How Many Anemias Do They Know? What indicators of laboratory analysis should we worry about and why? Dr Mihaela Andreescu, head of the Haematology Section of Colentina Hospital in Bucharest, responds promptly to these challenges in a series that will try to tell all about their anemia and reality with blood
"There are a number of common symptoms found in most types of anemia: physical asthenia, pale skin, decreased effort, headaches, dizziness, cold hands and feet, difficulty concentrating, irritability, insomnia. Considering the polymorphism of the described symptomatology and the non-specificity of the symptoms, often the symptoms occurring in the context of other diseases can be mistakenly interpreted as a state of anemia. Anemia is the cause of these symptoms only if they are accompanied by a decrease in hemoglobin, "says Dr Mihaela Andreescu.
"Causes can be multiple: iron deficiencies, folate, vitamin B12, hemoglobin (thalassemia) abnormalities, enzyme defects (G6PDH deficiency), red blood cell membranes (hereditary spherocythosis), then chronic disease anemias frequent), myelodysplasias, posthemorrhagic anemias, haemolytic anemias, etc. The specific symptom appears as a result of the deficits I mentioned (iron, B12, folati). In feripriva anemia, for example, we can see the iron deficiency in the tissues: dry skin, dry and brittle hair, naughty nails (in severe forms of feriprious anemia appear "nasty" nails, cracks at the corners of the mouth, smooth tongue , glossy and painful, difficulty in swallowing, dry throat), "explains Dr Mihaela Andreescu.
Let's understand the anemia!
What happens to a simple chronic anemia? Dr Mihaela Andreescu explains: "In the simple chronic anemia, the specific symptom relates to the infectious, inflammatory or neoplastic disease that caused anemia. However, there is a predominant feature of the chronic disease that caused anemia and is due to iron blockade in macrophages due to proinflammatory molecules, this iron being prevented from being used in hemoglobin formation. "
Red, yellow skin
Anemia, however, is of several types: "In Biermer's anemia (pernicious anemia) caused by vitamin B12 deficiency, the same symptoms appear as with other types of anemia, but it is also frequently accompanied by some specific manifestations: neurological abnormalities (peripheral neuropathy), manifestations of atrophic gastritis of the anorexia type, dyspepsia and glomerulus Hunter, characterized by a red, deppilated language. Often, what brings the patient to a medical check is neurological symptomatology – harder to tolerate than the non-specific symptom of anemia, which does not create major problems, even at very low levels of hemoglobin, "says Dr Mihaela Andreescu.
"In haemolytic anemias, the yellow coloration of the skin often results from indirect bilirubin growth, generated in turn by increased red blood cell destruction."
It is not a disease in itself
"A mild anemia (over 10g% of hemoglobin) is more difficult to see clinically, except for a discreet skin tone. The more severe anemia, the more the symptoms become more acute and the patient gets to the doctor. Besides routine analyzes, he also recommends a blood count, "says Dr Mihaela Andreescu. "After highlighting anemia, it is very important to find out the cause, because anemia is not a disease in itself, but rather a consequence of a dysfunction or a condition that must necessarily be detected and treated. Clearing the deficiency found in the analysis temporarily solves the anemia and improves the condition of the patient, but if the cause is not detected and not treated, anemia will come back after a while, "warns Dr Mihaela Andreescu.
Indicators that need to dampen us
"Complete hemogram is a mandatory primary investigation. Such an analysis is made in minutes in modern laboratories equipped with performance equipment.
Hemogram gives us details about:
– Number of red blood cells – Anemia can be low, normal or increased depending on the age of anemia and bone marrow capacity to compensate for anemia;
– hematocrit – in anemias is low;
– Hemoglobin – in anemias is low;
– Mean erythrocyte volume (VEM) – decreased in feriprival anemias and thalassemia, normal in post-haemorrhagic anemias, increased in B12 deficiency anemia, folate;
– Medium erythrocyte hemoglobin (HEM) – decreased in feripriva anemia and thalassemia, normal in recent post-haemorrhagic anemia, increased in B12 deficiency anemia, folate;
– Concentration of mean red blood cell hemoglobin (CHEM) – lower in feriprival and normal anemia in the rest of the anemia ";
How do you know you suffer from anemia
Dr Mihaela Andreescu: "In principle, the diagnosis of anemia is based on hemoglobin levels below 13 g / 100 ml for men and 11 g / 100 ml for women. In order to confirm the diagnosis established after the clinical examination and primary assays, we may need additional investigations: dosing of the diarrhea (determination of the amount of iron in the blood), total iron binding capacity (CTLF), ferritin, haptoglobin, transferin, bilirubin, lactate dehydrogenase (LDH), Coombs test, hemoglobin electrophoresis, etc. In some situations, bone marrow can also be used to examine the bone marrow. "