Investigations in Anemia - All You Need to Know

Introduction

Anemia is a condition where the red blood cells in the body are reduced. The condition often needs to be diagnosed properly or given the importance it requires. Red blood cells carry hemoglobin. Hemoglobin carries oxygen to all parts of the body. The red blood cells are red because of the presence of hemoglobin. Many reasons can cause anemia. Proper investigation is required to diagnose the condition.

What Are the Types of Anemia?

There are many causes of anemia. The various types of anemia can include;

• Iron Deficiency Anemia: This is caused by iron deficiency in the blood. The most common cause behind this is heavy bleeding, especially in conditions like menstruation or bleeding in the gastrointestinal tract.

• Vitamin Deficiency Anemia: This is caused by vitamin C, B12, or folate deficiency.

• Aplastic Anemia: A condition where the bone marrow fails to produce sufficient red blood cells is called aplastic anemia.

• Hemolytic Anemia: This is a condition where the body itself destroys the red blood cells prematurely.

• Sickle Cell Anemia: This is an inherited condition where the red blood cells formed are of an abnormal shape.

• Thalassemia: This is also an inherited condition where the hemoglobin destroys the red blood cells prematurely.

How Is Anemia Diagnosed?

The World Health Organization (WHO) proposed criteria for diagnosing the condition in 2010. It considers hemoglobin levels less than 12 grams per deciliter (g/dl) in premenopausal women and 13 g/dl in postmenopausal women and men of all ages as anemic. However, this was opposed by the journal 'Blood' and proposed new standards based on race, gender, and age.

According to these standards, anemia is defined as hemoglobin levels of less than 13.7 g/dl for Caucasian men between 20 and 60 years of age, less than 13.2 g/dl for Caucasian men older than 60, and Caucasian women of all ages were considered anemic at 12.2 g/dl. Nevertheless, a standard level for the diagnosis of anemia in these populations was not proposed.

Good case history and physical examination can give clues on the condition's cause. A blood test is a preliminary test done to find out the condition. The number of white blood cells, red blood cells, and platelets is analyzed by a test. This test is known as complete blood count (CBC). Further tests are done to determine the reason behind the decrease in red blood cells. Anemia causes a decrease in the overall supply of oxygen to the various parts of the body.

1. Blood Tests: It helps to know the severity of anemia. A decrease in the red blood cells causes anemia. Hemoglobin levels are another indicator of anemia. A low hematocrit level is another indication of anemia. It measures the space consumed by the red blood cells in the blood. Mean corpuscular volume (MCV) is the average size of the red blood cell. A decrease in it can also point out anemia.

2. Bone Marrow Tests: This test reveals whether the bone marrow is functioning properly and producing normal blood cells. Aspiration and biopsy are the two bone marrow tests. Bone marrow aspiration is usually done first. A small amount of bone marrow fluid is drawn in a needle in this procedure. On the other hand, in a biopsy, some bone marrow tissues are drawn out in a larger needle. Bone marrow tests help to find out the exact reason behind the decrease in the number of red blood cells. They help to differentiate between aplasia (failure of the bone marrow to produce red blood cells properly), megaloblastic hyperplasia (a condition with more immature blood cells), etc. Before these tests, the health care provider should be informed about any allergies, medication taken by the patient, or if the patient is pregnant.

3. Ultrasound: A routine ultrasound helps to identify the cause of anemia with minimum invasion and radiation exposure. It helps to detect an enlarged spleen or uterine fibroids. Circulatory problems that are indicative of anemia in unborn babies can be diagnosed by Doppler ultrasound.

4. Computed Tomography (CT): A CT helps to understand the presence of any bleeding in the gastrointestinal tract, like any malignancies or lymph node-associated problems that might cause anemia.

5. Magnetic Resonance Imaging: It helps to find any abnormalities with the bone and bone marrow. Assessment of iron concentrations in different organs, like the heart, liver, etc., can be done using this modality. This modality is beneficial for people who have had multiple blood transfusions and issues with iron concentration. It also helps to diagnose any coagulation related to aspirin consumption or platelet dysfunction. The presence of hookworm infestation can cause anemia and can be diagnosed by imaging modalities. It can also detect any tumors or adenomas that can cause anemia.

6. Coagulation Screening Tests: These tests help to find any clotting and bleeding disorders. It helps to find the reason why bleeding persists, causing anemia. It includes checking for bleeding time and clotting time.

7. Iron Profile: This provides an idea of the iron level in the body. It can include serum iron, ferritin, and total iron-binding content (TIBC).

8. Serum Creatinine: It helps to evaluate the functions of the kidney. The kidney has a vital role in being the cause of anemia. Primarily, it produces about ninety percent of erythropoietin, the precursor of red blood cells. Secondly, anemia caused by blood loss can cause hypotension due to the activation of intrarenal regulation.

9. Hemoglobin Electrophoresis: This test helps determine the hemoglobin's amino acid chain.

Conclusion

Anemia is a common condition seen in inpatient and outpatient. Many a time, it is not diagnosed or managed appropriately. The diagnosis and management of anemia is an interprofessional task. It is a condition that requires to be treated after understanding the exact etiology behind it. It can affect the patient's health directly and also be a cause of other related comorbidities. Follow-up care and regular reviews are essential to ensure that the treatment is on the right track and the outcome for the patient. The treatment can range from iron supplements to blood transfusion, depending on the cause and severity of the condition.