ANEMIA-AN OVERVIEW
Anemia is defined as a condition at which there are below normal levels of Red Blood Cells (RBC),Hemoglobin,and Hematocrits concentrations.
Hematocrit refers to the RBC count in total percentage.It is otherwise meaning that RBC in Packed Cell Volume(PCV) or Erythrocyte Volume Fraction(EVF).
Increasing the blood plasma volume disrespect to its hematocrit may also produce a temporary anemic condition as during pregnancy.
Comprehensively the growth factor known as erythropoietin a hormone secreted mainly from the kidneys and a little from liver acts on the bone marrows to produce and release RBCs in the blood.In emergency situations like accidents,starving and other incidents that causes heavy blood loss while RBC counts go down below normal the cells present at the cortex of the kidneys works hard and produce and release 100% erythropoietin in the blood.In this case the participation of liver is negligible.
Lack of erythropoietin will produce several forms of anemias and most importantly during Chronic Renal Failure.
Erythropeitin is not the sole responsible factor for erythropoiesis because it need several cofactors such as more importantly the sufficient supply of iron.In the absence or deficiency of iron the bone marrow will not properly respond to erythropoietin..
Uses of Erythropoietin
This medicines are used to correct anemias associated with Chronic Kidney Failure and Bone Marrow Failure
Side effecs
Can cause thrombosis and hypertension because of excessive over production of erythrocytes.
Types of Anemias
1.Microcytic anemia is defined as the presence of very small discoloured or pale coloured (microcytic hypochromic) red blood cells which are unable to carry sufficient oxygen because of its hemoglobin deficiency.Mostly this anemia is caused by insufficient dietry supply of iron and blood loss through internal bleeding such as ulcer bleeding in the stomach and menstural bleeding.
Children at the ages of rapid growth need more iron.If they do not get sufficient iron supply in that ages (the teen ages) they would possibly develop this kind of anemia.
Iron :-Most of the iron in our body is present as hemoglobin and the remaining portion is present as transporter protein known as transferrin,ferritin and hemosiderin
Iron supplements should be given only to iron deficiency anemias.
Iron in the form of ferrous compound is more advantageous to be taken to produce the required benefits.Oral ferrous supplements are more convenient to take as parenteral preparations such as deep intra muscular injections may often cause muscular necrosis and pain.These are reserved only for emergency situations.
Toxicities
1.Iron if taken carelessly on an empty stomach may produce damages and necrosis at the stomach and intestinal walls
2.On high dosages iron can produce shock,metabolic acidosis,and even death
Treating Iron intoxications
Produce deep emesis and remove the unabsorbed drug from the stomach by vomiting( Excess ingetion of coconut milk may be help full)
Give Deferoxamine a chelating agent to inactivate the iron already mixed with the digestive juice.
Regular phlebotomy (A regular periodical blood testing) should be performed.
2.Pernicious Anemia and Vitamin B-12 Deficiency
Pernicious anemia is well defined as a condition in which there is very insufficient quantity of RBC,and it is differing from Iron Deficiency Anemia (IDA) in which there is sufficient quantity of RBC is present but all of them are micro sized under developed and inefficient to carry oxygent because of their hemoglobin and iron deficiency.
Symptoms
1.Tiredness
2.Weakness
3.Shortness of Breath
4.Pale skin
5.Chest Pain
6.Hand and Foot Numbness
7.Difficult to balance on standing and walking.
Causes
Our stomach cells are producing a substance known as the intrinsic factor.Vitamin B-12 with the help of this factor keep and maitain the red blood cells healthy.
Either a deficiency in the supply of vitamin B-12 or the secretion of the intrinsic factor or both may cause pernicious anemia
Stomach cell damage by ulceration ,surgery,and tapeworm infection may cause the intrinsic factor secretion.
Vitamin B-12 can be given orally and as an intramuscular injection.
Side effects of vitamin B-12
Fortunately there are no known side effects to this vitamin have been established.
Folic Acid and Megalo Blastic Anemia (MBA)
Megloblastic Anemia is a condition in which there are unusually very large red blood cells (Megaloblastic or Macrocytic) without nucleous inside.
This is mainly due to the deficiency of folic acd which is needed by the cell to synthesize DNA.Lack of Vitamin B-12 may also can be a cause for this type of anemia but with sufficient supply of folic acid alone can cure this provided that there is no vitamin B-12 deficiency as because folic acid alone cannot cure the neurological defects.In such cases Folic acid with vitamin B-12 supplements should be prescribed.
Remember that body can store vitamin B-12 for longer time for years and years but folic acid stores will run out in months.Hence in most cases for treating MBA only folic acid supplements are enough but the deficiency of vitamin B-12 should first be ruled out.
Folic acid is a well known needed vitamin during pregnancy as its deficiency will leads to neural tube defects.
Causes for folate deficiency 1.Inadequate dietary sources
2.Pregnancy
3.Drugs such as Phenytoin
4.Drugs such as oral contraceptives.
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