Severe anemia: a case report (original) (raw)
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Cureus
Although hemoglobin levels beneath 6.5 g/dl are considered to be life-threatening and the patients theoretically suffer from a cluster of symptoms, few cases of patients who seek medical assistance when their hemoglobin levels had fallen beneath 3 g/dl have been reported in the literature. Here, we describe the case of a 97-year-old patient who was transferred to the emergency department with dyspnea and the initial screening tests showed a hemoglobin level of 1.7 g/dl, due to iron deficiency. The patient was hemodynamically stable, and no ischemic lesions were seen on the electrocardiogram. His dyspnea was due to a lower respiratory tract infection and bilateral pleural effusion. He was bedridden for two years. His absence of physical activity in combination with the slow onset of anemia and the absence of severe underlying pulmonary and cardiovascular diseases could hide the symptoms until additional stressful events, such as the respiratory tract infection and the deterioration of heart function, occurred. So, we must keep in mind that in elderly patients with reduced physical activity and without severe pulmonary and cardiovascular comorbidities, the symptoms of severe anemia may go unnoticed until hemoglobin reaches life-threatening levels.
Clinical Emergencies Presented by Anemia
Emergency Medicine: Open Access, 2016
Anaemia affects 24.8% of the population worldwide. It has wide variety in terms of clinical manifestation of the disease severity. It can also ranges from almost asymptomatic to severe haemolytic anaemia. In contrast to all other nucleated cells, RBCs show very interesting biology. An alteration in any of the major factors in RBCs (eg. shape, size, and structural or functional or quantitional abnormalities in haemoglobin) usually results in compensatory changes in the other compensatory factors. Sometimes, the compensatory responses may fail because of severity of disease or due to underlying pathologic conditions. The result of failed compensatory responses is cellular dysfunction, tissue hypoxia and eventual cell death, which ultimately leads to severity in anaemia and emergency situations due to it. In this paper, we have concentrated to focus on how the extrinsic and intrinsic defects on RBCs cause severe haemolytic anaemia, leading to emergencies. We have also discussed the destructions of RBCs in both extra and intra vascular regions, contributing to severe haemolysis. Other than haemolytic anaemia, other structural and functional defects of haemoglobin, which can lead to life threatening conditions (e.g.: β thalassemia major and transfusion dependent haemoglobinopathies) are also being discussed here. In nutshell, this paper is an exclusive review on all forms of clinical emergencies due to anaemia's and other haemoglobinopathies.
International Journal of Statistics in Medical Research, 2022
Purpose: To investigate the frequency and types of severe unknown anemia in patients referred to the Baqiyatallah Hospital (Tehran) for six months. Methods: In this descriptive cross-sectional study, the patients with severe unknown anemia referred to the Baqiyatallah Hospital (Tehran, Iran) were selected over six months. Following consideration of inclusion and exclusion criteria, 230 patients with severe anemia (hemoglobin (Hb) > 8gr/dl) were included. Complete medical history was obtained from the patients and additional biochemical blood analyses were applied to determine the frequency and type of anemia. SPSS (v.19) software was used to analyze the findings and the significance level was defined as a p-value <0.05. Results: In chronic disease anemia (47.5%), gastrointestinal bleeding-associated anemia (29%), bleeding malignancies anemia (21.5%), and aplastic anemia (2%). There were significant differences (p<0.05) in the frequency of different types of normocytic anemia. The highest frequency was detected in folate deficiency anemia (46%), hypothyroidism anemia (34%), and B12 deficiency anemia (20%), respectively. The hemolytic anemia represented a significant difference (p<0.05) in comparison with sickle cell anemia (95%). Also, sickle cell anemia showed a significant difference (p<0.05) between thalacemia-associated anemia (95%) and malignancy-related anemia (95%) Conclusion: Respectively, the highest frequency of anemia in patients was found in chronic diseases and gastrointestinal bleeding. It is suggested that more attention should be paid to the type of anemia of patients referred to the urgency of hospitals.
Anemia as a Problem: GEH Approach
Digestive Diseases
Background: Anemia is present in almost 5% of adults worldwide and accompanies clinical findings in many diseases. Diseases of the gastrointestinal (GI) tract and liver are a common cause of anemia, so patients with anemia are often referred to a gastroenterologist. Summary: Anemia could be caused by various factors such as chronic bleeding, malabsorption, or chronic inflammation. In clinical practice, iron deficiency anemia and the combined forms of anemia due to different pathophysiological mechanisms are most common. Esophagogastroduodenoscopy, colonoscopy, and the small intestine examinations in specific situations play a crucial role in diagnosing anemia. In anemic, GI asymptomatic patients, there are recommendations for bidirectional endoscopy. Although GI malignancies are the most common cause of chronic bleeding, all conditions leading to blood loss, malabsorption, and chronic inflammation should be considered. From a gastroenterologist’s perspective, the clinical spectrum o...
The American Journal of Medicine, 1996
Inherent in any decision to treat a patient for anemia is an appreciation of the underlying cause of a decrease in the oxygen-carrying capacity of blood. Equally important is an understanding of how this acute or chronic decrease in oxygen delivery affects individual patients. Anemia generally results from blood loss, decreased red blood cell (RBC) production, poor RBC maturation, or increased RBC destruction. This article reviews the pathophysiology of anemia, with specific emphasis on its physiologic consequences in the surgical patient, and provides a contemporary definition of anemia for use in that context. Taking a broader, more functional view of anemia paves the way for understanding and appreciating the newer techniques of RBC conservation and transfusion avoidance, as well as of pharmacologic methods available to counter this disorder. Am J Med. 1996; 101(suppl 2A):7S-11S.
Multidisciplinary approach to anemia
Romanian Journal of Military Medicine, 2015
Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild irondeficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract-normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdominopelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo-medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic-apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
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.
Assesment of the patients presenting with severe anemia to the emergency internal medicine clinic
Northern Clinics of Istanbul, 2014
OBJECTIVE: Etiological evaluation of the patients who were hospitalized with the diagnosis of severe anemia (Hb<7 gr/dl) in the emergency internal medicine clinic between January and July, 2013. METHODS: In this study, 112 patients who were hospitalized in Dr. Lutfi Kirdar Kartal Education and Research Hospital emergency internal medicine clinic with severe anemia between January and July 2013 were retrospectively analyzed. Patients' initial complaints, underlying causes of their anemia and prognosis of the patients were evaluated. RESULTS: The etiology of anemia was iron deficiency in 60 (53.6%), chronic kidney failure in 16 (14.2%), hematologic malignancies in 12 (10.7%), liver cirrhosis in 12 (10.7%) and other non-malignant hematologic disorders in 4 (3.6%) patients. CONCLUSION: The most common cause of anemia in patients who apply to emergency internal medicine clinic with severe anemia is iron deficiency. The most common complaints on admission are subjective ones such as weakness, fatigue and lassitude. Chronic disease anemia does not cause severe anemia as much as iron deficiency.