Anemia: definição, epidemiologia, fisiopatologia, classificação e tratamento / Anemia: definition, epidemiology, pathophysiology, classification, clinical picture, and treatment

Anemia é a redução da massa de hemoglobina e, portanto, da massa eritrocitária. Sua consequência é a hipóxia tecidual. A anemia é a manifestação de uma doença de base que muitas vezes está oculta. Ela afeta mais de um bilhão de pessoas em todo o mundo. A anemia pode ser classificada de várias formas, mas, na prática clínica, a mais usada é de acordo com o volume corpuscular médio das hemácias. Os dois tipos mais prevalentes de anemia são a ferropriva e a decorrente da doença inflamatória. A anemia ferropriva decorre do esgotamento das reservas de ferro, na maioria das vezes, por perda crônica de sangue, por exemplo, por fluxo menstrual aumentado e sangramento por trato gastrointestinal. A anemia da doença inflamatória decorre do bloqueio do ferro no sistema reticuloendotelial, da redução da eritropoese e da menor sobrevida das hemácias. A ferritina está diminuída na anemia ferropriva e aumentada na anemia da doença inflamatória. Outros tipos mais comuns de anemia são a anemia da gestação, a secundária à insuficiência renal e a do idoso. O tratamento da anemia depende de sua causa, como a reposição de ferro ou de eritropoetina, entre outros. A transfusão de hemácias pode ser necessária nas situações mais graves, independentemente do tipo da anemia, ou em caráter periódico e perene, como na talassemia maior. Nesse artigo de revisão, discute-se a prevalência da anemia, sua classificação, fisiopatologia, os tipos mais comuns e o tratamento.Palavras-chave: Anemia; Deficiência de Ferro; Transfusão.(AU)

ABSTRACTAnemia is the reduction of hemoglobin mass and, consequently, of erythrocyte mass. Its result is tissue hypoxia. Anemia is the manifestation of an underlying illness, frequently not apparent. It affects more than one billion people around the world. Anemia can be classified based on several characteristics, however, in daily practice, the most used is the one based on the mean corpuscular volume of erythrocytes as microcytic, normocytic and macrocytic. The most prevalent types of anemia are iron deficient anemia and anemia secondary to inflammation. The iron deficiency anemia appears when the iron store is exhausted, most frequently due to chronic bleeding, for instance, augmented menorrhea and gastrointestinal bleeding. The anemia of inflammation is secondary to iron sequestration in macrophages, decreased erythropoiesis, and lower erythrocyte survival. Ferritin is decreased in the iron deficient anemia and increased in the anemia of inflammation. Other common types of anemia are those secondary to pregnancy, chronic renal failure, and ageing. Treatment of anemia depends on its type, such as iron supplementation or erythropoietin, among others. Red blood cell transfusion can be performed in more severe conditions, independently of the type of anemia, and must be adopted in diseases such as thalassemia major. This article reviews the prevalence of anemia, its classification, pathophysiology, and discusses the commonest types and treatment according to the type of anemia (AU)

Anemia en pacientes ingresados en el Hospital Roosevelt / Anemia in patients admitted to the Roosevelt Hospital

Antecedentes: Según la Organización Mundial de la Salud, la prevalencia mundial de la anemia es de 24.80%.Es frecuente en el paciente hospitalizado y causa de agravamiento de las patologías de base. En Centro América no se han realizado estudios sobre la prevalencia de anemia en pacientes hospitalizados. Metodología: Se realizó un estudio transversal con estadística descriptiva primaria y analítica secundaria, para determinar la prevalencia de anemia y los factores de riesgo en pacientes hospitalizados en el Departamento de Medicina Interna del Hospital Roosevelt, agosto de 2013...(AU)

Background: According to the World Health Organization, the global prevalence of anemia is 24.80%. It is common in hospitalized patients and cause of worsening in the underlying pathologies. In Central America, studies have not been performed on the prevalence of anemia in hospitalized patients. Methodology: A cross-sectional study was performed using descriptive and analytical statistics, to determine the prevalence of anemia and risk factors for patients hospitalized in the Department of Internal Medicine at the Roosevelt Hospital, august 2,013. Results: 117 patients were included in the study of which 64/117 (55%) were female, the average age was 47 years (range 12-92 years), with an average hospital stay of 13 days (range 2 - 44 days). On admission the diagnosis of anemia was documented on the files of 26/117 (22%) patients, according to hemoglobin level at admission 69/117 (58%) and hemoglobin last control 74/117 (63%). It was found that 5 phlebotomy or more a week and a hospital stay longer than 15 days were 70% and 84% higher risk of developing anemia respectively, but without statistical significance. Conclusions: Anemia has a high prevalence in hospitalized patients (63%) and is under diagnosed in the emergency unit of Internal Medicine at the Roosevelt Hospital.(AU)

Anemia in hospitalized patients with pulmonary tuberculosis / Anemia em pacientes internados com tuberculose pulmonar

OBJECTIVE: To describe the prevalence of anemia and of its types in hospitalized patients with pulmonary tuberculosis. METHODS: This was a descriptive, longitudinal study involving pulmonary tuberculosis inpatients at one of two tuberculosis referral hospitals in the city of Rio de Janeiro, Brazil. We evaluated body mass index (BMI), triceps skinfold thickness (TST), arm muscle area (AMA), ESR, mean corpuscular volume, and red blood cell distribution width (RDW), as well as the levels of C-reactive protein, hemoglobin, transferrin, and ferritin. RESULTS: We included 166 patients, 126 (75.9%) of whom were male. The mean age was 39.0 ± 10.7 years. Not all data were available for all patients: 18.7% were HIV positive; 64.7% were alcoholic; the prevalences of anemia of chronic disease and iron deficiency anemia were, respectively, 75.9% and 2.4%; and 68.7% had low body weight (mean BMI = 18.21 kg/m2). On the basis of TST and AMA, 126 (78.7%) of 160 patients and 138 (87.9%) of 157 patients, respectively, were considered malnourished. Anemia was found to be associated with the following: male gender (p = 0.03); low weight (p = 0.0004); low mean corpuscular volume (p = 0.03);high RDW (p = 0; 0003); high ferritin (p = 0.0005); and high ESR (p = 0.004). We also found significant differences between anemic and non-anemic patients in terms of BMI (p = 0.04), DCT (p = 0.003), and ESR (p < 0.001). CONCLUSIONS: In this sample, high proportions of pulmonary tuberculosis patients were classified as underweight and malnourished, and there was a high prevalence of anemia of chronic disease. In addition, anemia was associated with high ESR and malnutrition. .

OBJETIVO: Descrever a prevalência de anemia e de seus tipos em pacientes internados com tuberculose pulmonar. MÉTODOS: Estudo descritivo e longitudinal com pacientes com tuberculose pulmonar hospitalizados em dois hospitais de referência na cidade do Rio de Janeiro (RJ). Foram avaliados o índice de massa corpórea (IMC), dobra cutânea tricipital (DCT), área muscular do braço (AMB), VHS, volume globular médio e red blood cell distribution width (RDW, índice de anisocitose eritrocitária), assim como os níveis de proteína C reativa, hemoglobina, transferrina e ferritina. RESULTADOS: Foram incluídos 166 pacientes, sendo 126 (75,9%) do sexo masculino. A média de idade foi de 39,0 ± 10,7 anos. Alguns dados não estavam disponíveis para todos os pacientes: 18,7% eram portadores de HIV; 64,7% eram etilistas; as prevalências de anemia da doença crônica e de anemia ferropriva foram, respectivamente, de 75,9% e 2,4%; e 68,7% apresentaram baixo peso (média do IMC = 18,21 kg/m2). Com base em DCT e AMB, respectivamente, 126/160 pacientes (78,7%) e 138/157 pacientes (87,9%) foram considerados desnutridos. A presença de anemia associou-se às seguintes variáveis: sexo masculino (p = 0,03), baixo peso (p = 0,0004), baixo volume globular médio (p = 0,03), alto RDW (p = 0,0003), alto nível de ferritina (p = 0,0005) e de VHS (p = 0,004). Houve diferenças significativas entre pacientes anêmicos e não anêmicos em relação a IMC (p = 0,04), DCT (p = 0,003) e VHS (p < 0,001). CONCLUSÕES: Nesta amostra, a proporção de pacientes com tuberculose pulmonar classificados com baixo peso e desnutrição foi elevada, assim como a prevalência de anemia da doença crônica. Além disso, a anemia associou-se a VHS elevada e desnutrição. .

Nutritional Status and Anaemia with Special Reference to Morphological Classification in Underfive Children.

Nutrition of pre-school children (0-5 years age group) is of paramount importance because the foundation for lifetime health, strength and intellectual vitality is laid during this period. Aims: To assess the nutritional status and hemaoglobin status and morphological classification of anaemia of children below five years of age. Settings and Design : Community based cross-sectional study in children below five years of age from urban slum, Nagpur. Methods and Material : A house-to-house survey was done. By systematic random sampling 434 children below five years of age were included in the study. Every child was subjected to anthropometric measurements using standard technique. Haemoglobin estimation was done by using Sahli’s haemoglobinometer and peripheral smear was prepared. Statistical analysis : Data was analyzed on Epi- Info Software 3.2 version. Chi square test is used to test the significance. Result : 52.23 % were suffering from various grades of malnutrition. 32.18 % children were in grade I, 16.09 % in grade II, 3.46 % in grade III and 0.5 % in grade IV malnutrition. 78.71 children had anaemia (Hb < 11gm/dl). It was observed that 34.9 % children had microcytic and hypochromic anaemia, 19.6 % had dimorphic, 13.7% had normocytic normochromic and 7.5% had macrocytic anaemia. Out of these 2 children had sickle cell disease. A statistically significant association was observed between malnutrition and anaemia. Conclusion : Nutritional rehabilitation centers should be started in the community and linked with health centers to treat less severely affected undernourished children.

Asociación entre la ingesta de nutrientes hematopoyéticos y el origen nutricional de la anemia en mujeres en edad fértil en Colombia / Association between hematopoietic nutrient intake and the origin of nutritional anemia in women of childbearing age in Colombia

OBJETIVO: Comparar el origen de la anemia nutricional según las variables sociodemográficas y analizar su asociación con la deficiencia en la ingesta de nutrientes hematopoyéticos. MÉTODOS: Se utilizó la base de datos de la Encuesta Nacional de la Situación Nutricional de Colombia, 2005. Los datos se obtuvieron por muestreo complejo representativo de la población y se procesaron con el programa SPSS, v.15. Se seleccionaron mujeres en edad fértil con anemia y se clasificaron en dos grupos según la ferritina sérica. Se determinó la ingesta usual de nutrientes hematopoyéticos y el riesgo de deficiencia. Se compararon las proporciones de los tipos de anemia según las variables sociodemográficas utilizando la prueba F de Rao-Scott de segundo orden (P < 0,05). Se analizó la asociación entre el origen de la anemia y la clasificación del nutriente mediante la razón de posibilidades (odds ratio, OR). RESULTADOS: Muestra: 595 mujeres. Predominó la anemia no ferropénica (67,2 por ciento), sin diferencia estadística por variables sociodemográficas, excepto en la región Pacífica (anemia ferropénica, 52,1 por ciento). La prevalencia de la deficiencia en la ingesta usual de nutrientes hematopoyéticos fue alta. No se encontró asociación significativa entre el déficit de consumo y el origen de la anemia. CONCLUSIONES: La anemia no ferropénica fue más frecuente, sin diferencia según los indicadores sociodemográficos excepto en la región Pacífica. Todas las mujeres presentaron alto riesgo de deficiencia en la ingesta usual de nutrientes hematopoyéticos, pero no se observó una asociación estadísticamente significativa entre la deficiencia y el origen de la anemia nutricional. Se justifica implementar programas orientados a mejorar el aporte de nutrientes y continuar la búsqueda de otras causas de la anemia nutricional diferentes a la deficiencia de hierro.

OBJECTIVES: Compare the nutritional origin of anemia by sociodemographic variables and analyze its association with deficient hematopoietic nutrient intake. METHODS: The database of Colombia's 2005 National Survey of Nutritional Status was used. The data were obtained through complex representative sampling of the population and processed using SPSS v.15. Anemic women of childbearing age were selected and divided into two groups according to serum ferritin levels. Their customary hematopoietic nutrient intake and risk of deficiency were determined. The proportions of anemia types were compared by sociodemographic variables using the F-distribution, the Rao-Scott second order correction (P < 0.05). The association between the origin of the anemia and classification of the nutrient was analyzed using the odds ratio (OR). RESULTS: Sample: 595 women. Non-hypoferric anemia (67.2 percent) predominated, with no statistical difference by sociodemographic variable, except in the Pacific region (hypoferric anemia, 52.1 percent). The prevalence of deficiency in the customary intake of hematopoietic nutrients was high. There was no significant association between the deficit in consumption and the origin of the anemia. CONCLUSIONS: Non-hypoferric anemia was most common, with no difference by sociodemographic indicators except in the Pacific region. All the women were at high risk of deficiency in their customary hematopoietic nutrient intake, but a statistically significant association between the deficiency and the origin of the nutritional anemia was not observed. Programs to improve nutrient intake and a continued search for causes of nutritional anemia other than iron deficiency are justified.

Anemias / Anemia

As anemias constituem as doenças do sangue mais frequentes. O termo anemia significa redução da hemoglobina por unidade de volume de sangue, de acordo com a idade, sexo e tensão de oxigênio do ambiente. Pode referir-se ainda a uma síndrome clínica ou a um quadro laboratorial. As anemias podem ser provocadas por vários fatores e se classificam segundo os critérios morfológicos (normocítica/normocrômica microcítica/hipocrômica macrocítica/normocrômica) ou fisiopatológicos, considerando-se a etiologia, em anemias por falta de produção - hipoproliferação, por sobrevida diminuída dos eritrócitos - hemólise ou por perda sanguínea - hemorragia. As avaliações clínica e laboratorial são de fundamental importância para a elucidação diagnóstica e tratamento adequado.

Anemia among female college students attending the University of Sharjah, UAE: prevalence and classification

Anemia remains a public health challenge worldwide. Very few studies have been conducted on anemia in the United Arab Emirates and they have focused on children and pregnant women. Little is known about anemia among college female students from a preliminary study of iron deficiency anemia that was conducted on medical college students. This study aimed to estimate the prevalence of anemia among female college students attending the University of Sharjah [UoS] in the United Arab Emirates [UAE]. A secondary analysis of the records of 258 complete blood cell count results from consented female college students. Hemoglobin [Hb], hematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration [MCHC] were used to determine the prevalence of and classify anemia according to RBC indices and disease severity. Emirati students represented 50.8% of the studied population. The overall prevalence of anemia [Hb <12g/dL] was 26.7% and the majority [88.4%] of the 69 anemic students had mild anemia, whereas 7.2% were moderately anemic and 2.3% Emirati students were severely anemic [hemoglobin <7g/dL]. About 15.9% of the anemia cases were microcytic [MCV <80fL] and 1.6% were macrocytic [MCV >96fL]. The results showed that anemia constitutes a health problem among female college students in the UAE, and most of the detected anemia was microcytic with mild severity. This warrants further study on a larger sample of healthy college students to validate these findings and eventually encourage the development of directed educational and nutritional programs to safeguard the health of these future mothers

pattern of common haemoglobinopathies among anaemic patients in eastern province of Saudi Arabia

Haemoglobinopathy is a collection of a number of diseases, including sickle-cell disease and thalassemia. Several reports indicate that haemo-globinopathies with or without G6PD are the most common genetic abnormalities in the population of the Arabian- Peninsula. However the exact frequencies of neglected cases of these abnormalities among anaemic patients have not yet been determined. 1372 patients were selected from those who attending the out patients from multicenter clinics in Eastern Province of Saudi Arabia.. No one of our patients had been diagnosed for haemoglobinopathies or other chronic diseases. The control groups were as following: 152 children who attended the pediatric clinics for general checkup; 84 adult females; and 92 adult males who attended for blood donation. All individuals were subjected for the following tests: [1] complete blood picture and blood smear, [2] HB electrophoresis, [3] Sickling test [4] G6PD screening, [5] G6PD assay for positive screening cases [6] anemia test panel including serum iron, serum ferritin, and total iron binding capacity. The highest prevalence of haemoglobinopathies is sickle cell diseases. The carriage of at least one of S allele was 41.9%. The second commonest haemoglobinopathies in this study was beta thalassemia represent about 23.46% of total haemoglobinopathies. The third commonest haemoglobinopathies were hereditary persistent fetal haemoglobin [HPFH] and G6PD representing about 15% and 10.26% respectively. Significant differences of haemtological parameters were observed among haemoglobinopathies compared with control groups. Our results suggest the importance of screening tests of Haemoglobinopathies in individuals in Eastern region of Saudi Arabia

Estrategias diagnósticas utilizadas para detectar deficiencias de hierro subclínicas y asociadas a enfermedades crónicas / Diagnostic strategies for detecting subclinical iron deficiencies and associated to chronic diseases

La homeostasis y las variaciones fisiológicas horarias en el metabolismo del hierro se constituyen en verdaderos desafíos para los expertos, quienes intentan diseñar pruebas altamente sensibles y específicas que cuantifiquen los niveles circulantes y de depósito de este elemento, su repercusión en la eritropoyesis,cuantificación de las proteínas, transportadores y receptores involucrados en el proceso, a fin de descartar la presencia de estados carenciales. Las deficiencias de hierro pasan por tres fases; las dos primeras son lasmás difíciles de identificar porque son subclínicas, más aún, cuando pueden cursar simultáneamente con enfermedades crónicas inflamatorias, infecciosas y neoplásicas que de por sí son anemizantes. En este trabajose revisarán las principales pruebas de laboratorio utilizadas para la identificación de deficiencias de hierro, sensibilidad, especificidad, ventajas y limitaciones para su uso.

Anaemia in children with tuberculosis prevalence, type and efficacy of therapy

The aim of this work was to study the prevalence, type and outcome of therapy of anemia in children with tuberculosis to form a strategy for intervention. Children from birth to 15 years old were enrolled in the study. There were 152 TB cases, 72 males and 80 females. Before treatment, there were 65 non-anemia cases, 87 total anemia cases, 58 normocytic-normochromic anemia cases and RDW was 10-15% in 66 cases. After treatment, there were 111 non-anemic cases, 41 anemic cases and 27 normocytic-normochromic cases and RDW was 10-15% in 36 cases. Anemia was very common among TB children and was of the normocytic- normochromic type. CBC and RDW must be done for TB cases to detect concomitant iron deficiency anemia. Anti-TB drugs with iron were effective in its corrections

Anemias carenciais na infancia / Nutritional deficiency-related anemias in children

Na faixa etaria pediatrica, a carencia alimentar se constitui na causa mais comum de anemia, particularmente nos paises em desenvolvimento. O acesso irregular a uma alimentacao balanceada, a elevada incidencia de parasitoses intestinais e o requerimento continuo e elevado de nutrientes devido ao crescimento, tornam as criancas propensas a desenvolver anemia carencial. Apesar de ser um problema clinico de resolucao relativamente facil apos instalado, estaria nos esforcos de prevencao a atitude mais correta dos pontos de vista medico, social e politico. Os autores fazem uma revisao da literatura abordando as tres principais deficiencias alimentares que resultam em anemia (ferropenia e as deficiencias de vitamina B12 e folato), com especial enfase as suas causas, manifestacoes clinicas, diagnostico tratamento

Enfermedad de Gaucher: a propósito de un caso / Gaucher's disease: report a case

Se reporta un caso de enfermedad de Gaucher. La enfermedad es un trastorno familiar crónico raro que se debe a la acumulación progresiva de glucocerebrósido en las células fagociticas del sistema de monocitos y macrófagos. Es producida por el déficit de ß-Glucocerebrosidasa. La enfermedad se hereda de forma autosómica recesiva. Usualmente existen esplenomegalia, anemia, trombocitopenia y leucopenia. Fue necesario practicar esplenectomía. Evolución postoperatoria buena. Una hermana del paciente presenta la enfermedad