the cell division for a few days following which reticulocytosis occurs within the bone marrow. The other symptoms associated with the condition include spleen enlargement, susceptibility to infection by Streptococcus pneumonia and Salmonella, growth retardation, loss of weight, painful and swollen hands and/or feet, acute chest syndrome, pulmonary hypertension, avascular necrosis, stroke, vascular changes in the retina, retinitis and ptosis, ventricular and left atrium dilation, cholelithiasis, concentrating capacity of kidney is lost and the presence of priapism, leg ulcers and hypoxemia, dehydration and changes in body temperature also occurs due to vaso-occlusion. Treatment in the case of sickle cell disease mainly revolves around management of the various complications involved in the condition such as vaso-occlusion, pain episodes, anemia, infection and potential damage to organs. Medications corresponding to the various symptoms such as analgesics, antibiotics, antimetabolites, vaccines and vitamin supplements are usually included. Other approaches to treatment include bone marrow stem cell transplant, transfusions, physiotherapy, hot and cold compress, acupressure and TENS (Maakaron, 2011). Thalassemia Causes Another common inherited condition that results in anemia is thalassemia. This condition occurs due to inherited disorders in the genes that code for the two alpha and two beta chains in the hemoglobin protein. The alpha chains are coded by four proteins and when one or two of the genes are missing it causes the alpha thalassemia trait and in case of more than two genes alpha thalassemia results which is characterized by moderate to severe anemia. When three genes are missing and only one gene is inherited it results in Hemoglobin H disease. Alpha thalassemia major condition occurs when all the four genes are deleted and as a result the body is unable to make the hemoglobin molecule. This usually results in intra-uterine death of the child or death shortly after birth. Signs and symptoms The hemoglobin H disease is characterized by chronic hemolytic anemia, hepato- and splenomegaly, leg ulcers, aplastic crisis, improper skeletal development, spinal compression fractures and osteopenia. The beta chain of hemoglobin is coded by two genes and when one of the genes is altered it results in beta-thalassemia trait or minor and defects with both the beta-chain coding genes results in thalassemia major condition. While the trait condition is asymptomatic, the thalassemia major condition is characterized by severe anemia, deficient erythropoiesis, jaundice, cardiac failure and arrhythmia, hepato- and splenomegaly, symptoms of iron overload, hormonal changes in the pancreas, thyroid and testes and infections. Treatment The major treatment strategies adopted for thalessemias include repeated blood transfusions, splenectomy, and hematopoietic transplantations (Maakaron, 2011). Aplastic anemia Causes Aplastic anemia, which is a characteristic feature in many etiologies of anemia, is due to failure of the bone marrow to produce sufficient red blood cells. This may occur due to inherited defects in the bone marrow stem cells or external damage to the microenvironment of the bone marrow and defects in the stromal environment of the marrow which is essential for the normal proliferation and functioning of the stem cells. While some cases involve inherited defects of the stem cells a majority of the cases are acquired and the causes are largely idiopathic. Some other causes associated with the condition include infections with viruses such as hepatitis, radiation and chemical exposures, reactions due to graft transplantations and pregnancy. However the acquired condition presents with autoimmunity and the marrow antigens against which the body produces antibodies is still not known. The blood and bone marrow fluids of such individuals show a large amount of cytotoxic T lymphocytes. The hematopoietic stem cells which are the precursors of red blood cells have been found to be largely reduced in this case. Signs and symptoms The major signs and symptoms of the condition include anemia, bleeding, increased susceptibility to infections, thrombocytopenia or reduced platelet count, and neutropenia which is characterized by reduced neutrophils. Treatment The treatment modules offered in this case include supportive care that manages the anemic conditions and infections, immunosuppressive therapy and bone marrow transplantation. Care should be taken to control the dietary habits as these individuals might be more prone to infections which necessitate the exclusion of raw meat, fruits and vegetables. Suitable precautions in lifestyle should be taken for thrombocytopenia and neutropenia. Transfusion of blood components like packed RBCs and platelets can also be administered (Maakaron, 2011). Fanconi’s anemia Causes This is a rare form of inherited bone marrow failure conditions. This disease presents as an autosomal recessive condition in which individuals inherit a mutated copy of one of the 15 genes associated with the disease. The mutated cells are more susceptible to damage by free radicals, have defective cell cycle regulation, defective hematopoiesis and responses to DNA-damage and can exhibit malignancy over the course of time. Fanconi anemia is also responsible for 25% of cases presenting with aplastic anemia. Signs and symptoms The major signs and symptoms of the disease include birth defects such as reduced growth, microcephaly and dangling thumbs. In addition these individuals also present with skin pigmentations, and have increased risk of hemorrhages, infections. Other complications include leukemia, myelodysplastic syndrome involving the blood forming cells of the bone marrow, liver tumors, brain tumors, and other forms of cancer. Treatment The treatment strategies usually followed for Fanconi anemia includes transfusions with packed RBCs or platelets depending on the clinical presentation. The aplastic anemia can be treated with hematopoietic stem cell transplants involving bone marrow, cord blood or peripheral blood stem cells. Androgen therapy can be considered in cases where transplantation cannot be done. Surgical interventions may be required to cure dangling thumbs and other radial problems. Heart defects and problems associated with the gastro-intestinal tracts may also require surgery in some cases. The various cancers that may arise should be treated with suitable interventions. In general individuals with thrombocytopenia and neutropenia should abstain from strenuous activities or those that have a risk of trauma and should also protect themselves from possible infections (Maakaron, 2011). Pure Red Cell Anemia (PRCA) and Diamond Blackfan anemia Causes Diamond Blackfan anemia is a congenital form of Pure Red Cell Anemia (PRCA). PRCA is a rare form of anemia in which the maturation of the RBC is arrested and there is less than 0.5% mature erythroblasts in the bone marrow. This form of anemia is in most cases transient and can be reversed. The congenital form of the disease is due to deletions in genes that code for a specific ribosomal protein which results in defective synthesis of the ribosome. In the adult form of the disease infections with parvovirus 19, HIV, respiratory tract, gastroenteritis, pneumonia, mononucleosis that is infectious, mumps and viral hepatitis have been associated with the condition. In addition medications for seizures, azathioprine, chloramphenicol, thiamphenicol, sulphonamides and isoniazid have been shown to cause PRCA. PRCA has also been shown to present secondary to several disorders such as autoimmune disorders such as diabetes, thymoma, leukemias, pregnancy, systemic lupus erythematoses and renal failure. It has also been found to occur in cases where an ABO incompatible bone marrow transplant has taken place. Signs and symptoms of the congenital form of the anemia referred to as Diamond Blackfan syndrome include the presence of macrocytic anemia, developmental defects such as cleft palates, macroglossia, defects in the development of the skull and face, thumb or upper limb defects, cardiac problems and urogenital defects. These individuals generally show stunted growth. Treatment strategies for the disease include blood transfusions in cases where the anemia is severe and in individuals who have cardiopulmonary problems or who are already suffering from hemolysis. Medications causing the anemia should be discontinued. Infections and underlying conditions such as malignancies need to be treated suitably with immunotherapy, surgeries or radiation therapies. PRCA with idiopathic causes or when autoimmunity is onvolved corticosteroids can be admisntered. However care has to be taken when administering these medications to children as they may cause growth retardation. In addition immunosuppressive agents can be used and plasmapheresis can be employed to remove the autoantibodies. Patients who do not respond to the normal course of therapy can be provided with autologous stem cell transplantation. In case of use of multiple transfusions iron chelation therapy can be used when iron overload is observed. The prognosis for the disease is good with the anemia being transient and reversible in most cases (Maakaron, 2011). Hemolytic anemia Causes Hemolytic anemia is constituted by premature erythrocyte destruction and can result due to hereditary or acquired consequences. The hereditary causes may involve defects with the erythrocyte membrane, defects in enzymes and abnormalities associated with hemoglobin production. Examples include hereditary spherocytosis, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and sickle cell anemia. The acquired causes may involve destruction of RBCs by the immune system, effect of toxic chemicals and drugs and antiviral agents. In addition physical damage and infections may also cause hemolytic anemia. Hemolytic anemia can occur in three ways: extracellular, intracellular or intramedullary. In case of extravascular hemolysis the red blood cells are destroyed in the spleen or other reticulo-endothelial tissues as in the case of autoimmune conditions and hereditary spherocytosis. Hemolysis can also occur intravascular in the presence of prosthetic cardiac valves, G-6-PD deficiency, blood-coagulation disorders such as thrombotic thrombocytopenic purpura (TTP), intravascular coagulation that has disseminated transfusion of ABO incompatible blood and hemoglobinurias such as paroxysmal nocturnal hemoglobinuria. In case of intramedullary hemolysis the RBC precursors are destroyed in the bone marrow before they are enter circulation as observed in conditions such as pernicious anemia and thalassemia major. Signs and symptoms The majority of the signs and symptoms are due to anemia with tachycardia, dyspnea, angina and general weakness occurring in cases of chronic anemia. Hemolytic anemia results in the release of large amounts of hemoglobin that indirectly increases the bilirubin and urobilinogen content. The large amount of bilirubin can cause gallstones that may give rise to abdominal pain. An overload of iron can occur when there are multiple transfusions involved or when given incorrect iron therapy. In case of blood coagulation disorders such as TTP, individuals may experience fever, kidney failure, neurological symptoms and reduction in platelet count. Other symptoms include leg ulcers and medication related side-effects. Treatment The treatment strategies followed for hemolytic anemia include folic acid supplements as folate is used during the hemolytic process, administration of corticosteroids in autoimmune conditions and intravenous supply of immunoglobulin G. transfusion of blood should be carried out only when indicated as it carries the risks of incompatibility, increased rate of destruction and iron overload. In case of iron overload chelation therapy can be administered. Medications that increase the chances of hemolysis should be avoided and iron therapy should be given to patients only when there is significant loss of iron during severe intravascular hemolysis and chronic hemoglobinuria. In case of hereditary spherocytosis in which hemolysis occurs in organs such as the spleen, splenectomy may be a viable treatment option. However, suitable immunizations against Haemophilus influenza and Streptococcus pneumoniae should be provided. In addition, long-term monitoring of vital parameters indicated in the disease should be done at regular intervals (Maakaron, 2011). Types of anemia’s due to decreased production of red blood cells Iron deficiency anemia Causes As the name suggests this type of anemia occurs when there is insufficient iron in the body. Iron is an important constituent of hemoglobin and in its absence the number and size of red blood cells decreases. The major causes for iron deficiency includes heavy menstrual bleeding, insufficient intake of iron through food especially by smaller children, teenagers and pregnant women. Internal bleeding due to ulcers, hemorrhoids, cancer or regular use of aspirins can also deplete iron stores. Decreased absorption of iron occurs during conditions such as Celiac disease in which the ability of the intestine to absorb iron is lost. Pregnant and lactating women who do not take enough iron in their diets or any form of iron supplementation are also at risk of developing a deficiency. In addition, vegetarians and frequent donors of blood and low consumption of vitamin C which enhances the absorption of iron also increase the risk of iron deficiency. Signs and symptoms Though mild forms of the deficiency do not cause any major symptoms chronic deprivation of iron can lead to irregular heartbeat, heart enlargement or failure, babies born prematurely or with a lower birth weight and growth and developmental problems in young children. The signs and symptoms which occur in chronic cases include fatigue, paleness, breathing difficulties, headache and dizziness, cold hands and feet, irritability, tongue soreness and inflammation, brittle nails, poor appetite and tingling feeling in the legs. Treatment The treatment for the condition includes intake of iron supplements along with foods rich in vitamin C or a corresponding supplement. The intake of iron tablets can cause constipation which can be relieved using stool softeners. In order to prevent recurrence of iron deficiency the causative factor should also be corrected. In case of heavy menstrual flow oral contraceptives can be taken, peptic ulcers can be treated with medications, tumors and fibroids can be surgically corrected. In general consumption of iron rich foods such as beans, lentils, green leafy vegetables, eggs, iron-fortified cereals, peas, pork, red meat and sea food can reduce the chances of developing a deficiency. Foods rich in vitamin C such as citrus juices can also be taken to enhance the absorption of iron (Mayo Clinic, 2013). Vitamin deficiency anemia Causes Lack of vital vitamins such as folic acid, vitamin B-12 and vitamin C can lead to anemia. The absorption of iron is enhanced by the presence of certain vitamins. Deficiency in folic acid which is found in many fruits and green leafy vegetables can lead to anemia. An inability to absorb the vitamin in the presence of intestinal disease such as Crohn’s and celiac diseases can also cause a deficiency. Deficiency also results when the small intestine has been removed, or during excessive consumption of alcohol and intake of anti-seizure medications and deficient in take of higher amount folic acid supplements during pregnancy and lactation. Vitamin B-12 deficiency occurs when the diet lacks sufficient amounts of meat, eggs and milk which are a rich source of the vitamin. Intestinal diseases, abnormal microbial growth and surgical removal of the intestines can also decrease the absorption of the vitamin. Ingestion of tapeworm infected fishes also causes the condition but in majority of the cases it is due to the absence of intrinsic factor which is secreted by the stomach and aids in the absorption of the vitamin. When the lack of the intrinsic factor is the cause of anemia it is termed as pernicious anemia. The lack of vitamin C or conditions that reduce its absorption such as smoking can also lead to anemia as vitamin C plays a crucial role in the absorption of iron. Signs and symptoms The major symptoms of vitamin deficiency anemia include fatigue, breathing difficulties, dizziness, pale skin, swollen or reddish tongue, loss of weight, diarrhea, numbness in hands and feet, muscular weakness, irritability and a confused and unsteady state. The symptoms are however more pronounced only when the deficiency is chronic. Treatment The treatment afforded for vitamin deficiency anemia includes supplementation with the specific vitamins until the level in the body reaches the normal value. In case of vitamin B-12 deficiency vitamin injections need to be administered in case of severe conditions and once normalcy is maintained they can be discontinued. In addition, the condition can also be effectively managed through intake of foods rich in the particular vitamin which is a more effective method of preventing the disease. Smoking and alcohol intake that interferes with the absorption of these vitamins should also be stopped (Mayo Clinic, 2013). Anemia due to inflammation and chronic diseases Causes Anemia that presents due to chronic disease (ACD) is one of the most commonly encountered types as is the case with anemia due to blood loss and iron deficiency. Anemia that occurs following an infection can be considered to be a subset of ACD. While this form of anemia could be confused with iron-deficiency anemia as the circulating levels of red cells is lower it usually occurs due to the inability of the body to use the stored iron or normally absorb iron from the diet due to the chronic illness and inflammation. The levels of iron are usually found to be normal or even elevated in many cases. Increased quantities of cytokines released during infections can also interfere with the activity of erythropoietin (EPO) hormone produced by the kidneys that is required for normal production of RBC. The erythroid progenitors do not respond to the stimulation of EPO hormone and they generally succumb to apoptosis. In addition the mobilization and utilization of iron is also low in these cases (National Hematologic Diseases, 2012; Ma, n.d). Chronic diseases such as kidney diseases and cancer can cause anemia. In the case of kidney diseases the main reason for the onset of anemia is the failure to produce the hormone erythropoietin. In addition the utilization of iron is also reduced due to lower absorption rates. As the diseases worsen anemia becomes more evident and most individuals with severe kidney problems have anemia. Hemolysis which is usually prescribed for patients with end-stage kidney problems can also cause anemia as blood loss is associated with the condition. In the case of cancer Hodgkin’s disease, non-Hodgkin’s lymphoma and breast cancer is associated with anemia. These conditions also involve the production of inflammatory cytokines that can interfere with red blood cell production. The treatments afforded to cancer such as chemotherapy and radiation can also impede the ability of the bone marrow to produce red blood cells or in the end-stages the cancer can itself invade the bone marrow and affect its functioning (National Hematologic Diseases, 2012). The infections that can lead to anemia include tuberculosis, HIV, emphysema, infections of the heart such as endocarditis and bone infections like osteomyelitis and fungal infections that are chronic. Inflammatory conditions such as rheumatoid arthritis, lupus, diabetes, joint and bowel inflammatory diseases can cause anemia. Other causes of anemia due to infection include immune and non-immune hemolysis, hemophagocytosis, and infection of the progenitor cells by viruses such as parvovirus, iron deficiency caused by Helicobacter pylori infection and anemia that result due to anti-infective treatments (National Hematologic Diseases, 2012; Ma, n.d; Medline Plus, 2013). Signs and symptoms The major symptoms of anemia associated with infections and chronic diseases include fatigue and the inability to concentrate, general weakness, paleness of skin, increased heart beat and breathing difficulties and decreased tolerance to exercise. Treatment When anemia is present along with a chronic disease or infection the treatment strategies are generally targeted towards the underlying disorder as they would require immediate interventions as in the case of rheumatoid arthritis or inflammatory bowel disorder. As the condition subsides the anemic condition is more likely to resolve on its own. However, in cases such as kidney failure or cancer where the production of the erythropoietin hormone is affected or decreased the hormone can be supplemented in its synthetic form in addition to vitamin B-12, iron and folic acid supplements (National Hematologic Diseases, 2012; Medline Plus, 2013). Types of anemia’s due to blood loss Physical injuries and excessive bleeding Causes when blood is lost rapidly due to an injury, surgery, childbirth or blood vessel rupture it causes severe symptoms at the onset. They may include a fall in blood pressure due to insufficient fluid present in the blood vessels and there is insufficient oxygen supplied to the body tissues due to rapid loss of red cells during the bleeding. Severe conditions like these can lead to heart attack, stroke or even death. Small amounts of blood can also be lost from the body over a period of time like small amount of blood lost in stools. Minor diseases such as ulcers of the stomach or small intestine, diverticulosis, polyps and cancers in the gut, tumors in the kidney or bladder and excessive menstrual bleeding can all result in significant loss of blood over a period of time. This type of bleeding is medically referred to as occult bleeding and when it continues over a long period of time it can result in significant blood loss Signs and symptoms of the condition depend on whether the blood loss is rapid or chronic. When blood is lost rapidly over a period of hours it can cause dizziness while sitting or standing. When the loss occurs over a few days or weeks it can cause severe fatigue and body weakness. Symptoms may also manifest depending on the cause of blood loss such as passing of tarry stools when the bleeding is from the stomach or small intestine and reddish or brown urine could be passed when the bleeding is within the kidney or bladder. Treatment modalities offered in such cases include immediate identification of the underlying condition and taking the necessary steps to stop bleeding. Transfusion might be required in cases of rapid and heavy bleeding as the body would be unable to replenish the large amounts of blood lost within a short time. In case of slow and chronic bleeding the body would produce more red cells in order to compensate for the loss of blood when right supplements in the form of iron are provided to the patients (WebMD, n.d; Medline Plus, 2013). Conclusion In conclusion, anemia is a condition in which oxygen transport to the various tissues are affected due to insufficient red blood cells present in the blood. This can occur when the production of these cells is decreased or faulty and in cases when they are subjected to increased destruction or lost in cases of excessive bleeding. All these conditions give rise to specific types of anemia which present with psrticular symptoms. The treatment modalities revolve around increasing the red cell count and once the right treatment is provided the anemia can be effectively managed. References . 1. Anemia. (2008). What is anemia? Retreievd April 19, 2013, from http://www.anemia.org/patients/feature-articles/content.php?contentid=000174§ionid=00015 2. Uthman, E. (n.d). Understanding Anemia. Retreievd April 19, 2013, from http://web2.airmail.net/uthman/unanemia/unanemia_ch1.html 3. Maakaron, J. E. (2011). Anemia. Medscape Reference. Retreievd April 19, 2013, from http://emedicine.medscape.com/article/198475-overview 4. WebMD. (n.d). Understanding Anemia—the Basics. Retreievd April 19, 2013, from http://www.webmd.com/a-to-z-guides/understanding-anemia-basics 5. Mayo Clinic Staff. (2013). Anemia. Retreievd April 19, 2013, from http://www.mayoclinic.com/health/anemia/DS00321 6. National Hematologic Diseases Information Service. (2012). Anemia of Inflammation and Chronic Disease. Retreievd April 19, 2013, from http://hematologic.niddk.nih.gov/anemiachronic.aspx?control=PDF 7. Ma, S. K. E. (n.d). Hematological changes in infection: tips for interpretation. The Hong Kong Association of Blood Transfusion and Hematology. Retreievd April 19, 2013, from http://www.fmshk.com.hk/hkabth/em/jul2001.htm 8. Medline Plus. (2013). Anemia. Retreievd April 19, 2013, from http://www.nlm.nih.gov/medlineplus/anemia.html#cat1 Read More