What is Anaemia?
Blood consists of a fluid (plasma) which contains three main types of cells:
1. Red blood cells
2. White blood cells
The numbers of each type of blood cell vary between people and at different ages but are quite stable for healthy individuals.
Red cells contain a pigment called haemoglobin, which can bind oxygen and carry it from the lungs to the tissues where it is released to fuel the body’s chemistry.
Red cells are made in the bone marrow which is a spongy tissue in the middle of bones. Blood cells are made from primitive cells known as stem cells.
When there is a reduction in the number of red cells produced haemoglobin levels are low. This is known as Anaemia.
Anaemia may be caused by many conditions including:
- Nutritional deficiencies – Vitamin b12, Folic acid, iron
- Blood loss
- Chronic medical disorders – chronic kidney disease
- Bone marrow disorders – leukaemia, myeloma, myelodysplasia or lymphoma
Anaemia impairs the ability of the blood to adequately carry oxygen to the tissues.
This can cause the following symptoms:
- Reduced capacity for exercise
- Breathlessness on exertion
Iron Deficiency Anaemia
Iron deficiency Anaemia is by far the most common blood disorder encountered in general practice.
Risk of iron deficiency is greatest at times of rapid growth, during pregnancy or excessive blood loss.
The key laboratory measurement for its identification is the serum ferritin which is a measure of the body’s iron stores. A low haemoglobin concentration in a patient with a serum ferritin <30 is diagnostic of iron deficiency.
Well known limitations of the serum ferritin are the elevation in values that occur with acute or chronic inflammation, liver disease, alcoholism and malignancy. The Bone marrow iron stain is still widely regarded as the gold standard for the diagnosis of iron deficiency in these situations.
Treatment of Iron deficiency
Oral iron therapy – it is preferable to treat iron deficiency with oral rather than potential iron. 1 iron tablet taken daily without food is a effective as 3 tablets with meals. The major obstacle to successful oral therapy is the nausea and epigastria discomfort that occur 30-60 minutes after taking iron. These symptoms usually subside after 2-3 days with continued treatment
Intravenous iron therapy – the main indications are intolerance to oral iron and intestinal malabsorption.
Anaemia of Chronic disease
Anaemia of Chronic disease is common in patients aged 60 and above affecting 10% of the population.
It is associated with increased morbidity and mortality from co-existing medical conditions such as heart failure and respiratory failure.
Anaemia of chronic disease is thought to be caused by an abnormal inflammatory response of the body to stimulus from a chronic medical condition.
Unlike iron deficiency, the ferritin may be raised, the MCV is often normal and the bone marrow iron stain shows plentiful iron in the stainable bone marrow particles.
Treatment of Anaemia of Chronic disease
- Blood transfusions and iron chelation therapy
- Recombinant Human Erythropoietin
Recombinant human erythropoietin is a growth factor produced by the kidneys which stimulates the production of red blood cells.
It is indicated in patients with symptomatic anaemia needing blood transfusion, where iron, B12 and folate levels are normal
Response definition – patients can be said to have responded to Erythropoietin when the haemoglobin concentration rises by >1g/dl after 1 month. A good response is defined as a response in haemoglobin concentration of>2g/dl in 6-8 weeks.
If patients do not respond after 4 weeks the dose can be doubled. If there is still no response then the Erythropoietin therapy should be stopped.
Side effects include hypertension (BP should be checked weekly for the first 1 month of therapy), flu like symptoms, raised platelets and venous thrombosis.
The major benefits of treatment are:
- Reduction in the use of blood transfusion
- Prevention of iron overload
- Improvement in quality of life
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