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Anaemia - Understanding symptoms, diagnosis and treatment strategies

Digestion, General | September 23, 2014 | Author: The Super Pharmacist


Anaemia - Understanding symptoms, diagnosis and treatment strategies

Anaemia is a condition in which there is a deficiency in the numbers of 'red blood cells' in the blood. These cells, also known as erythrocytes, exist for the sole purpose of supplying and transporting oxygen to tissues throughout the body. Erythrocytes contain large concentrations of a protein called haemoglobin, to which oxygen is bound for transport. This confers a significant degree of pigmentation to these cells, which is why blood appears to be red. If the population of erythrocytes is low and/or dysfunctional, this results in a deficiency of vital oxygen in various cell and tissue types in the body. This leads to a gradual deterioration of the tissues affected, which may contribute to skin or organ damage and thus increase the risk of poor health.

Types of Anaemia

Anaemia may be associated with deficiencies in folic acid and vitamin B12, which contribute to the development of erythrocytes. It may also be associated with deficiencies in iron, an important component of haemoglobin. Without iron, oxygen cannot be transported by red cells. Some types of anaemia are associated with genetic disorders that affect the normal formation or production of red blood cells. Abnormal red blood cells are associated with a reduced capacity for haemoglobin. The more prominent forms of anaemia are:

  • Iron deficiency: This is a straightforward lack of iron, which may occur as a result of a low intake of iron-rich foods. Iron deficiency may occur as a result of blood loss, including loss as a result of menstruation. Bleeding as a result of gastrointestinal lesions or organ damage may also cause iron deficiency. Therefore, anaemia may be a symptom of gastroenterological diseases, including irritable bowel disease (IBD), or of kidney disorders.
  • Sideroblastic anaemia: This is a condition in which red blood cells are dispersed into the bloodstream before they have been fully developed, in which case their capacity for haemoglobin is reduced5. Sideroblastic anaemia may be a result of an inherent genetic disorder, or as a side-effect of drug treatment.
  • Megaloblastic anaemia: This is anaemia as a result of deficiencies in both vitamin B12 and folic acid. It is associated with the production of dysfunctional red blood cells with an abnormally enlarged, swollen appearance. Megaloblastic anaemia is also associated with pregnancy.
  • Sickle cell anaemia: This is a genetic disorder that is associated with malformations in red blood cells, giving them a half moon-like appearance that gives rise to the name. Sickle cell anaemia is strongly associated with African ancestry.
  • Thalassaemia: Thalassaemia is also a genetic, hereditary disorder. In this case, the biological mechanism by which haemoglobin is synthesised is affected, resulting in a reduced concentration of oxygen available in the blood.
  • Aplastic anaemia: This is a type of anaemia in which the body's ability to produce erythrocytes is severely compromised. Aplastic anaemia may be a result of a genetic disorder, or associated with damage as a result of radiotherapy or infection.

Another factor relevant to anaemia is malaria, as an advanced infection may infect and destroy red blood cells.

One major type of the micro-organism that causes this disease (Plasmodium falciparum) appears to have a preference for erythrocytes with a higher concentration of haemoglobin. Therefore, treatment for anaemia in countries where malaria is prevalent should take this phenomenon into account.

Symptoms of Anaemia

The symptoms of anaemia are varied, as many areas of the body may be affected by oxygen deprivation. The more serious of these may be related to the conditions that are comorbid (or casually associated) with anaemia, as above. Symptoms may include:

  • Fatigue
  • Lethargy
  • Dizziness
  • Respiratory problems after exercise
  • Cardiac arrythmia
  • Angina (chest discomfort) as a result of exercise
  • Brittle and mis-shapen fingernails
  • Leg pains
  • Cracks in the skin of the corners of the mouth, which may be painful
  • Sensory problems
  • Abdominal pains
  • Spontaneous bleeding, which may be subcutaneous or from tissues such as the gums, nasal linings or anus
  • Blood in stool

Anaemia is typically diagnosed by blood testing of samples taken at a consultation with a physician. This analysis often takes the form of haemoglobin concentration measurement.

Treatments for Anaemia


Iron deficiency may be addressed by increasing the intake of foods containing high levels of this element. Or by supplementation which are commonly available over the counter in retail stores and pharmacies.

Oral iron tablets may also be part of treatment for chronic illnesses such as IBD and renal failure, if these conditions cause blood loss.

Folic acid and vitamin B12 concentrations may be increased using the same strategies.

As folic acid cannot be stored in the body, it is important to maintain adequate levels of this vitamin. Women may need to maintain high levels of daily folic acid while pregnant.

Folic acid is found in a wide range of fruits and vegetables, beans and peas, and in fortified grain products such as pasta and bread. Chicken and chicken eggs contain high levels of both iron and vitamin B12. Liver and liver products also contain high levels of iron, and some may also contain appreciable concentrations of vitamin B12. Leafy green vegetables are also good sources of iron. Vitamin B12 is also found in dairy products and fish.

Blood transfusion

This may be an option for anaemia associated with thalassaemia or blood loss. Transfusions of red cells alone is also an option in the treatment of severe anaemia.

Intravenous iron therapy

This is a form of iron therapy often administered to patients in whom chronic or heavy blood loss results in iron deficiency. These may include individuals with renal failure, heavy menstrual flow or gastrointestinal disorders.

Ferric carboxymaltose is a chemical iron complex bound to carbohydrate molecules. This intravenous formulation is designed for the replenishment of tissues affected by iron deficiency.

When injected, it can deliver 1000mg of iron in approximately fifteen minutes Several studies have demonstrated the ability of this treatment to correct haemoglobin concentrations. The efficacy of weekly ferric carboxymaltose injection was found to be comparable to daily iron tablets.

A similar formulation, iron polymaltose, demonstrated significant efficacy in restoring haemoglobin levels in comparison with oral supplements.


This is a drug (also known as hydroxycarbamide) associated with the correction of impaired haemoglobin synthesis in thalassaemia patients, particularly infants born with this condition. A study of 82 paediatric and 18 adult patients found that hydroxyurea treatment achieved a significant increase in haemoglobin  concentrations, and reduced the need for transfusion by half.

Bone marrow transplant

As bone marrow is the tissue in which red blood cells are formed and developed, severe cases of aplastic anaemia may benefit from a transplant. This may address the significant deficiency of cells seen in this condition. Australia's best online pharmacy


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