What is anemia
Anemia is a common condition characterized by a decreased red blood cell (RBC) count. It may be acute or chronic and the severity of anemia varies from mild to severe. Usually, the disease develops gradually and symptoms progressively worsen. However, unless treated promptly anemia may lead to life-threatening complications.
Red blood cells carry oxygen to the tissues and nurture the cells. Therefore, when the amount of erythrocytes in the blood is low the tissues suffer from oxygen deficiency causing worrisome symptoms.
Signs and symptoms
Signs and symptoms of anemia are typical and occur due to decreased oxygen supply to the tissues and include:
- General malaise;
- Dizziness, lightheadedness;
- Craving for clay, chalk;
- Inability to exercise (exercise intolerance);
- Shortness of breath and chest pain, especially on exertion;
- Fast heartbeat or irregular rhythm;
- Frequent headaches;
- Bone and joint pain;
- Cold limbs;
Other symptoms of anemia develop in association with the cause of anemia:
- Iron deficiency is associated with weird cravings to eat substances that are not eatable such as clay, paper products, dirt, laundry starch, chalk, etc. This is known as pica. Quite common is craving for ice, it may be present even before other obvious symptoms of anemia develop. Iron deficiency affects also the connective tissues and therefore many changes in skin, nails, and hair may be noticed. Skin appears dry or rough, nails become thin, flat, or concave (koilonychia), hair looks brittle and is prone to falling out, rarely in severe cases alopecia is possible;
- In sickle cell anemia, individuals experience recurrent painful crises during which they feel the pain that may affect any part of the body, pain may be accompanied by fever, anxiety, and rapid heartbeat;
- Vitamin B12 is crucial for the nervous system therefore B12-deficiency anemia is often accompanied by numbness, loss of tactile sensations and difficulties in walking and equilibrium. Other prominent symptoms are soreness of the tongue (glossitis), dyspepsia, and diarrhea;
- Jaundice is usually observed in a hemolytic anemia;
- Spleen enlargement (splenomegaly) is a typical feature of hereditary spherocytosis;
Lab tests for anemia
Further testing is necessary to establish the cause of anemia and prescribe appropriate treatment.
Full blood count helps to reveal the size and form of red blood cells. Large so-called macrocytic RBC suggests B12 or folate deficiency. Small erythrocytes appear in iron deficiency and thalassemia. In hemolytic anemias and anemia of chronic disorder, the cells are of normal size.
Iron status should be checked – in iron deficiency ferritin levels are low whereas total iron-binding capacity (TIBC) increases. On the contrary in anemia of chronic disease ferritin levels are normal or increased and TIBC is decreased.
Serum vitamin B12 and folic acid levels have to be measured when macrocytic anemia is suspected. In vitamin B12 deficiency methylmalonic acid and homocysteine levels are elevated.
Serum lactate dehydrogenase (LDH) and bilirubin concentrations should be checked if hemolytic anemia is suspected as in case of hemolysis their concentration will appear elevated.