Relevance to Pathology.
Anemia refers to the condition that results from a reduction of red blood cells (RBC) or hemoglobin (Hb) count in the blood. Anemia is a serious global health issue that arises from both natural and unnatural causes that affect individuals from all age groups and genders (Teressa, 2019). In order to effectively develop a treatment remedy for the condition, there are various methods of discovering anemia. An example is through using the mean corpuscular volume (MCV), where anemia can be categorized into normocytic, macrocytic, or microcytic (Turner et al., 2023). Macrocytic anemia is the condition where the red blood cells become larger than normal due to an impairment of DNA synthesis that is important for cell division in the bone marrow. During blood tests on a macrocytic anemic patient, results are likely to indicate an elevation in the mean corpuscular volume (MCV) since the red blood cells are larger than normal.
On the other hand, microcytic anemia is a condition where the red blood cells appear smaller than normal. Blood tests on a microcytic anemic patient are likely to indicate a low mean corpuscular volume (MCV) due to the smaller red blood cells (Turner et al., 2022). In regards to normocytic anemia, it is a condition where blood tests may indicate normal red blood cells and normal MCV despite the presence of Anemia (Turner et al., 2022). Understanding the size of the red blood cells is considered an important step towards the successful narrowing down of the possible causes of anemia. Aside from MCV, there are also methods of identifying anemia such as Hb concentration, Hematocrit and bone marrow examination.
Etiology/ Risk Factors.
Various causes of anemia can influence how the body produces RBCs or affect Hb in these cells. Some of these causes may be natural causes, while others may be unnatural. An example of a natural risk factor for anemia is genetics or inherited conditions. Genetic disorders such as sickle cell anemia and thalassemia may cause abnormal Hb production that leads to fragile RBCs (Chiabi et al., 2019). In addition, pregnancy is also another natural cause that may lead to anemia. Garzon et al. (2022) state that during pregnancy, expectant mothers often experience an increased demand for iron as the volume of blood in their bodies increases. This increased demand for iron in the body can lead to iron deficiency anemia in situations where one lacks sufficient iron stores (Garzon et al., 2022). Age is also a natural risk factor for anemia as certain age groups, such as infants between 6-59 months and menstruating girls, are more at risk of being anemic.
The widely considered leading cause of anemia is nutritional deficiencies. According to Paul et al. (2021), inadequate intake of vital minerals responsible for RBC production can cause different types of anemia. Some of these vital minerals are such as iron, folate and vitamin B12 (Paul et al., 2021). Additionally, chronic diseases have also emerged as one of the leading risk factors for anemia as they often impair vital organs responsible for the immune system in the body. For instance, chronic kidney disease impacts the kidney’s ability to produce erythropoietin, which is an essential hormone responsible for the stimulation of RBC production in the bone marrow (Wong et al., 2020).
Further, patients with bone marrow disorders are also at risk of anemia as the bone marrow is responsible for the production of RBCs, platelets and white blood cells (Teressa, 2019). Bone marrow disorders such as myelodysplastic syndromes cause abnormal blood cell production in the bone marrow, which could lead to anemia (Turner et al., 2022). Blood loss is also a common cause of anemia as excessive bleeding during surgery or trauma reduces the RBC count in circulation (Garzon et al., 2022). Menstruating women are the more likely group to get anemia through blood loss.
Structural/Physical Alterations Related to the Pathology.
Patients suffering from anemia are likely to experience a range of structural or physical alterations in their bodies due to the reduction in RBC count or Hb concentration. An example of these structural changes is in their cardiovascular adaptations. As anemia leads to a reduction in Hb levels, patients with anemia experience oxygen reduction in their bodies (Teressa, 2019). Hemoglobin is critical for binding oxygen molecules in the lungs, where there is a high concentration of oxygen and transporting it to the vital organs and tissues (Turner et al., 2022). In anemic patients, hemoglobin levels are low; thus, inadequate oxygen is bound and transported to the tissues and organs in the body (Teressa, 2019).
Additionally, hemoglobin also plays the role of transporting excess carbon dioxide in the tissues and organs to be exhaled. With the reduced hemoglobin levels, carbon dioxide builds up in the body, disrupting the acid-base balance as oxygen molecules are also reduced (Turner et al., 2022). Hence, the heart is compelled to work harder and pump more blood to compensate for the lack of oxygen supply to organs and tissues.
Over time, the heart’s structure also changes due to being overworked. As it tries to pump more blood to the tissues and organs, its muscularity is likely to change as the heart muscles tend to increase in size (Wong et al., 2020). When a patient has prolonged anemia, the increase in the heart’s muscularity is not the only structural change noticed. It also experiences remodelling where its shape and functionality are impacted, increasing the likelihood of left ventricular hypertrophy (Wong et al., 2020). With the increased strain on the heart, anemic patients are likely to contract cardiovascular diseases such as hypertension, heart failure and arrhythmias.
Enlargement of other vital organs is also another noticeable change experienced by anemic patients. One of the main reasons why organs such as the liver are likely to enlarge is due to the increase in the volume of blood pumped by the heart (Teressa, 2019). According to Chiabi et al. (2019), the tissues in these organs are likely to be swollen or engorged as blood flow increases. Blood vessels may also expand with the increase in the amount of blood that flows through them. As Teressa (2019) states, the expansion in the blood vessels, also known as vasodilation, is a risk factor for fluid shifts, where fluid moves into the tissues from the bloodstream. Vasodilation may thus expose the body to swelling or edema.
Clinical Manifestations.
Due to the structural and functional changes, there are various signs and symptoms an anemic patient might experience. One of these is shortness of breath. As the body experiences challenges delivering sufficient oxygen due to reduced Hb levels, anemic patients may encounter shortness of breath, particularly while undertaking any physically demanding tasks such as walking (Mamatova, 2022). Further, the increase in blood being pumped by the heart also leads to heart palpitations or chest pains, also known as angina. Angina is a sensation of pressure or discomfort in the heart muscles felt by anemic patients that arises from inadequate oxygen in the blood. Angina is mainly a symptom of severe cases of anemia.
Dizziness due to fatigue and weakness is also the other common symptom of anemia. With insufficient oxygen supply to the body’s tissues and organs, there is a great reduction in energy production in cells (Teressa, 2019). The reduction in energy production can contribute to a feeling of tiredness as the body feels overworked (Mamatova, 2022). As inadequate oxygen is being supplied to vital organs such as the brain, feelings of dizziness and lightheadedness are likely to be experienced (Teressa, 2019). The brain needs sufficient oxygen supply for its optimal functioning and survival.
In addition, another common symptom in severe cases of anemia is brittle nails and hair loss. As the body lacks vital nutrients such as iron to make new RBCs, nail abnormalities such as spoon nails arise where the center of a nail becomes sunken with a spoon-like appearance (Paul et al., 2021). Hair loss, on the other hand, arises due to a lack of oxygen and nutrients reaching the hair follicles (Mamatova, 2022). Without adequate oxygen and nutrients reaching the hair follicles, they are likely to weaken, leading to thinning and eventually falling out.
Anemic patients are also likely to feel cold in areas such as hands and feet due to reduced metabolic activity in cells around these extremities. According to Paul et al. (2021), anemic patients are likely to feel cold around these areas due to the body prioritizing oxygen supply to essential organs such as the heart and the brain. Moreover, the body is likely to initiate vasoconstriction to peripheral blood vessels in response to the decrease in oxygen levels. Vasoconstriction refers to the narrowing of blood vessels important to the supply of blood to the peripheral blood vessels (Mamatova, 2022). With these vessels narrowed, blood flow to the extremities is reduced, making the hands and feet cold.
General Interventions.
Once anemia has been identified using different methods such as MCV, Hb concentration, Hematocrit or bone marrow examination, treatment remedies are prepared based on the nature of the patient’s conditions. Dietary changes are one of the most common interventions recommended for anemic patients by nurses and physicians (Teressa, 2019). By consuming foods high in iron, diet adjustments can help the body retain more nutrients, especially for those who suffer from iron deficiency anemia (Paul et al., 2021). Dietary changes are often recommended in conjunction with lifestyle changes to avoid factors that may worsen anemia. According to Mamatova (2022), lifestyle changes such as regular exercising can reduce excessive vasoconstriction, enhancing blood flow to extremities. Patients are urged to avoid unhealthy habits such as smoking and eating imbalanced diets as part of their lifestyle changes.
Medication is also a common general intervention of anemia, where different medications are administered to help reduce the effects of anemia. There is a wide range of medications that can be administered, including supplements (iron and vitamins), erythropoiesis-stimulating agents (ESAs), antibiotics, bone-marrow stimulating medications and corticosteroids (Paul et al., 2021). The choice of medication always varies depending on the type of anemia, its severity and the underlying causes.
Blood transfusion can also be considered a possible intervention for anemia, especially in instances where it is caused by blood loss through trauma. Blood transfusion is effective in quickly restoring the RBC levels and improving the body’s oxygen-carrying capacity, which is affected by blood loss (Mamatova, 2022). However, each intervention administered should be accompanied by close monitoring and follow-up to ensure that they are effective in addressing anemia (Mamatova, 2022). Close monitoring and follow-up ensure that adjustments in treatment can be made if needed.
References.
Chiabi, A., Moyo, G. K., Ngone, I., Kago, D. A. T., Tchouamou, A., & Obadeyi, B. (2019). Persistent spleen enlargement in sickle cell disease: An unresolved dilemma. ARC J Pediatr, 6, 8-14.
Garzon, S., Cacciato, P. M., Certelli, C., Salvaggio, C., Magliarditi, M., & Rizzo, G. (2020). Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Medical Journal, 35(5), e166.
Mamatova, M. A. (2022). Signs of the spread of anemia among the population and the role of blood in the body. INTERNATIONAL JOURNAL OF RESEARCH IN COMMERCE, IT, ENGINEERING AND SOCIAL SCIENCES ISSN: 2349-7793 Impact Factor: 6.876, 16(09), 16-20.
Paul, P., Maiti, D., & Adhikary, T. (2021). Iron deficiency anemia-An updated overview. International Journal of Research in Pharmacy and Pharmaceutical Sciences, 6(4), 28–33.
Teressa, H. (2019). A Review on Major Causes of Anemia and its Prevention Mechanism. International Journal of Cell Science & Molecular Biology, 6(3), 57–62.
Turner, J., Parsi, M., & Badireddy, M. (2022). Anemia. In StatPearls [Internet]. StatPearls Publishing.
Wong, M. M., Tu, C., Li, Y., Perlman, R. L., Pecoits-Filho, R., Lopes, A. A., … & CKDopps Investigators Combe Christian Jacquelinet Christian Ayav Carole Briançon Serge Fouque Denis Frimat Luc Laville Maurice Pascal Christophe Herpe Yves-Edouard Lange Céline Legrans Karine Liabeuf Sophie Metzger Marie Speyer Elodie. (2020). Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated. Clinical Kidney Journal, 13(4), 613-624.
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