Cómo saber si se tiene anemia

Experts in Internal Medicine define it as a decrease in the concentration of hemoglobin in peripheral blood, below 13 g / dL in the adult male, and 12 g / dL in the adult woman, or decrease in the hematocrit below 39 % in men and 37% in women.

In situations such as pregnancy, heart failure and edematous states, the hemoglobin levels may be falsely diminished and is not really anemia, and the opposite occurs in situations of dehydration.

In addition to the concentration of hemoglobin and hematocrit, there are other useful parameters to focus on the causal diagnosis of anemias, such as the mean corpuscular volume, which allows us to classify anemias as normocytic, microcytic or macrocytic, depending on the size of the anemias. red blood cells; the average corpuscular concentration of hemoglobin, which allows us to classify anemias as hypochromic or normochromic; the amplitude of the erythrocyte distribution, which differentiates us from the iron deficiency anemia of the thalassemia trait; and the number of reticulocytes, which allows us to know if an anemia is regenerative or not, depending on the response of the bone marrow.

How do I know if I have anemia?

Clinical symptoms depend fundamentally on the intensity and rapidity of the onset of anemia. Thus, acute anemia is much worse tolerated and is usually due to hemorrhage or hemolysis.

Generally, patients report dizziness, tiredness, paleness, coldness, headache and even confusion. The doctor can see coldness in the skin, hypotension, fragility of hair and nails, as well as tachycardia and sometimes functional heart murmurs.

Causes of anemia

The patient with anemia should have a complete medical history and a detailed physical examination, to clarify the cause of the same, collecting data such as possible bleeding, characteristics of menstruation in women, intestinal habit alteration, drug intake, nutritional habits, etc., as well as personal or family history of anemia.

The most frequent causes of microcytic anemia are iron deficiency, insufficient dietary intake or impaired iron absorption, gastrointestinal bleeding or other levels, and intravascular hemolysis, which may be due to infectious causes, valvular prostheses or alterations in transport. of iron. They also present a corpuscular volume under anemia due to hereditary alterations of hemoglobin synthesis, the most frequent being thalassemia, which is very frequent in our environment.

The normocytic anemias are very important, since they appear in a multitude of chronic diseases and hospitalized patients, being the causes very varied, from infectious diseases, neoplastic to immunological. They can also undergo normocytic anemia alterations of the bone marrow, when this is unable to synthesize red blood cells, and in case of hematological diseases, such as leukemia, myeloma and myelodysplastic syndromes.

Hemolytic anemia , which may be primary or secondary to infectious, neoplastic or inflammatory diseases, is also a cause of normocytic anemia. As for the macrocytic anemias, they are mainly due to deficiency of folic acid or vitamin B12, generally in relation to nutritional habits or digestive diseases, although they can also be detected in patients with hypothyroidism, liver failure or in cases of alcohol or drug abuse. drugs.

How is anemia diagnosed

The possible studies to be performed in a patient with anemia can be very varied, depending on the clinical data obtained in the anamnesis and physical examination, and should always be carried out from less to more aggression and high cost, to avoid study abuse and unnecessary expenses. All patients should have a standard blood count and biochemistry, analysis of urine, iron, ferritin and transferrin.

In many occasions, the number of reticulocytes, haptoglobin and coombs test should be determined. If applicable, depending on the type of anemia, the levels of thyroid hormones, folic acid and vitamin B12 will be determined, and in certain situations an autoimmunity and microbiological study will be carried out, as well as a study of possible hemoglobinopathies and enzymes, to rule out congenital diseases. And if the clinical history is suggestive, imaging studies should be done to detect tumor diseases.

In case of suspicion of gastrointestinal losses, imaging studies and the necessary endoscopies should be done. Sometimes it will be necessary to do a bone marrow study, by aspiration or biopsy.

What is the treatment of anemia

For all the above, it can be deduced that the treatment of anemia will be individualized in each patient, since we have seen that the causes can be very varied, and each one has its specific treatment. The most used treatments are the administration of iron, folic acid or vitamin B12, depending on the cause, without forgetting that the disease that causes anemia must be treated.. If the anemia is very acute and important, a transfusion may be necessary, and in cases of chronic anemia, the administration of erythropoietin or its derivatives may be necessary.. When the cause is an immunological disorder, treatment with corticosteroids or immunosuppressants will be necessary.