Types of Anemia

1. Iiron deficiency anemia 

• often falls into this category. In this case, the disorder is brought on by a shortage of iron, most often caused by blood loss.
• When blood is lost, the body reacts by pulling in water from tissues outside the bloodstream in an attempt to keep the blood vessels filled. This additional water dilutes the blood, and, as a result, the red blood cells are diluted.
• Blood loss can be categorized as acute and rapid or chronic. Rapid blood loss can include surgery, childbirth, trauma, or a ruptured blood vessel.
• Chronic blood loss is more frequent among patients diagnosed with anemia. Here, the blood loss can be a result of stomach ulcers, cancer, or tumor.
• Gastrointestinal conditions – such as ulcers, hemorrhoids, cancer, or gastritis
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) – such as aspirin and ibuprofen
• Menstrual bleeding

2 .Anemia caused by decreased or faulty red blood cell productions

• Located in the center of our bones is a soft, spongy tissue, called bone marrow, it is essential for the creation of red blood cells. Bone marrow produces stem cells, which develop into red blood cells, white blood cells, and platelets.
• Bone marrow can be affected by a number of diseases, including leukemia, where abnormal white blood cells are produced in excess, which disrupts normal production of red blood cells.
• Other examples of anemias caused by decreased or faulty red blood cells are:

3. Sickle cell anemia

• Red blood cells are misshapen and break down abnormally quickly. The crescent-shaped blood cells can also get stuck in smaller blood vessels, causing pain.
• Iron-deficiency anemia – not enough red blood cells are produced because not enough iron is present in the body. This can be because of a poor diet, menstruation, frequent blood donation, endurance training, certain digestive conditions, such as Crohn’s disease, surgical removal of part of the gut, and some foods.
• Bone marrow and stem cell problems – for instance, aplastic anemia occurs when there are little or no stem cells present. Thalassemia occurs when red blood cells can’t grow and mature properly.

4. Vitamin deficiency anemia

• Vitamin B-12 and folate are both essential for the production of red blood cells; therefore, if either is deficient, red blood cell production will be too low. Examples of this type of anemia are megaloblastic anemia and pernicious anemia.

5. Anemia caused by the destruction of red blood cells

• Red blood cells typically have a life span of 120 days in the bloodstream, but they can be destroyed or removed beforehand.
• One type of anemia that falls into this category is autoimmune hemolytic anemia, where the body’s immune system mistakenly identifies its own red blood cells as a foreign substance and attacks them. Excessive hemolysis (red blood cell breakdown) can occur for many reasons, including:
• Infections
• Certain drugs – some antibiotics, for instance
• Snake or spider venom
• Toxins produced through advanced kidney or liver disease
• Autoimmune attack – for instance hemolytic disease
• Severe hypertension
• Vascular grafts and prosthetic heart valves
• Clotting disorders
• Enlargement of the spleen
• There are a LOT of diseases and conditions which can lead to anemia. These diseases can be grouped together into four broad causes of having too few red blood cells (RBCs) in blood.

Diagnosis of Anemia

The doctor will perform a physical examination, and may find:

• Heart murmur
• Low blood pressure, especially when you stand up
• Pale skin
• Rapid heart rate

Some types of anemia may cause other findings on a physical exam.

Blood tests used to diagnose some common types of anemia may include:

• Blood levels of iron, vitamin B12, folic acid, and other vitamins and minerals
• Red blood count and hemoglobin level
• Reticulocyte count

Other tests may be done to find medical problems that can cause anemia

• Anemia can usually be confirmed with a CBC test. Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments. They may also examine your blood through a microscope. These blood tests will provide information including:
• iron level in your blood
• RBC size and color
• RBCs are pale in color if they’re deficient in iron.
• ferritin levels
• Ferritin is a protein that helps with iron storage in your body. Low levels of ferritin indicate low iron storage.
• total iron-binding capacity (TIBC)
• Transferrin is a protein that transports iron. A TIBC test is used to determine the amount transferrin that’s carrying iron.

Tests for internal bleeding

• If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed. One test you may have is fecal occult test to look for blood in your feces. Blood in your feces may indicate bleeding in your intestine.
• Your doctor may also perform endoscopy, in which a small camera on a flexible tube is used to view the linings of your gastrointestinal tract. An EGD test (upper endoscopy) allows a doctor to examine the lining of the esophagus, stomach, and the upper part of the small intestine. A colonoscopy (lower endoscopy) allows a doctor to examine the lining of the colon, the lower portion of the large intestine. These tests can help identify sources of gastrointestinal bleeding.

Treatment of Anemia

• Oral iron supplements are the best way to restore iron levels for people who are iron deficient, but they should be used only when dietary measures have failed. However, iron supplements cannot correct anemias that are not due to iron deficiency.
• Iron replacement therapy can cause gastrointestinal problems, sometimes severe ones. Excess iron may also contribute to heart disease, diabetes, and certain cancers. Doctors generally advise against iron supplements in anyone with a healthy diet and no indications of iron deficiency anemia.
• Treatment of Anemia of Chronic Disease. In general, the best treatment for anemia of chronic diseases is treating the disease itself. In some cases, iron deficiency accompanies the condition and requires iron replacement. Erythropoietin, most often administered with intravenous iron, is used for some patients.

Oral Iron Suppliment

• Supplement Forms. There are two forms of supplemental iron: ferrous and ferric. Ferrous iron is better absorbed and is the preferred form of iron tablets. Ferrous iron is available in three forms: ferrous fumarate, ferrous sulfate, and ferrous gluconate.
• The label of an iron supplement contains information both on the tablet size (which is typically 325 mg) and the amount of elemental iron contained in the tablet (the amount of iron that is available for absorption by the body.) When selecting an iron supplement, it is important to look at the amount of elemental iron.

A 325 mg iron supplement contains the following amounts of elemental iron depending on the type of iron:

• Ferrous fumarate. 108 mg of elemental iron
• Ferrous sulfate. 65 mg of elemental iron
• Ferrous gluconate. 35 mg of elemental iron

Dosage. Depending on the severity of your anemia, as well as your age and weight, your doctor will recommend a dosage of 60 – 200 mg of elemental iron per day. This means taking one iron pill 2 – 3 time during the day. Make sure your doctor explains to you how many pills you should take in a day and when you should take them. Never take a double dose of iron.

Side Effects and Safety. Common side effects of iron supplements include

• Constipation and diarrhea are very common. They are rarely severe, although iron tablets can aggravate existing gastrointestinal problems such as ulcers and ulcerative colitis.
• Nausea and vomiting may occur with high doses, but can be controlled by taking smaller amounts. Switching to ferrous gluconate may help some people with severe gastrointestinal problems.
• Black stools are normal when taking iron tablets. In fact, if they do not turn black, the tablets may not be working effectively. This tends to be a more common problem with coated or long-acting iron tablets.
• If the stools are tarry looking as well as black, if they have red streaks, or if cramps, sharp pains, or soreness in the stomach occur, gastrointestinal bleeding may be causing the iron deficiency and the patient should call the doctor promptly.
• Acute iron poisoning is rare in adults but can be fatal in children who take adult-strength tablets. Keep iron supplements out of the reach of children. If your child swallows an iron pill, immediately contact a poison control center.

Other Tips for Safety and Effectiveness. Other tips for taking iron are as follows

• For best absorption, iron should be taken between meals. Iron may cause stomach and intestinal disturbances, however. Low doses of ferrous sulfate can be taken with food and are still absorbed but with fewer side effects.)
• Drink a full 8 ounces of fluid with an iron pill. Taking orange juice with an iron pill can help increase iron absorption. (Some doctors also recommend taking a vitamin C supplement with the iron pill.)
• If constipation becomes a problem, take a stool softener such as docusate sodium (Colace).
• Certain medications, including antacids, can reduce iron absorption. Iron tablets may also reduce the effectiveness of other drugs, including the antibiotics tetracycline, penicillamine, and ciprofloxacin and the Parkinson’s disease drugs methyldopa, levodopa, and carbidopa. At least 2 hours should elapse between doses of these drugs and iron supplements.
• Avoid taking milk, caffeine, antacids, or calcium supplements at the same time as an iron pill as they can interfere with iron absorption.
• Tablets should be kept in a cool place. (Bathroom medicine cabinets may be too warm and humid, which may cause the pills to disintegrate.)

Full recovery takes 6 – 8 weeks. Recovery will take longer in people with internal bleeding that is not under control. Iron replacement therapy must continue for about 6 months, even if anemia has been reversed. Treatment must be continued indefinitely for people with chronic bleeding; in such cases, iron levels should be closely monitored.

Intravenous or Injected Iron

In some cases, iron is administered through muscular injections or intravenously. Intravenous iron has the advantage of causing less gastrointestinal discomfort and inconvenience. It may be in the form of iron dextran (Dexferrum, InFed), sodium ferric gluconate complex in sucrose (Ferrlecit), or iron sucrose (Venofer). Ferrlecit or Venofer are proving to be at least equally effective and safer than iron dextran.

Candidates. The injected or intravenous forms should be limited to the following patients with iron deficiency:

• People with iron deficiency anemia in whom oral therapy has clearly failed.
• Patients with bleeding disorders in which blood loss continues to exceed the rate at which oral iron is absorbed.
• In emergencies, when people need red blood cells but transfusion is not appropriate or available.
• In people with serious gastrointestinal disorders, such as inflammatory bowel disease, who cannot take iron therapy by mouth.
• People undergoing hemodialysis who receive supplemental erythropoietin therapy. Sodium ferric gluconate complex in sucrose (Ferrlecit) or iron sucrose (Venofer) is specifically approved as first-line therapy for these patients.

Certain patients, even if they meet these qualifications, may not be appropriate candidates or should be monitored closely for complications. They include:

• Patients with any underlying autoimmune disease.
• Malnourished patients who also have an underlying infection.
• Patients who are at risk for iron overload.

Side Effects. Some side effects differ depending on how the iron is administered and include the following:

• Muscular injections include pain at the site.
• Intravenous administration can cause pain in the vein, flushing, and metallic taste, all of which are brief.

For both methods, side effects and serious complications can include:

• Blood clots
• Fever
• Joint aches
• Headache
• Rashes
• A delayed reaction of joint and muscle aches, headache, and malaise occurs 1 – 2 days after the infusion (most commonly with iron dextran) in about 10% of patients. These symptoms respond quickly to NSAIDs, such as ibuprofen or naproxen, in most people.
• Iron toxicity. Symptoms include nausea, dizziness, and a sudden drop in blood pressure. Sodium ferric gluconate in sucrose (Ferrlecit) or iron sucrose (Venofer) may pose a lower risk for toxicity than iron dextran.
• Allergic reactions. Allergic reactions that occur with intravenous iron can be very serious and, in rare cases, even fatal. Iron dextran appears to pose a much higher risk than sodium ferric gluconate complex in sucrose or iron sucrose, although allergic reactions can also occur with the latter forms.

Oral and injected iron should never be given at the same time. Intravenous iron therapy may be appropriate for some pregnant women who meet these requirements, depending on the pregnancy term and other factors.

Blood Transfusions

• Transfusions are used to replace blood loss due to injuries and during certain surgeries. They are also commonly used to treat severely anemic patients who have thalassemia, sickle cell disease, myelodysplastic syndromes, or other types of anemia. Some patients require frequent blood transfusions. Iron overload can be a side effect of these frequent blood transfusions. If left untreated, iron overload can lead to liver and heart damage.
• Iron chelation therapy is used to remove the excess iron caused by blood transfusions. Patients take a drug that binds to the iron in the blood. The excess iron is then removed from the body by the kidneys. For many years, deferoxamine (Desferal) was the only drug used in chelation therapy. This drug is usually injected intravenously, using an infusion pump. The infusion can last 8 – 12 hours and may be needed 5 – 7 days a week until iron levels are normal.
• A new drug, deferasirox (Exjade), was approved in 2005 for children and adults as a once-daily treatment for iron overload due to blood transfusions. It does not require injections. Patients mix the deferasirox tablets in liquid and drink the medicine. However, deferoxamine can cause gastrointestinal tract ulcerations and hemorrhage and patients should be carefully monitored. Deferoxamine can interact with certain types of medications such as nonsteroidal anti-inflammatory drugs, corticosteroids, bisphosphonates, and anticoagulants.

Erythropoiesis Stimulating Drugs

• Erythropoietin is the hormone that acts in the bone marrow to increase the production of red blood cells. It has been genetically engineered as recombinant human erythropoietin (rHuEPO) and is available as epoetin alfa (Epogen, Procrit, and Eprex). Novel erythropoiesis stimulating protein (NESP), also called darbepoetin alfa (Aranesp), lasts longer in the blood than epoetin alfa and requires fewer injections. These medications are also called “erythropoiesis-stimulating drugs.”
• Levels of erythropoietin are reduced in anemia of chronic disease. Injections of synthetic erythropoietin can help increase the number of red blood cells in order to avoid receiving blood transfusions. Erythropoietin is used to treat anemia. It does not help improve anemia symptoms, fatigue, or quality of life for patients with cancer or HIV. This drug can cause serious side effects, including blood clots, and is approved only for treating patients with anemia related to the following conditions:

• Cancer. For select patients, erythropoietin is used to treat the anemia associated with chemotherapy.
• Chronic kidney failure. Erythropoietin is an important anemia treatment for patients with chronic kidney failure, including those on dialysis.
• HIV/AIDS. Erythropoietin helps treat the anemia caused by zidovudine (AZT) therapy.
• Erythropoiesis-Stimulating Drugs and Cancer. Erythropoietin should be used only to treat anemia caused by chemotherapy — not anemia due to other causes in patients with cancer. Erythropoietin treatment does not help prolong survival. In fact, these drugs can shorten survival time and cause tumors to grow faster. Discuss with your doctor whether an erythropoiesis-stimulating drug is appropriate for you.
• Survival and tumor growth risks are especially pronounced for patients with advanced breast, head and neck, lymphoid, or non-small cell lung cancer when dosing attempts to achieve a hemoglobin level of 12 g/dL or greater. However, there may be similar risks for patients dosed to less than 12 g/dL. (The American Society of Clinical Oncology and the American Society of Hematology recommend starting erythropoietin when a patient’s hemoglobin level falls to less than 10 g/dL.) The doctor should use the lowest effective dose and erythropoietin treatment should be stopped as soon as the chemotherapy course is completed.
• Erythropoiesis-Stimulating Drugs and Chronic Kidney Failure. For patients with chronic kidney failure, the FDA recommends that erythropoiesis-stimulating drugs be used to maintain hemoglobin levels between 10 – 12 g/dL. (The exact level within this range varies by individual.) There is a greater risk of death and serious cardiovascular events, such as heart attack, stroke, and heart failure when these drugs are used to achieve higher hemoglobin levels (13.5 – 14g/dL) compared to lower hemoglobin levels (10- 11.3 g/dL).

In 2007, the Food and Drug Administration (FDA) made major changes to the prescribing information for erythropoiesis-stimulating drugs. The new labels describe in detail the risks that Aranesp, Epogen, and Procrit can pose to patients with cancer and chronic kidney disease. The FDA has also established separate dosing recommendations for each of these conditions.