Difference between Anemia and Polycythemia

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ANEMIA

POLYCYTHEMIA

· Deficiency of Hemoglobin or few RBCs in the blood

· Decreased Oxygen carrying capacity in the blood

· Viscosity of blood is reduced

·  Rapid blood flow

· Risk of heart failure or some inherited anemias, such as sickle cell anemia leads to life-threatening complications

· Treatment (Mx): blood transfusion and supplements which deficiency cause anemia e.g. Iron deficiency

· Large quantities of extra RBCs

· Increased Oxygen carrying  capacity in the blood

· Viscosity of blood is increased

·  Slow blood flow

· Increase the risk of intravascular clotting ischemia and infarction

· Treatment (Mx):  aspirin may help to reduce burning pain, Hydroxyurea to suppress bone marrow’s ability to the production of blood, Phlebotomy.

Erythrocytes disorders

Red blood cells are the vital cells of blood that carries oxygen to all parts of the body. Red blood cells disorders are the condition in which there is a problem with red blood cells that affect their function

Difference between Anemia and Polycythemia

Types of red blood cells disorders:

A number of red blood cells disorders that are discussed below:

  1. ANEMIA
  2. POLYCYTHEMIA

1. ANEMIA

Anemia is the disorder that the inability of the red blood cells to carry enough oxygen to meet the needs of the body, or a condition in which a person has a lower than the normal number of red blood cells or hemoglobin. A lack of the mineral iron in your blood commonly causes this disorder. There are low levels of hemoglobin in blood is a cause of anemia but if any defect in the production of red blood cells that produced faulty hemoglobin or red blood cells also causes of anemia.

 Anemia is classified depending on the cause:

  • A production of insufficient or defective erythrocytes Blood loss or excessive loss of erythrocytes. Another and common classification of anemia is based on mean cell volume (MCV) of red blood cells
  • Microcytic anemia (low cell volume <80)
  • Normocytic anemia (normal cell volume range of 80 to 100)
  • Microcytic anemia large cell volume

SIGN & SYMPTOMS OF ANEMIA

It’s related to the inability of the red blood cell to supply enough oxygen to the other body cell

  • Tiredness
  • Fatigue
  • Pale appearance
  • Shortness of breath
  • Breathlessness
  • Palpitation

TYPES OF ANEMIA

  1. Iron deficiency anemia
  2. Vitamin B12 /Folic acid deficiency anemia
  • Aplastic anemia
  1. Hemolytic anemia
  2. congenital hemolytic anemia
  3. Sickle cell anemia
  4. Thalassemia
  5. Hemolytic disease of the newborn
  6. Acquired hemolytic anemia

IRON DEFICIENCY ANEMIA:

This is the most common form of anemia in many parts of the world .when your body does not have enough iron or insufficient red blood cells or hemoglobin, that causes iron deficiency anemia.  Our body needs iron to make hemoglobin. In iron deficiency anemia, the red blood cell count often normal, but cells are the small size that contains less hemoglobin than normal. A poor diet or certain intestinal disease that affects the body absorbs iron can also cause iron-deficiency anemia.  Dietary iron comes mainly from red meat and highly colored vegetables. The daily iron requirement in males about 8miligram per day and for women 18miligram per day it’s higher to compensate for menstrual losses.

SYMPTOMS:

  • Weakness
  • General fatigue
  • Pale skin
  • Shortness of breath
  • Dizziness
  • Cold hands and feet
  • Fast or irregular pulse
  • Brittle nails
  • Headaches

CAUSES:

  • Inadequate iron intake
  • Pregnancy or blood loss due to menstruation
  • Internal bleeding
  • Inability to absorb iron

RISK FACTORS:

  • Women of childbearing age
  • Pregnant women
  • Poor diet
  • Donate blood frequently
  • Prematurely born child

DIAGNOSTIC EVALUATION:

  • Red blood cell size and color
  • Hematocrit
  • Hemoglobin
  • Ferritin( protein helps store iron in our body)

TREATMENT:

  • Iron supplements:
  • Take iron tablets on an empty stomach
  • Don’t take iron with antacids
  • Take iron tablets with vitamin C

Vitamin B12 / folic acid deficiency anemia:

Deficiency of vitamin B12  and/ or folic acid impairs erythrocytes maturation and abnormally large erythrocytes (megaloblasts) are found in the blood circulation. During normal erythropoiesis abnormal cell division occurs the cells grow larger than normal between divisions, and circulating cells are immature, larger than normal and some are nucleated (usually normal RBC  haven’t nucleus). This situation causes a reduced life span between 40 to 50days (normally 120days), and depressed production and early lysis cause anemia.

If we don’t get enough vitamin B12 in our diet from foods like milk, eggs, and meat, our intestines absorb vitamin B12  from food. A protein our stomach makes called “intrinsic factor” helps our body absorb it. When we don’t have enough, we have a type of vitamin B12   deficiency anemia called “pernicious anemia”

PERNICIOUS ANEMIA:

This is the most common form of vitamin B12 deficiency anemia. It is commonest in females over 50. It is an autoimmune disease in which autoantibodies destroy intrinsic factor and parietal cells in the stomach.

CAUSES:

  • A lack of vitamin B12
  • A certain condition that makes difficulties to absorb enough vitamin B12,
  • Chronic alcoholism
  • Crohn disease
  • Pernicious anemia
  • Gastrectomy (removal of stomach part)

SYMPTOMS:

  • Diarrhea or constipation
  • Fatigue
  • Loss of appetite
  • Pale skin
  • Shortness of breath during hard work

DIAGNOSTIC EVALUATION:

  • A complete blood cell count
  • Examination of a blood smear
  • Blood vitamin B12measurement
  • Test for the presence of autoantibodies to instruct factor or stomach
  • Bone marrow biopsy

TREATMENT:

  • Vitamin B12 injection
  • Vitamin B12 supplements and multivitamins

APLASTIC ANEMIA:

Aplastic (hypoplastic) anemia results from bone marrow failure. In a rare condition when the body stops producing enough new blood or reduced numbers of erythrocytes.  Since the bone marrow also produces leukocytes and platelets, leucopenia (low white blood cell) and thrombocytopenia (low platelet count) is also likely. This condition is occasionally inherited. Usually, no causes are identified, known causes including;

  • Drugs; cytotoxic therapy
  • Radiation therapy and chemotherapy for cancer
  • Certain medicines
  • Exposure to toxic chemicals
  • Autoimmune disorder
  • A viral infection
  • Pregnancy
  • Unknown factor

SYMPTOMS:

  • Fatigue
  • Shortness of breath with exertion
  • Rapid or irregular heart rate
  • Pale skin
  • Frequent or prolonged infection
  • Unexplained or easy bruising
  • Nose bleeds and bleeding gums
  • Skin rash
  • Dizziness
  • Headache

DIAGNOSTIC EVALUATION:

  • Blood test
  • Bone marrow biopsy

TREATMENT:

  • Blood transfusion
  • Stem cell transplant
  • Immunosuppressant
  • Bone marrow stimulants
  • Antibiotic, antiviral

HEMOLYTIC ANEMIA:

Hemolytic anemia occurs when circulating red blood cells are destroyed and removed prematurely from the bloodstream because of abnormal cells or the spleen is overactive. At the end of red blood cells, life spans their go to the spleen to destroy and converting in bilirubin but in such condition before their lifespan they destroyed. The bone marrow production of erythrocytes increases to compensate, so there may be ongoing hemolysis without anemia. However, if the bone marrow cannot compensate red blood cell numbers will fall and anemia results.

CAUSES:

  • Infection
  • Tumors
  • Autoimmune disorder
  • Medication side effect
  • Leukemia
  • Lymphoma
  • Splenomegaly (Enlarge spleen)
  • Hepatitis
  • Lupus (an inflammatory disease condition when the immune system attacks its own tissues)

SYMPTOMS:

  • Fever
  •  Weakness
  • Confusion
  • Dizziness
  • Pale skin
  • Headache
  • Dark urine
  • Heart murmur
  • Enlarged spleen
  • Enlarged liver
  • Jaundice

DIAGNOSTIC EVALUATION:

  • Bilirubin measurement
  • Hemoglobin
  • Liver function test
  • Reticulocyte count

TREATMENT:

  • Blood transfusion
  • Intravenous immunoglobulin
  • Corticosteroid medication
  • surgery

CONGENITAL HEMOLYTIC ANEMIA

Congenital hemolytic anemia or hereditary hemolytic anemia refers to hemolytic anemia which is primarily due to congenital disorders. In this disease, genetic abnormality leads to the synthesis of abnormal hemoglobin and increased red blood cell membrane fragility, reducing their oxygen-carrying capacity and lifespan. The most common forms are sickle cell anemia and Thalassaemia.

CAUSES:

  • Defective gene
  • Abnormal red cell membrane

SYMPTOMS:

  • Jaundice
  • Weakness
  • Low blood cell count
  • Lethargy
  • Nosebleed in child
  • Vomiting
  • Abdominal pain
  • Fever
  • Headache
  • Tiredness
  • Enlarge spleen
  • Anorexia

DIAGNOSTIC EVALUATION:

As same as hemolytic anemia’s diagnosis

TREATMENT: splenectomy

SICKLE CELL ANEMIA:

The abnormal hemoglobin molecules become misshapen when deoxygenated, making the erythrocytes sickle-shaped (weapon used to cut wheat) or crescent moons. The lifespan of cells is reduced by early hemolysis; they usually die in 10 to 20days, which causes anemia. Sickle cells do not move smoothly through the circulation. They obstruct blood flow.

The sickle cell gene is passed from generation to generation it’s called autosomal recessive inheritance means both parents can be passed on the defective form of the gene to the child.

Sickle cell trait: with one normal hemoglobin gene and one defective gene they can pass the gene to their child.

CAUSES:

The sickle cell anemia is an inheritance, passes from generation to generation called autosomal recessive inheritance.

SYMPTOMS:

  • Weakness
  • Anemia
  • Delayed growth
  • Vision impairment
  • Frequent infection
  • Fever
  • Pale skin
  • Pale nail beds

DIAGNOSTIC EVALUATION:

  • Blood test (hemoglobin S)

TREATMENT:

  • Medication
  • Blood transfusion
  • Vaccinations( prevent infection)
  • Bone marrow transplant

Thalassemia:

This inherited condition involving a lower amount of hemoglobin production, which in turn reduced erythropoiesis and stimulates hemolysis. In the most severe form of the disease, regular blood transfusion is required. This can lead to iron overload.

There are mainly two types of Thalassaemia

  • Alpha Thalassaemia: when genes related to the alpha globin protein are missing
  • Beta Thalassaemia: when similar gene defect affects the production of the beta-globin protein
  • Mainly they both alpha and beta Thalassaemia include two forms
  1. Thalassaemia major: inherit the gene defect from both parents.
  2. Thalassaemia minor: defective gene from only one parent

CAUSES:

  • Maturation in the DNA of cells that produce hemoglobin
  • Inheritance
  • Abnormal hemoglobin production

SYMPTOMS

  • Weakness
  • Pale skin
  • Dark urine
  • Abdominal pain
  • Abdominal swelling
  • Slow growth
  • Facial bone deformities
  • Fatigue

DIAGNOSTIC EVALUATION:

  • Blood test for Thalassaemia

TREATMENT:

  • Mild Thalassaemia: occasionally blood transfusion
  • Moderate /severe Thalassaemia: frequent blood transfusion
  • Stem cell transplant

HEMOLYTIC DISEASE OF THE NEWBORN:

In this disorder, the mother’s immune system makes antibodies to the baby’s red blood cells, causing the destruction of fetal erythrocytes. This antigen system involved is usually (not always) the rhesus (Rh) antigen.

CAUSES:

  • Rh incompatibility
  • Develops when an Rh –ve mother conceives a fetus which is Rh +ve
  • ABO incompatibility
  • Thalassemia
  • Autoimmune hemolytic anemia

SYMPTOMS:

  • Jaundice
  • Enlarge liver & spleen
  • Ascites
  • Generalized edema
  • Respiratory distress

DIAGNOSTIC EVALUATION:

  • Biochemistry tests for jaundice
  • Complete blood count
  • Bilirubin level

TREATMENT:

  • Feeding often & receiving extra fluids
  • Phototherapy
  • Antibodies
  • Medicines to raise blood pressure if it drops too low

ACQUIRED HEMOLYTIC ANEMIAS:

In this context ‘acquired’ means Hemolytic anemia in which no familial or racial factors involved, there are several Causes:

  • Chemical agents
  • Autoimmunity
  • Blood transfusion reaction
  • Hypersplenism (entrapment)

SYMPTOMS:

  • Dark urine
  • Pale skin
  • Heart murmur
  • Increase heart rate
  • Splenomegaly
  • Hepatomegaly (enlarged liver)

Difference between Anemia and Polycythemia

  1. POLYCYTHAEMIA

This means an abnormally larger number of erythrocytes in the blood. Also, a decrease in the volume of plasma and it’s sometimes called erythrocytosis but usually, it’s not referred.  This increases blood viscosity, slow blood flow, and increases the risk of intravascular clotting ischemia and infarction.

Anemia and Polycythemia

CAUSES:

  • High altitudes
  • Pulmonary disease
  • Hypoventilation
  • Cardiovascular diseases (congenital with the cyanosis)
  • Heavy cigarette smoking

SYMPTOMS:

  • Headache
  • Dizziness
  • Fatigue
  • Blurred vision
  • Joint pain
  • Numbness
  • Fever
  • Weight loss
  • Shortness of breath
  • Weakness
  • Itching (especially following a warm bath)
  • Bleeding

DIAGNOSTIC EVALUATION:

Blood test

  • Bone marrow aspiration
  • Test for the gene mutation that causes polycythemia vera

TREATMENT:

  • Phlebotomy: removal of blood from the circulation.
  • Aspirin: reduce the burning pain
  • Hydroxyurea:  to suppress bone marrow’s ability to produced blood cells.

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