Practice diagnosis and treatment of anemia

2021-02-05 12:00 AM

Malignant anaemia: Vitamin B12 deficiency is caused by a decrease in the body's production of intrinsic factors needed for the absorption of this vitamin.

Anemia is a condition in which the concentration of oxygen-carrying pigment (haemoglobin) in the blood falls below normal. Under normal circumstances, the concentration of haemoglobin in the blood is always kept at a stable level thanks to the balance between making red blood cells in the bone marrow and destroying red blood cells in the spleen. A number of different causes can cause this balance to be lost, and then there is the possibility of anemia. Therefore, anemia is not a disease, but can be seen as the result of a number of different diseases, even malnutrition, when the food does not provide enough iron to make red blood cells.

It is also important to know about the natural cycle of formation and destruction of red blood cells in the body. Red blood cells are produced by the bone marrow from a number of esterified cells called stem cells. Over a period of about 5 days, these cells change shape and accumulate haemoglobin. These cells then leave the bone marrow into the bloodstream, called reticulocytes. It takes about 1-2 days for reticulocytes to develop into red blood cells, and can actually be responsible for carrying oxygen, carbon dioxide and nitrite oxide. Haemoglobin makes up about 35% of the mass in red blood cells and is a key component to help red blood cells carry out the transport function. The haemoglobin in red blood cells is capable of carrying 20 times its own mass of oxygen.

The red blood cells function for about 120 days to become "old and weak". The old red blood cells become trapped in small blood vessels, mainly in the spleen, and destroyed. The "materials" that make up red blood cells, such as iron, are captured by the body and used in making new red blood cells.


Each type of anemia often has different causes, so the diagnosis of anemia requires comprehensive attention to the relevant factors before conclusions can be reached:

Iron deficiency anemia: Due to the lack of iron in the body, it is also commonly referred to as iron deficiency anemia. Iron is the main component of haemoglobin, so iron deficiency inevitably reduces the ability to form haemoglobin in the bone marrow. The causes of iron deficiency are often:

Due to lack of iron in food, it can be due to poor diet, but it can also be caused by diseases of the digestive tract that cause a sharp decrease in food intake, or due to incorrect diet, especially. nutritionally imbalanced diets.

Due to heavy blood loss in a short time, iron loss in the blood and the body cannot recover in time, such as bleeding in the gastrointestinal tract, urinary tract bleeding, irregular menstruation, hookworm infection ...

Due to long-term treatment with nonsteroidal anti-inflammatory drugs or aspirin ...

Large red blood cell anemia: Due to lack of vitamin B12 or vitamin B9 (folic acid), it affects the formation of red blood cells in the bone marrow, causing red blood cells to be larger than normal size, thus called erythrocyte anemia. big.

Malignant anemia: Vitamin B12 deficiency is caused by a decrease in the body's production of intrinsic factors needed for the absorption of this vitamin.

Aplastic anemia: Because bone marrow reduces the ability to create stem cells, thereby reducing the ability to make red blood cells. This type of anemia is very rare, known as aplastic anemia. The causes of aplastic anemia are usually caused by radiation or chemicals, but in some cases, it can also be a spontaneous disease.

Haemolytic anemia: Because red blood cells are destroyed earlier than normal time, making the ability to create new red blood cells in the bone marrow cannot be balanced. Although the bone marrow has the ability to accelerate erythropoiesis 6 times faster than normal, when red blood cells are destroyed even more rapidly, anemia occurs. Early destruction of red blood cells is called haemolysis, so this type of anemia is also called haemolytic anemia.

Anemia due to inherited diseases: In some cases, anemia is also caused by a genetic defect, creating a disorder in the ability to make red blood cells, or an abnormality in the destruction of red blood cells, or red blood cells. the bridge has an abnormal structure. Based on the difference, people distinguish some cases of anemia of this type as follows:

Sickle cell anemia: A genetic factor that causes the production of abnormal haemoglobin-carrying red blood cells, called haemoglobin S.

Pay attention to the causes of anemia, such as:

Menstrual irregularities, with excessive blood loss. Anal bleeding is also a common cause.

Diet lack of nutrition, especially iron deficiency. Elderly people, vegetarians, developing children, pregnant or lactating women, physical workers or a lot of physical activity ... are all special subjects that need attention. Because there are many risks of insufficient nutrition in daily meals.

Patients with a history of iron deficiency anemia are at increased risk of repetition.

The common physical symptoms are: fatigue, shortness of breath, dizziness, angina, palpitations ...

Notice some of the test results that may suggest anemia:

Iron deficiency anemia is typically characterized by a low mean erythrocyte volume (<76 fl) and a low mean erythrocyte hemoglobin concentration (<30g / dl). However, definitive diagnosis requires further examination of serum iron. Iron deficiency anemia when serum iron is reduced (<15mmol / L in men and <14mmol / L in women).

The high total iron binding capacity (> 70mmol / L in men and> 74mmol / L in women) also helps in the diagnosis of iron deficiency anemia. In contrast, a low total iron binding capacity (<45mmol / L in men and <40mmol / L in women) suggests a case of chronic anemia.

If an enlarged erythrocyte is detected (mean erythrocyte volume> 96fl), attention should be paid to the possibilities:

Hypothyroidism: check for thyroid stimulating hormone.

Alcoholism: iron gamma test (glutamyl transferase).

Vitamin B12 or B9 deficiency: Check blood concentration.

Women are pregnant.

And some of the rarer possibilities include: malignant anemia (erythrocyte sedimentation rate - ESR), radiation therapy anemia, or anemia caused by liver disease (liver function tests).

The accompanying symptoms such as many bruises on the skin, the patient easily bleed the nose, bleeding teeth, easy to infection ... it is likely that aplastic anemia, due to leukocytes and platelets are reduced.

Malignant anemia may show signs of loss of sensation in the legs. In addition, the conjunctiva may be slightly pale and the facial skin yellow. In this disease, vitamin B12 deficiency is caused by poor absorption, due to the lack of intrinsic factors necessary for the absorption of this vitamin. Blood tests are needed to assess this intrinsic factor.

Certain chronic diseases can be the cause of anemia, such as kidney failure, enteritis, rheumatoid arthritis ... In some cases, cancer can also cause anemia.

Anemia during pregnancy can be life-threatening both before and after birth. Therefore, every prenatal visit should have a haemoglobin level monitoring test, especially at the 28th and 34th week of pregnancy. Haemoglobin levels decrease naturally during pregnancy, due to diluted blood. Low reduction is considered normal due to dilute blood when haemoglobin is about 10-11g / dl with medium red blood cell volume and mean red blood cell hemoglobin is normal. Pregnant women are identified with anemia and need treatment when haemoglobin <10g / dl.

In cases where the cause of anemia cannot be determined, gastrointestinal diagnostic tests should be performed immediately. Anemia is often a manifestation of some dangerous, on-the-go illness.


Treatment of anemia largely depends on the diagnosis of the cause of anemia. The following suggestions are applicable in some situations:

Mild iron deficiency anemia (hemoglobin> 7g / dl) can be treated with iron sulfate tablets (Feospan, Toniron ...) 200mg per day. Do a complete blood count after one month to check results. At the same time, pay attention to addressing the causes, such as adjusting to diet, taking deworming, treating menorrhagia ...

If the patient cannot use iron sulfate tablets due to side effects, fumarate iron tablets (Fersaday, Fersamal ...) can be used.

If the patient has difficulty in taking the oral tablet form, or the drugs are not effective enough, the injection form can be used.

If severe anemia (haemoglobin> 5g / dl) is accompanied by many symptoms, a referral to hospital should be considered for a blood transfusion. Each time can be infused from 200-300ml of blood and about every 4-5 days transfusion until the anemia improves.

Some patients have chronic illnesses with mild anemia (haemoglobin about 10g / dl), usually do not need to treat symptoms of anemia but just treat the disease. These patients often do not have symptoms of anemia, and do not in fact respond to treatment of anemia.

Big red blood cell anemia needs to determine the cause and treat the cause.

When determining vitamin B12 deficiency in malignant anemia, treatment with 1mg hydroxocobalamin intramuscularly once every 3 days, continuously for 2 weeks. Then reduce to every 3 months, prolong. Complete blood count after one month of treatment to ensure no large red blood cells, as well as to rule out the possibility of iron deficiency anemia, since iron deficiency anemia makes treatment with vitamin B12 complex. more complicated.

Folic acid deficiency is often caused by poor absorption in intestinal diseases, but in very rare cases it may also be due to poor nutrition. When determining folic acid deficiency, it can be treated in the form of tablets (Cytosol, Folamin, Folsan ...) with a daily dose of 5mg. However, it is important to be sure that vitaminB12 deficiency is well treated, since peripheral neuropathy caused by vitamin B12 deficiency becomes more severe with folic acid. Anemia during pregnancy is usually iron deficiency anemia and is treated with fumarate iron tablets (Fersaday, Fersamal ...) one tablet a day. A combination of 100mg of elemental iron and 350 μg of folic acid can be used. After 2 weeks of treatment, check the haemoglobin level. If the response is good, the concentration should increase by about 0.5 g / dl after each week of treatment. If the therapeutic effect is low, or if the anemia is more severe, give twice the dose. After 2 weeks, check the haemoglobin level, if still lower than 9g / dl should refer to a specialist or recommend the patient to be treated in hospital. Pregnant women should receive iron deficiency prophylaxis if they have the following risks:

A miserable diet, or a long-term diet, a vegetarian diet ...

Pregnancy period is too close to previous pregnancy.

A history of iron deficiency anemia.

All pregnant women should receive folic acid prophylaxis at a dose of 4 mg daily during the first 12 weeks of pregnancy. The higher dose, 5mg per day, is recommended for the following subjects:

A history of folic acid deficiency.

Have a history of having a child with spina bifida or a family history of spina bifida.

Signs of poor absorption.

Have haemoglobin disease.

Are being treated with anticonvulsants such as phenytoin.

Pregnant with twins, triplets ... or has pregnant many times.