Anemias beyond B12 and iron deficiency: the buzz about other B's, elementary, and nonelementary problems (original) (raw)
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Anemia as a Problem: GP Approach
Digestive Diseases, 2021
Background: Anemia is a presentation of an underlying disease or deficiency. As stated by the WHO, anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. This review of clinical practice aimed to determine the diagnostic approach to anemia in primary care patients. Summary: Nutritional deficiencies, medications, chronic inflammatory conditions, malignancy, renal dysfunction, and bone marrow and inherent disorders contribute to anemia development. Anemia is classified and diagnosed by the values of hematological parameters, underlying pathological mechanism, and patient history. The diagnostic approach of anemia in primary care settings is focused on history, physical examination, laboratory findings including complete blood cell count, reticulocyte count, and peripheral smear examination, fecal occult blood test, and ultrasound findings. Key Messages: Anemia is the most common hematological disorder that represents a major health burden worldwid...
Vitamin B12 deficiency from the perspective of a practicing hematologist
Blood, 2017
B12 deficiency is the leading cause of megaloblastic anemia, and although more common in the elderly, can occur at any age. Clinical disease caused by B12 deficiency usually connotes severe deficiency, resulting from a failure of the gastric or ileal phase of physiological B12 absorption, best exemplified by the autoimmune disease pernicious anemia. There are many other causes of B12 deficiency, which range from severe to mild. Mild deficiency usually results from failure to render food B12 bioavailable or from dietary inadequacy. Although rarely resulting in megaloblastic anemia, mild deficiency may be associated with neurocognitive and other consequences. B12 deficiency is best diagnosed using a combination of tests because none alone is completely reliable. The features of B12 deficiency are variable and may be atypical. Timely diagnosis is important, and treatment is gratifying. Failure to diagnose B12 deficiency can have dire consequences, usually neurological. This review is w...
Anemia: winning elbow room in the field of hematology and hemotherapy
Revista Brasileira de Hematologia e Hemoterapia, 2012
Anemia, one of the most common and widespread disorders in the world, is a public health problem in both industrialized and non-industrialized countries. In 2002, the WHO estimated that anemia resulting from iron deficiency was one of the ten most important factors contributing to the global burden of diseases and that it increases morbidity and mortality in preschool-aged children and pregnant women (1). Anemia is defined as a decrease in the concentration of circulating red blood cells or in the hemoglobin (Hb) concentration and a concomitant impaired oxygen-carrying capacity in order to meet the body`s physiologic needs. Specific physiologic needs vary with a person's age, gender, altitude of residence, smoking behavior and in different stages of pregnancy (1). Iron deficiency is by far the most common cause of anemia globally (causing approximately 75-80% of the total burden of anemias), but other nutritional deficiencies (including folate, and vitamins A and B 12), acute or chronic inflammation, parasitic infections, and inherited or acquired disorders that affect Hb synthesis, red blood cell production or red blood cell survival, can all cause anemia and can occur alone or together in the same individual (1). Because iron metabolism disorders [particularly iron deficiency anemia (IDA) and anemia of chronic disease] make a large contribution to anemia, global efforts to reduce the anemia burden have largely been directed towards better programs for the assessment, prevention, diagnosis and management of these diseases around the world.
The Journal of the Association of Physicians of India, 2020
1. Russell RM, Suter PM. Chapter 74. Vitamin and Trace Mineral Deficiency and Excess. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds.Harrison’s Principles of Internal Medicine, 18e. New York, NY: McGrawHill; 2012. http://accessmedicine.mhmedical.com.proxy.mul.missouri.edu/content.aspx?book id=331&Sectionid=40726808. Accessed September 10, 2014. 2. Isenberg-Grzeda E, Kutner HE, Nicolson SE. 2012. Wernicke-Korsakoffsyndrome: under-recognized and under-treated. Psychocomatics53: 507516.http://ew3dm6nd8c.search.serialssolutions.com.proxy.mul.missouri.edu/?sid= Mizzou&genre=article&issn=15457206&volume=53&issue=6&date=&year=&pages=50716&rft_id=info%3Apmid%2F%3E23157990&id=pmid:23157990&atitle=&stitle =Psychosomatics 3. Nguyen-Khoa D. (2014). Beriberi (Thiamine Deficiency).In: Medscape Reference, Khardori R (Ed.), Medscape Reference, New York, NY. Retrieved from http://emedicine.medscape.com/article/116930-overview.
Etiology of Severe Anemia in Children at a Tertiary Care Hospital
Asian Journal of Clinical Pediatrics and Neonatology, 2018
Background: Public health significance of anemia in children was classified as severe in India. Severe anemia (Hb < 7g/dL) significantly increases the risk of death. Critical diagnostic evaluation and a thorough work-up make the accurate diagnosis of intrinsic red cell abnormalities feasible. Review of etiology helps to formulate strategies to prevent them, and to know the degree of achievement of the targets. Objectives: The aim of the present study was to identify the etiology of severe anemia. Subjects and Methods: It is a retrospective record based study done at a tertiary care center. All new severe anemia cases aged 1 month to 18 yrs, which were admitted on Monday from Jan 2017 to Dec 2017 were included. Previously worked up cases coming for transfusions and anemia due to bleeding were excluded. Details of history, physical examination and work-up were obtained for justification of diagnosis based on existing evidence. Results: 112 children were included. Mean age was 3.94 yrs (+/_3.52) (Range: 1 month-13 years), median and mode were 3 years. Male to female ratio was 1.95:1. 51% of severe anemia cases were due to iron deficiency. 11.6% had confirmed β-Thalassemia Trait (BTT) and 18.75% had suspected Thalassemia Trait (TT). Other causes of severe anemia were: folate deficiency (13.4%), B12 deficiency (1.8%), hereditary spherocytosis (HS) (7.1%), marrow replacement by acute leukemia (6.25%), aplastic anemia (2.7%), malaria (2.7%), and antiretroviral therapy induced anemia (0.9%). HS was the second most common cause of hemolytic anemia after thalassemias. Conclusion: Though a number of nutrition based initiatives have been initiated in the country, the burden of preventable iron deficiency, contributing to severe anemia cases is enormous, signifying the need for more effective programs to be implemented in India. Folate should be supplemented to all children with anemia irrespective of the cause. Essential workup with proper interpretation of investigations for arriving at diagnosis prior to transfusing the child is obligatory.
Anemia by Vitamin B12 and Latent Iron Deficiency
2016
The aim of this work is to illustrate a difficult diagnostic in vitamin B12 deficiency because of using of multivitamin preparations to a patient with unknown etiology of anemia. History Patient: a 70 year old engineer, following 8 years vegetable – dietary, was admitted to the county hospital, in neurology department, with diagnostic of poli-radiculonevrites, received in ward the treatment with milgama (containing 250 micro-gram multivitamin). After a lipotimia status the patient was transferred to cardiology department. Laboratory examinations showed in peripheral blood: Hb = 6 3 g/dl; Ht = 18.8%; RBC= 290.000/mm³; PLT. = 214000/mm³; WBC = 5300/³mm; Ret. = 3, 7%; Erythrocytes indices = normal values; ESR = 38 mm/h, moderate increase and serum iron decreased, 36 microgram/dl value. On blood smear in optic microscopy was registered: Band = 5% (with nucleus in ring!!!), differential count being normally with aspect flags on Coulter HMX Analyzer with 22 parameters: neutrophilia, ...
Anemia refers to a hemoglobin or hematocrit level lower than the age-adjusted reference range in healthy children and adults. Anemia is not a specifi c disease entity but is a condition caused by various underlying pathologic processes. The clinical effects of anemia depend on its duration and severity. When a precipitous drop in the hemoglobin or hematocrit level occurs (eg, due to massive bleeding), the clinical presentation is typically dramatic and can be fatal if the patient is not immediately treated. Even then, mortality risk is very high. We report the case of a 76-year-old woman with clinical symptoms and laboratory confi rmation of severe anemia with level of hemoglobin 24 g/l, and hematocrit 0.08. Anemia was a sign of malignoma of the stomach, later patohistologicaly verifi ed gastric adenocarcinoma. Aim of management is to prevent tissue hypoxia by maintaining an adequate circulating volume and oxiform capacity. However, as shown in this case, the very rapid correction of anemia and the circulatory volume does not decrease the risk of fatal outcome.