Hypoplastic anemia is a form or type of aplastic anemia which is primarily due to a congenital disorder. Broadly, it is also a part of a broad category of anemia characterized by decreased production of red blood cells. It is also characterized by defective function of the blood-forming organs (such as bone marrow) and is caused by toxic agents such as chemicals or x rays.

Impairment of blood formation, which is manifested in perversion of the formation of the primordial cells from which erythrocytes, leukocytes, and thrombocytes form in the bone marrow, leads to the development of hypoplastic anemia. A reduction in the number of erythrocytes, leukocytes, and thrombocytes per unit volume of blood is typical of hypoplastic anemia. Hormone drugs (glucocorticoid and male sex hormones) have a therapeutic effect, and sometimes removal of the spleen is effective. In addition, bone marrow is sometimes transplanted.

Hemolytic anemia is caused by increased hemolysis (the destruction of erythrocytes). Erythrocytes usually live about 120 days. When antibodies against the patient’s own erythrocytes appear, the life-span of the erythrocytes is significantly shortened. Rapid destruction of a large number of erythrocytes occurs; as a result of the decomposition of hemoglobin in the patient, the tissues of the organism take on a yellow pigmentation (jaundice). Immune hemolytic anemia develops; to treat it, hormone drugs (glucocorticoid hormones) are used.

Sometimes acute hemolytic anemia develops in an infant during its birth; this is associated with an incompatibility between the mother’s blood and the infant’s blood. Thus, hereditary forms are common in hemolytic anemia. Their development is associated with genetic impairment of the function of the enzymes which participate in formation of the walls of the erythrocytes or in accumulating the energy necessary for their vital activity and for preserving the walls. Removing the spleen is sometimes effective in hereditary hemolytic anemia.

In the same geographic zones, hereditary anemia associated with impairment of synthesis of the protein part of hemoglobin is widespread. Therapy for all types of anemia including hypoplastic is conducted only after a detailed and precise determination of the diagnosis and form of anemia.

Megaloblastic type of anemia occurs due to vitamin B 12 or folic acid deficiency. Some types are the result of problems in the bone marrow where blood cells are produced. Red blood cell production may be reduced or affected by chemicals or viruses that attack the bone marrow. The goal of treatment is to determine the cause of anemia and treatment depends on the cause. Anemia’s related to vitamin deficiencies are discussed separately.

Diseases of the small intestine causing malabsorption can cause vitamin B12 deficiency. Vegans (people who eat absolutely no animal foods) are at risk of inadequate vitamin B12 because of this vitamin in their diet. But it takes a long time to exhaust all the vitamin B12 is stored in the liver. There is a congenital form of pernicious anemia due to a defect of intrinsic factor in the birth that is clearly inherited as an autosomal recessive trait with the affected child having received two copies of the gene, one from each parent. Vitamin B12 helps in the process of contraction. Without vitamin B12, there are not enough red blood cells, and those in circulation are large and quickly damaged. This leads to anemia, which means that there is a deficiency of normal red cells. Symptoms, which usually start gradually, include loss of appetite, diarrhea, pallor, fatigue and headache. Tingling in hands and feet as well as the appearance of spastic movements, may indicate that the nervous system is affected. The word “pernicious” is highly injurious, destructive or deadly.

“Megaloblastic anemia is an anemia that results from inhibition of DNA synthesis in red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the G2 growth stage to the mitosis (M) stage. This leads to continuing cell growth without division, which presents as macrocytosis”.

Symptoms

There are many factors affecting this disease, so in this article we going to mention some of them. The B12 vitamin deficiencies impair the normal function of DNA and can cause numerous abnormalities of the blood, the brain, and the nervous system.

Some common symptoms are as follows:

Painful tingling of the hands and feet

  • Weakness
  • Loss of coordination
  • Irritability and mental status changes
  • Gastrointestinal problems (e.g., diarrhea)
  • Decreased appetite
  • Changes of taste perception
  • Weight loss
  • Change in skin color
  • Headaches
  • Loss of appetite
  • Pale skin color
  • Sore mouth and tongue
  • Tingling and numbness of hands and feet
  • Tiredness

Myelophthisic Anemia a type resulting from displacement or crowding out of erythropoietin cells of the bone marrow by foreign tissue, as in leukemia, metastatic carcinoma, lymphoblastoma, multiple myeloma, osteoradionecrosis, and xanthomatosis.

Myelophthisic anemia (or myelophthisis) is a severe kind of anemia found in some people with diseases that affect the bone marrow. Myelophythisis refers to the displacement of hemopoietic bone-marrow tissue into the peripheral blood, either by fibrosis, tumors or granulomas.

Causes

Myelophythisis can occur in the setting of chronic myeloproliferative disease (e.g. myelofibrosis), leukemia, lymphoma, and metastatic carcinoma or myeloma. It is common in people who have chronic idiopathic myelofibrosis. It has been linked to small-cell lung cancer, breast cancer or prostate cancer that metastasizes to the bone marrow.

Diagnosis

The first test for diagnosis myelophthisis involves looking at a small sample of blood under a microscope. Myelophthisis is suggested by the presence of red blood cells that contain nuclei or are teardrop-shaped (dacryocytes), or immature granulocyte precursor cells which indicates leukoerythroblastosis is occurring because the displaced hematopoietic cells begin to undergo extramedullary hematopoiesis. These immature granulocytes are seen in peripheral blood smears. Diagnosis is confirmed when a bone marrow biopsy demonstrates significant replacement of the normal bone marrow compartment by fibrosis, malignancy or other infiltrative process. The presence of immature blood cell precursors helps distinguish another cause of pancytopenia, aplastic anemia; from myelophthisic anemia because in aplastic anemia the hematopoietic cells are damaged and immature blood cells are not seen in the peripheral blood.

Microcytic anemia is a term used to characterize any type of anemia caused due to small red blood cells in human blood. In Microcytic anemia the red blood cells are paler than usual. Microcytic anemia is the most common types of anemia which is found.

Causes

In most of the cases Microcytic anemia is caused because of the deficiency of iron. Thus it is the most sought after thing when a person is contacted with Microcytic anemia. Once it is confirmed that the cause of Microcytic anemia is the deficiency of anemia than the most important task for a doctor is to identify the reason which is causing iron deficiency in human body. The cause of iron deficiency in human body may either be loss of blood cells due to heavy bleeding, poor intake of iron in the body or the loss of capability to absorb iron from the food.  The most causes of iron deficiency caused by excessive bleeding are blood loss caused in intestine due to colon, gastritis, cancers, ulcers or esophagietis.  Heavy menstruation is another most common cause of Microcytic anemia in women.

After iron deficiency, lead poisoning is one of the most common causes of Microcytic anemia. This cause needs to be taken into consideration when the patient did not responds to the iron supplements or lives in area or home with lead exposure which are generally old homes.

Anemia caused due to chronic disease is another cause which can lead to Microcytic anemia. Normally this is a case of Normocytic anemia but in rare cases anemia caused due to chronic disease can lead to Microcytic anemia.

Sideroblastic anemia is yet another cause of Microcytic anemia.  This case is generally found in people having serious bone marrow disease, leukaemia and myelodyplasia.

Symptoms

Microcytic anemia can be detected on a routine test lab. Some common symptoms of this type are pale skin, dizziness, conjunctivitis, short breath during exercise, fatigue, urge to eat chalk or dirt and decreased stamina.

Treatment

The treatment of Microcytic anemia caused due to iron deficiency is usually successfully accomplished with the help of oral intake of iron supplements. However in severe cases the iron supplements are given intravenously, this process comes with a risk of serious allergic reaction and thus needs to avoid if possible.  In case the cause of Microcytic anemia is internal bleeding than it should immediately be stopped and if Microcytic anemia is caused due to some chronic illness than effort should be made to cure illness.

Normochromic  Anemia is a type of medical condition in which the number of red blood cells is within the normal range and they are normal colored and sized also. It includes hemolytic anemia, aplastic posthemorrhagic and anemia related to chronic diseases.

It is also called as Normocytic Anemia. Its diagnosis based on morphology characteristics is made on blood film and values of blood counts which needs to be complete and sufficient. This condition can be due to fall in number of RBCs or red blood cells or can be due to red cell hemolysis and hemorrhage (blood loss).The major features of acute blood loss are peptic ulceration of stomach or bowel ,ulcerative lesions of other types and trauma. Treatment of blood loss includes replacement by transfusion and proper steps directed against the cause. Major cause of hemorrhage is gastrointestinal or genitourinary tracts secondary to any type of disease related to these systems. Other factors leading to above condition is bleeding disorders von will brand disease or hemophilia.

Acute red cell breakdown (Hemolytis) may occur due to heemoglobinopathies, red cell enzymopathies, acquired platelet disorders, HUS, DIC and autoimmune hemolytic anemia. Significant causes can be hypo plastic /aplastic(bone marrow failure) anemia or myelodysplastic syndrome. One has to treat the cause of anemia and not the anemia alone. The overall levels of hemoglobin are increased in this type of anemia.

When the count of reticulocyte is decreased then malignancy and hypo proliferative anemia takes place and in reverse case, increased reticulocyte count, acute blood loss takes place and coombs test is conducted. If the coombs test is positive then intracorpuscular and extra corpuscular defects takes place. In particular intracorpuscular defects, abnormal hemoglobin, enzyme and membrane defects occur.

Normocytic anemia results because of impaired red cells production and in failure of kidney when there is a deficiency of erythropoietin, the major factor in body that accelerates red cell production. In these sorts of condition, the life duration of the red cell may be reduced slightly but reason for cause of anemia is failure of production of red cells.

The condition in which there are not sufficient red blood cells in the blood of a human due to the premature destruction of red blood cells is known as Hemolytic anemia. There are several types of Hemolytic anemia which are described individually. Hemolytic anemia can be caused due to various reasons which can be harmless or even life threatening. The general forms of Hemolytic anemia can either be inherited or acquired. The treatment Hemolytic anemia is totally based on the cause lead to this condition.

Causes of Hemolytic anemia

Hemolytic anemia is caused when the bone marrow is unable to make production of red blood cells to be replaced with the dead red blood cells which died due to premature destruction. Hemolytic anemia can either be caused by intrinsic factors (within blood) or extrinsic factors (outside blood). Intrinsic factors are usually present at the time of birth of child. Intrinsic factors include differences in the protein which is inside a red blood cell that are responsible for carrying oxygen and abnormalities in the proteins that are responsible to build red blood cells in the blood. The extrinsic factors include blood clotting in small blood vessels, infections, abnormal response from immune system and side effects from medications.

Types of Hemolytic anemia

The various types of Hemolytic anemia are Thalassemia, Malaria, Sickle cell anemia, Hemolytic anemia due to the deficiency of G6PD, blood transfusion of blood with a different blood group, secondary immune Hemolytic anemia.

Symptoms

The symptoms shown in a patient suffering from Hemolytic anemia are fever, fatigue, chills, dark urine, increased heart rate, jaundice, dark urine, enlarged spleen, pale skin and short breath.

Tests of Hemolytic anemia

There are specific tests conducted in order to identify the type of Hemolytic anemia a patient is suffering from.  These tests are conducted when Hemolytic anemia is confirmed or suspected. Serum LDH, free hemoglobin serum or urine, serum levels, blood platelet count, white blood count differential are some of the tests which can be recommended to a patient suffering from Hemolytic anemia.

Treatment

As stated earlier the treatment of Hemolytic anemia totally depends on the cause and the type of Hemolytic anemia a patient is suffering from.  Iron replacement, folic supplements, corticosteroids may be recommended and in case of severe Hemolytic anemia a patient can undergo blood transfusion or the removal of spleen.

Complications

The complications of Hemolytic anemia also depend upon the cause and type. In severe Hemolytic anemia the risk of cardiovascular collapse is high and it can also worsen already existing cerebro-vascular disease, heart disease and lung disease.

Generally, Anemia is described as lack of appropriate number of red blood cells (RBCs) in the blood, therefore a person with low blood count is considered by physicians as anemic.

According to doctors, there are three types of anemia depending upon the blood disorders. Aplastic anemia is one of them. It is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. Exposure to ionizing radiation from radioactive materials or radiation-producing devices is also associated with the development of aplastic anemia.

Aplastic anemia is also sometimes associated with exposure to toxins such as benzene, or with the use of certain drugs, including chloramphenicol, carbamazepine, felbamate, phenytoin, quinine, and phenylbutazone. Many drugs are associated with aplasia mainly according to case reports but at a very low probability.

As the name suggests, it involves both aplasia and anemia. Usually, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia.

Aplastic anemia(AA)  is a rare disease, with an incidence of only 1–2 per million population per year in the West. The treatment options involve immunosuppressive therapy and bone marrow transplantation.

The diagnosis is mainly based on bone marrow examination. Before this procedure is undertaken, a patient will generally have had other blood tests to find diagnostic clues, including a complete blood count (CBC), renal function and electrolytes, liver enzymes, thyroid function tests, vitamin B12 and folic acid levels.

Bone marrow aspirate and biopsy, X-rays, computed tomography (CT) scans, or ultrasound imaging, liver, viral infestions, antibodies tests are done in determining differential diagnosis for aplastic anemia.

Treating immune-mediated aplastic anemia involves suppression of the immune system, an effect achieved by daily medicine intake, or, in more severe cases, a bone marrow transplant, and a potential cure.

Untreated aplastic anemia is an illness that leads to rapid death, typically within six months. If the disease is diagnosed correctly and initial treatment is begun promptly, then the survival rate for the next five to ten years is substantially improved, and many patients live well beyond that length of time.

Well-matched bone marrow transplants from siblings have been successful in young, otherwise healthy people, with a long-term survival rate of 80%-90%. Most successful BMT recipients eventually reach a point where they consider themselves cured for all practical purposes, although they need to be compliant with follow-up care permanently. Older people (who are generally too frail to undergo bone marrow transplants) and people who are unable to find a good bone marrow match, who undergo immune suppression have five year survival rates of up to 75%.

Thalassemia is caused when the body starts making abnormal form of hemoglobin which carries oxygen to different parts of body. Anemia is caused when the excessive destruction of blood cells starts due to this disorder. Thalassemia is also known as Mediterranean anemia and jackcsh anemia. Thalassemia is not a single disorder but a chain of defects with similar clinical effects. Severe cases can cause early death due to heart failure which happens in age group of 20 and 30 years. Thalassemia if left untreated than it can lead to infections development, liver and heart problems. The severity of disease is decided by the number of affected genes.

Causes and symptoms

Hemoglobin consists of two proteins which are Alpha globin and beta globin and the reason of occurrence of Thalassemia is the defect in a gene which control production of these proteins. This can be divided in two main parts which are Alpha Thalassemia which occurs when the gene controlling the production of alpha globin protein is missing and Beta Thalassemia which occurs when the gene controlling the production of beta globin protein is missing. Beta Thalassemia is also known as Cooley’s anemia. These two types that can be sub divided in two parts which are known as Thalassemia minor and Thalassemia major.

  • Thalassemia minor occurs when the patient gets the defective gene from one parent.
  • Thalassemia major occurs when the patient gets defective gene from both parents.  The children born with Thalassemia major are normal at the time of birth but they develop severe anemia during their first 5 years. In extreme cases of alpha Thalassemia major the children are still born as they either died in the last month of pregnancy or during the time of birth. The symptoms of Thalassemia are growth failure, fatigue, jaundice, shortness of breath and bone deformities in the face.

Tests

The tests through which a Thalassemia patient can undergo are physical examination, blood test, complete blood count, hemoglobin electrophoresis and mutational analysis.

Treatment

The treatment given to a Thalassemia major patient involves regular blood transfusion and folate supplements. The patient who had blood transfusion should not take iron supplements as it can increase the amount of iron in the body which in turn will harm the body. In some patients especially children bone marrow transplant can help in curing the disease.

Prevention

The prevention of Thalassemia is in the hand of parents who have defective genes. The parents should apply for genetic counseling and prenatal screening if they are planning to have children.

Anemia is a disease which can be caused due to different reasons which includes high rate of blood cell destruction, lack of red blood cells production and blood loss. Anemia can be caused due to the deficiency of various minerals in the body. The most common causes of anemia are deficiency of vitamin and deficiency of iron.

Anemia caused due to deficiency of Vitamins

Anemia caused due to deficiency of vitamins is a state which occurs due to the lack of red blood cells. This lack of red blood cells is caused due to the deficiency of various vitamins in human body.

Causes and Symptoms

Vitamin B12, Vitamin C and folate are some of the vitamins which if are in less amount can lead to amenia. Vitamin deficiency takes time to develop and the symptoms of Anemia caused due to deficiency of Vitamins may be subtle in the beginning but it increases as the deficiency worsens. The signs and symptoms showed by body suffering from Anemia caused due to deficiency of Vitamins are diarrhea, irritability, mental confusion, dizziness, fatigue, short breath, pale skin, jaundice, numbness or tingling in arms and legs, weakness and loss of balance.

Tests

There are various tests through which Anemia caused due to deficiency of Vitamins can be identified. These tests are Complete blood count, antibodies test, schilling test and methylmalonic acid test.

Treatment

The treatment which is given to a patient suffering from Anemia caused due to deficiency of Vitamins includes supplements and change in diet.  The patient is given supplements to control the deficiency of vitamins such as folic acid, vitamin b12 and vitamin c in body.

Anemia caused due to deficiency of Iron 

Anemia caused due to deficiency of Iron is a state when the body does not have enough iron to produce red blood cells which leads to either reduction in the production of red blood cells or to production of too small red blood cells.

Causes and Symptoms

Anemia caused due to deficiency of Iron is caused by heavy blood loss due to injury or heavy menstruation, inability to absorb iron or lack of iron in the diet. The symptoms in a patient suffering from Anemia caused due to deficiency of Iron are very mild in the beginning. The symptoms of Anemia caused due to deficiency of Iron are headaches, problem in concentration, lethargic feeling, pale skin, sore tongue, shortness of breath, weight loss and dark colored blood.

Tests

The test which can be recommended for a patient suffering from Anemia caused due to deficiency of Iron are hemoglobin tests, RBS indices, colonoscopy and upper endoscopy.

Treatment

Anemia caused due to deficiency of Iron is cured by giving supplements and advising diet which is full of iron.

Pernicious anemia is a disease in which large, immature and nucleated cells form in the blood and do not work as blood cells. The main cause of Pernicious anemia is impaired intake of Vitamin B12. The disease is termed as Pernicious as this disease can be cured with Vitamin B12 and most of the people who suffers Pernicious anemia died. Human body gets Vitamin B12 from animal meat and dairy products which is stored in human body for long time thus it is considered that the in adequate intake of Vitamin B12 should be prolonged in order to reach the deficiency of Vitamin B12.

Causes and symptoms

Vitamin B12 is a necessary element to produce red blood cells and in order to absorb
vitamin b12 from the food the body uses a protein called intrinsic factor which is released in the stomach by the cells. Vitamin B12 bound with intrinsic factor is absorbed in the last part of small intestine and when stomach fails to produce enough intrinsic factor the intestine is unable to absorb vitamin b12 which leads to Pernicious anemia. The malfunction inn stomach can happen due to weakened stomach lining and can also be caused when the immune system of body starts attacking the cells which are behind the formation of intrinsic factor. Pernicious anemia can also happen due to family history of diseases or the patient has a medical history of autoimmune endocrine disorder. Pernicious anemia takes time to show its time, it is examined that the symptoms of Pernicious anemia do not occur before the age of 30 in adults.

The symptoms of Pernicious anemia are fatigue, lack of energy, loss of appetite, diarrhea, problem in concentrating, bleeding gums, swollen and red tongue, pale skin. Pernicious anemia also causes nerve which can lead to depression, loss of balance, numbness, tingling of hands and legs, confusion or dementia. There are very rare cases in which infants and children are born with the inability to produce enough intrinsic factor. Pernicious anemia happens at the time of birth is inherited which means that both mother and father of the children have defective gene.

Tests

The recommended tests for the proper diagnosis of Pernicious anemia are schilling test, complete blood count, bone marrow examination, serum LDH, cholesterol test, bilirubin, gastrin, TIBC and peripheral smear.

Treatment

The first and foremost recommended treatment for Pernicious anemia is the monthly
injections of Vitamin B12 which helps in increasing the quantity of Vitamin B12 in the
body. In people who are suffering from severe Pernicious anemia these injections are
recommended more often in a month. The elderly patients are recommended to take
Vitamin B12 supplements from mouth in addition to the regular injections as taking
Vitamin B12 supplements from mouth is highly effective. The patient suffering from
Pernicious anemia needs to have a well balanced diet which is full of elements like folic
acid, iron and vitamin C which encourages the development of healthy blood cells.

Prevention

Till today there are no Known ways to prevent Pernicious anemia.