-
Annals of the New York Academy of... Aug 2019Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological... (Review)
Review
Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. Understanding anemia's varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia and for monitoring anemia control programs. We outline definitions and classifications of anemia, describe the biological mechanisms through which anemia develops, and review the variety of conditions that contribute to anemia development. We emphasize the risk factors most prevalent in low- and middle-income countries, including nutritional deficiencies, infection/inflammation, and genetic hemoglobin disorders. Recent work has furthered our understanding of anemia's complex etiology, including the proportion of anemia caused by iron deficiency (ID) and the role of inflammation and infection. Accumulating evidence indicates that the proportion of anemia due to ID differs by population group, geographical setting, infectious disease burden, and the prevalence of other anemia causes. Further research is needed to explore the role of additional nutritional deficiencies, the contribution of infectious and chronic disease, as well as the importance of genetic hemoglobin disorders in certain populations.
Topics: Anemia; Developing Countries; Humans; Inflammation; Nutritional Status; Prevalence; Risk Factors
PubMed: 31008520
DOI: 10.1111/nyas.14092 -
Blood Aug 2022The World Health Organization estimates that approximately a quarter of the world's population suffers from anemia, including almost half of preschool-age children....
The World Health Organization estimates that approximately a quarter of the world's population suffers from anemia, including almost half of preschool-age children. Globally, iron deficiency anemia is the most common cause of anemia. Other important causes of anemia in children are hemoglobinopathies, infection, and other chronic diseases. Anemia is associated with increased morbidity, including neurologic complications, increased risk of low birth weight, infection, and heart failure, as well as increased mortality. When approaching a child with anemia, detailed historical information, particularly diet, environmental exposures, and family history, often yield important clues to the diagnosis. Dysmorphic features on physical examination may indicate syndromic causes of anemia. Diagnostic testing involves a stepwise approach utilizing various laboratory techniques. The increasing availability of genetic testing is providing new mechanistic insights into inherited anemias and allowing diagnosis in many previously undiagnosed cases. Population-based approaches are being taken to address nutritional anemias. Novel pharmacologic agents and advances in gene therapy-based therapeutics have the potential to ameliorate anemia-associated disease and provide treatment strategies even in the most difficult and complex cases.
Topics: Anemia; Anemia, Iron-Deficiency; Child; Child, Preschool; Genetic Testing; Humans; Nervous System Diseases
PubMed: 35213686
DOI: 10.1182/blood.2020006479 -
Journal of Internal Medicine Feb 2020Iron deficiency anaemia is a global health concern affecting children, women and the elderly, whilst also being a common comorbidity in multiple medical conditions. The... (Review)
Review
Iron deficiency anaemia is a global health concern affecting children, women and the elderly, whilst also being a common comorbidity in multiple medical conditions. The aetiology is variable and attributed to several risk factors decreasing iron intake and absorption or increasing demand and loss, with multiple aetiologies often coexisting in an individual patient. Although presenting symptoms may be nonspecific, there is emerging evidence on the detrimental effects of iron deficiency anaemia on clinical outcomes across several medical conditions. Increased awareness about the consequences and prevalence of iron deficiency anaemia can aid early detection and management. Diagnosis can be easily made by measurement of haemoglobin and serum ferritin levels, whilst in chronic inflammatory conditions, diagnosis may be more challenging and necessitates consideration of higher serum ferritin thresholds and evaluation of transferrin saturation. Oral and intravenous formulations of iron supplementation are available, and several patient and disease-related factors need to be considered before management decisions are made. This review provides recent updates and guidance on the diagnosis and management of iron deficiency anaemia in multiple clinical settings.
Topics: Anemia, Iron-Deficiency; Humans; Iron; Risk Factors
PubMed: 31665543
DOI: 10.1111/joim.13004 -
Blood Feb 2018Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like... (Review)
Review
Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like myelodysplastic syndrome (MDS), develop preferentially in elderly individuals. The prevalence of anemia at older age is increasing, and this is mainly attributable to more frequently applied diagnostics and demographic changes in our societies. The etiology of anemia at older age is complex and ranges from bone marrow failure syndromes to chronic kidney disease, and from nutritional deficiencies to inflammatory processes including inflammaging in immunosenescence. In a smaller number of cases, no clear-cut etiology is identified. These patients are referred to as unexplained anemia or idiopathic cytopenia of unknown significance. In others, somatic mutations in leukocytes are found, but diagnostic criteria for MDS or other hematologic diseases are not fulfilled, a condition termed clonal cytopenia of undetermined significance. Management of anemias at older age depends on (1) the severity of the anemia, (2) underlying condition(s), and (3) patient-related factors, including comorbidities. Even a mild anemia may substantially affect physical and cognitive capacities and quality of life. An underestimated aspect is that because of age-related changes, organ function such as erythropoietin production in the kidney may become suboptimal. Management and treatment of anemia in older patients often require a multidisciplinary approach and detailed investigations of organ function. In this article, we review current concepts around anemias at older age, with special emphasis on etiologies, clinical implications, and innovative concepts in the management of these patients.
Topics: Age of Onset; Aged; Aged, 80 and over; Aging; Anemia; Humans; Late Onset Disorders
PubMed: 29141943
DOI: 10.1182/blood-2017-07-746446 -
The Netherlands Journal of Medicine Apr 2020Anaemia is a common diagnosis for clinicians. This mini-review summarises criteria for diagnosing the cause of anaemia. Within the microcytic anaemias, iron-deficient... (Review)
Review
Anaemia is a common diagnosis for clinicians. This mini-review summarises criteria for diagnosing the cause of anaemia. Within the microcytic anaemias, iron-deficient anaemia is most common. In addition, we would like to raise awareness of thalassaemia as a differential diagnosis. A normocytic anaemia, such as anaemia of chronic disease, is a diagnosis of exclusion. A macrocytic anaemia scheme is provided and differentiates based on reticulocyte count. We aim to provide the readers a clear overview of anaemia and when to refer to haematologists.
Topics: Adolescent; Adult; Anemia; Child; Diagnosis, Differential; Female; Hemoglobins; Humans; Male; Pregnancy; Reference Values; Symptom Assessment; Young Adult
PubMed: 32332184
DOI: No ID Found -
American Family Physician Jun 2010Anemia is defined as a hemoglobin level of less than the 5th percentile for age. Causes vary by age. Most children with anemia are asymptomatic, and the condition is... (Review)
Review
Anemia is defined as a hemoglobin level of less than the 5th percentile for age. Causes vary by age. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. Screening is recommended only for high-risk children. Anemia is classified as microcytic, normocytic, or macrocytic, based on the mean corpuscular volume. Mild microcytic anemia may be treated presumptively with oral iron therapy in children six to 36 months of age who have risk factors for iron deficiency anemia. If the anemia is severe or is unresponsive to iron therapy, the patient should be evaluated for gastrointestinal blood loss. Other tests used in the evaluation of microcytic anemia include serum iron studies, lead levels, and hemoglobin electrophoresis. Normocytic anemia may be caused by chronic disease, hemolysis, or bone marrow disorders. Workup of normocytic anemia is based on bone marrow function as determined by the reticulocyte count. If the reticulocyte count is elevated, the patient should be evaluated for blood loss or hemolysis. A low reticulocyte count suggests aplasia or a bone marrow disorder. Common tests used in the evaluation of macrocytic anemias include vitamin B12 and folate levels, and thyroid function testing. A peripheral smear can provide additional information in patients with anemia of any morphology.
Topics: Adolescent; Age Factors; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Transfusion; Child; Child, Preschool; Erythrocyte Count; Erythrocyte Indices; Hemoglobins; Humans; Infant; Infant, Newborn; Iron; Reticulocyte Count; Risk Factors
PubMed: 20540485
DOI: No ID Found -
Clinical Medicine (London, England) Mar 2021Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by... (Review)
Review
Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation. Although the causes of iron deficiency may sometimes be obvious, many tend to be overlooked. Iron sufficiency throughout pregnancy is necessary for maternal and foetal health. Preoperative IDWA must be corrected to reduce the risk of transfusion and postoperative anaemia. Oral iron is the first-line treatment for managing IDWA; however, intravenous supplementation should be used in chronic inflammatory conditions and when oral therapy is poorly tolerated or ineffective. This review considers the causes and clinical features of IDWA, calls for greater awareness of the condition, and proposes diagnostic and management algorithms.
Topics: Anemia; Anemia, Iron-Deficiency; Blood Transfusion; Female; Hemoglobins; Humans; Iron; Pregnancy
PubMed: 33762368
DOI: 10.7861/clinmed.2020-0582 -
Anaesthesia Apr 2021Iron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been... (Review)
Review
Iron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been challenged by recent data from observational studies. Menstrual loss, abnormal uterine bleeding and pregnancy put women at risk of developing iron deficiency which can result in severe fatigue, reduced exercise capacity and poor work performance. Iron deficiency and anaemia during pregnancy are associated with adverse maternal and fetal outcomes, including neurocognitive deficits in children born to iron-deficient mothers. Both iron deficiency and anaemia are common in women undergoing surgery but their association with poor outcomes remains uncertain. The enduring burden of iron deficiency and anaemia in women suggests that current strategies for recognition, prevention and treatment are limited in their utility. Improvements in our understanding of iron homeostasis and the development of new iron preparations, which are better absorbed with fewer side-effects, may improve therapeutic effectiveness of oral iron. Intravenous iron is efficacious for correcting anaemia rapidly but high-quality data on patient-centred outcomes and cost-effectiveness are currently lacking. Many recommendations for the treatment of iron deficiency and anaemia in national guidelines are not supported by high-quality evidence. There is a need for robust epidemiological data and well-designed clinical trials. The latter will require collaborative working between researchers and patients to design studies in ways that incorporate patients' perspectives on the research process and target outcomes that matter to them.
Topics: Administration, Oral; Anemia; Anemia, Iron-Deficiency; Erythrocyte Transfusion; Female; Hepcidins; Histamine H2 Antagonists; Humans; Iron; Women's Health
PubMed: 33682105
DOI: 10.1111/anae.15405 -
Indian Journal of Dental Research :... 2011The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of... (Review)
Review
The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of hemostasis. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases, with emphasis on anemia. Mesh phrases used in the search were: oral diseases AND anaemia; orofacial diseases AND anaemia; orofacial lesions AND anaemia; orofacial manifestations AND disorders of haemostasis. The Boolean operator "AND" was used to combine and narrow the searches. Anemic disorders associated with orofacial signs and symptoms include iron deficiency anemia, Plummer-Vinson syndrome, megaloblastic anemia, sickle cell anemia, thalassaemia and aplastic anemia. The manifestations include conjunctiva and facial pallor, atrophic glossitis, angular stomatitis, dysphagia, magenta tongue, midfacial overgrowth, osteoclerosis, osteomyelitis and paraesthesia/anesthesia of the mental nerve. Orofacial petechiae, conjunctivae hemorrhage, nose-bleeding, spontaneous and post-traumatic gingival hemorrhage and prolonged post-extraction bleeding are common orofacial manifestations of inherited hemostatic disorders such as von Willebrand's disease and hemophilia. A wide array of anemic and hemostatic disorders encountered in internal medicine has manifestations in the oral cavity and the facial region. Most of these manifestations are non-specific, but should alert the hematologist and the dental surgeon to the possibilities of a concurrent disease of hemopoiesis or hemostasis or a latent one that may subsequently manifest itself.
Topics: Anemia; Facies; Hemostatic Disorders; Humans; Mouth Diseases
PubMed: 22048588
DOI: 10.4103/0970-9290.87070 -
Medical Principles and Practice :... 2017Anaemia is the most common haematological disorder affecting humanity and is usually observed in chronic disease states such as non-specific anaemia, which may cause... (Review)
Review
Anaemia is the most common haematological disorder affecting humanity and is usually observed in chronic disease states such as non-specific anaemia, which may cause diagnostic difficulties. In chronically ill patients with anaemia, this has a negative impact on quality of life as well as survival. This paper aims at reviewing the pathogenesis of this form of anaemia with a view to suggesting future targets for therapeutic intervention. The ability to diagnose this disorder depends on the ability of the physician to correlate the possible clinical pathways of the underlying disease with the patients' ferrokinetic state. It is important to rule out iron deficiency and other causes of anaemia as misdiagnosis will in most cases lead to refractoriness to standard therapy. The cytokines and acute-phase proteins play important roles in the pathogenesis of anaemia of chronic disease. Alterations in the metabolism of iron via the molecule hepcidin and ferritin are largely responsible for the consequent anaemia. Concomitant iron deficiency might be present and could affect the diagnosis and therapeutic protocol. Treatment options involve the use of erythropoiesis-stimulating agents, blood transfusion, and iron supplementation, in addition to treating the underlying disease.
Topics: Age Factors; Anemia; Chronic Disease; Diagnosis, Differential; Erythropoiesis; Humans; Interleukin-6; Iron Metabolism Disorders
PubMed: 27756061
DOI: 10.1159/000452104