During a medical check-up or medical visit
Routine blood tests are the most common laboratory tests
Patients are often told by their doctors
Routine blood tests show anemia
So what is "anemia"?
What causes it?
What do I need to look out for?
Is treatment needed?
▶ What is anemia
"Anemia" is a clinical symptom that can be one of the main clinical manifestations of hematologic diseases, or a symptom of non-hematologic diseases, such as tumors, infections, autoimmune diseases, etc. Anemia generally refers to the lower limit of the reference range in the volume of peripheral blood cells, the amount of hemoglobin, and the hematocrit in the blood. Indicates that the proliferation and consumption of red blood cells in the human body are out of balance, or underproduction or excessive consumption or coexist, so that the destruction of red blood cells exceeds the hematopoietic capacity of the bone marrow.
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▶ Criteria for general anemia
The criteria for general anemia are:
成年男性Hb<120 g/L；
成年女性Hb<110 g/L（孕妇<100 g/L）；
The reference range of hemoglobin in children is divided according to age, Hb < 90 g/L for newborns within 10 days, Hb<100 g/L for newborns over 1 month, Hb<110 g/L for children aged 6 months ~ 6 years, and Hb<120 g/L for children aged 6~14 years.
According to the Hb content, the severity of anemia is classified into 4 grades: mild, moderate, severe, and very severe. There are many ways to classify anemia, and the clinical practice is often based on the cell-related parameters in the blood routine report, such as mean corpuscular volume (MCV), mean corpuscular hemoglobin volume (MCH) and mean corpuscular hemoglobin concentration (MCHC), which are divided into macrocytic anemia, normocytic anemia and microcytic anemia, which helps clinicians quickly determine the possible causes of newly diagnosed anemia patients and narrow the scope of discrimination.
Image source: Tencent Medical Codex
For example, macrocytic anemia is common in megaloblastic anemia and myelodysplastic syndrome; Microcytic hypochromic anemia is common in iron deficiency anemia, thalassemia, and chronic disease anemia.
▶ Etiological classification of anemia
The etiological classification is based on the etiology and pathogenesis of anemia, which can be divided into 3 categories:
(1) Anemia with reduced erythropoiesis: such as aplastic anemia, acute hematopoietic stagnation, iron deficiency anemia, megaloblastic anemia;
(2) Excessive destruction of red blood cells: such as hemolytic anemia of various causes (such as sickle cell anemia, paroxysmal sleep anemia, autoimmune hemolytic anemia, transfusion incompatible hemolytic anemia);
(3) Hemorrhagic anemia: such as normocytic anemia caused by acute blood loss (such as acute traumatic hemorrhage) and microcytic hypochromic anemia caused by chronic blood loss (such as long-term excessive menstrual bleeding and long-term gastrointestinal bleeding caused by liver cirrhosis).
Image source: Tencent Medical Codex
▶ Laboratory tests for anemia
Laboratory tests for anemia include:
1. Peripheral blood cell examination: red blood cell count, hemoglobin amount, hematocrit and red blood cell related parameters, red blood cell morphology. Another important indicator is the reticulocyte count, which can determine the erythroid hematopoietic function of the bone marrow. Reticulocytes are the transition stage from red blood cell precursors to mature red blood cells, and normal human peripheral blood reticulocytes account for 0.5%~1.5% of the total number of red blood cells.
2. Bone marrow examination: exclude hematologic diseases and tumor bone marrow metastasis, causing inhibition of erythroid hyperplasia;
3. Biochemical examination: serum iron metabolism and folic acid examination to assess whether there is nutritional deficiency;
4. Immunological examination: autoantibody detection excludes autoimmune diseases such as systemic lupus erythematosus;
5. Etiological examination: malaria parasite and hookworm infection can cause anemia;
6. Other special tests include hemoglobin electrophoresis, genetic testing, etc., for the diagnosis of hereditary red blood cell diseases.
▶ Treatment of anemia
After anemia is clinically discovered, the primary cause and cause of anemia are generally treated aggressively. The treatments for anemia that are often used in clinical practice are usually divided into the following categories:
1. Supplement hematopoietic raw materials: mainly seen in iron deficiency anemia and nutritional megaloblastic anemia;
2. Stimulate hematopoiesis: Drugs that stimulate red blood cell production also have certain effects on renal anemia and some chronic disease anemia. Androgens have the effect of stimulating bone marrow hematopoiesis;
3. Glucocorticoids and other immunosuppressants: mainly used for autoimmune hemolytic anemia and treatment of severe aplastic anemia;
4. Blood transfusion: Anemia caused by acute massive blood loss should be transfused quickly to replenish blood volume. Severe aplastic anemia should also be transfused if hypoxic symptoms are severe;
5. Splenectomy: for hereditary diseases, such as hereditary spherocytosis, splenectomy is the preferred treatment;
6. Allogeneic hematopoietic stem cell transplantation: mainly used for aplastic anemia and anemia caused by genetic factors.
Image source: Tencent Medical Codex
Anemia is found, no need to be nervous
Laboratory tests should be refined under the guidance of a clinician
Acute leukemia, tumors and other malignant diseases are excluded
The most common cause is nutritional deficiencies
In the daily diet
Iron, folic acid, and vitamin B12 should be emphasized
Promote healthy eating habits and cooking habits
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