Anemia

Anemia is a state in which the hemoglobin concentration falls below the accepted normal range depending on age and sex.
Classification:
1. According to cause
1. Blood loss -- Acute or chronic posthaemorrhagic anaemia.
2. Impaired red cell formation
(1) Genetic disorders of haemoglobin synthesis -- Thalassemia syndromes.
(2) Acquired deficiency of substances essential for haemopoiesis -- (a)Iron deficiency anaemia. (b)Megaloblastic anaemia due to deficiency of vitamin B12 or folic acid. (c)Protein malnutrition.
(3) Disturbances of erythropoiesis not due to deficiency states or genetic causes -- (a) Secondary anaemia -- due to infection and/or inflammatory disorders; renal or hepatic failure;metastatic malignant diease. (b) Aplastic anaemia. (c) Drug-induced disorders of erythropoiesis.(d) Infiltrative disorders of bone marrow ?Cacute and chronic leukaemia, malignant lymphoma, multiple myeloma, metastatic carcinoma, myelosclerosis, (e) Refractory sideroblastic anaemia. (f) Endocrine deficiencies -- Myxoedema, panhypoptuitarism.
ii. According to size of red cells and their haemoglobin content (Morphological)
1. Normocytic -- Average cell volume (MCV) within normal range mostly normal average cell haemoglobin concentration (MCHC).
2. Hypochromic microcytic -- MCV reduced, MCHC reduced.
3. Normochromic microcytic -- MCV redeced, but MCHC normal.
4. Macrocytic -- MCV increased. Mostly normochromic.
iii. Haemolytic anaemia -- Inherited or acquir
1. Intrinsic (erythrocytic), defects.
2. Extrinsic (extraerythrocytic). Mechanisma.
Investigation of a cause of anemia
1. History
(1) Age and sex -- Prematurity in infants. Females during reproductive period of life. G6PD deficiency confined to males.Sideroblastic anaemia mostly in males.
(2) Rate of onset -- Rapid onset over days, or one or two weeks suggests acute bleeding, acute leukaemia or haemolysis.
(3) Drug ingestion -- Especially aspirin and NSAIDs.
(4) Occupation -- Exposure to toxic chemical at work.
(5) Diet -- History suggesting dietary deficiency.
(6) Family history of anaemia or jaundice commom in congenital heamolytic anaemia. Occasionally family history in pernicious anaemia.
(7) Bleeding -- Blood loss commomest cause of anaemia -- haematemesis, melena, bleeding piles, menorrhagia, haematuria, haemoptysis.
(8) Gastrointestinal system -- Symptoms suggestive of peptic ulcer, cirrhosis, neoplasm, hiatus hernia. Diarrhoea often intermittent and glossitis common in megalobloblastic anaemias.
(9) Reproductive system -- Menorrhagia. Number such as nocturnal polyuria.
(10) Urinary system -- Symptoms of renal insufficiency isuch as nocturnal polyuria.
(11) Nervous system -- Paraesthesia in hands and feet in deficiency anaemias.
(12) Bleeding tendency as suggested by easy bruising or skin petechiae, prolonged bleeding after trivial injuries, or bleeding from more than one site.
(13) Skeletal system -- Bone pains may occur in anamias due to marrow infiltration or replacement as in multiple myeloma, leukaemia, malignant lymphomas and myelosclerosis.
2. Physical examination
(1) Skin -- Colour of skin, petechiae and ecchymoses. In pernicious anaemia the skin may have a lemon yellow tint, and in acute leukaemia an ashen tint. In myxoedema coarse and dry. Petechiae in anaemia suggest diagnosis of aplastic anaemia or leukaemia.
(2) Nails -- Brittleness and longitudinal ridging common in chronic iron deficiency anaemia, occasionally koilonychia.
(3) Conjunctivae -- show pallor due to anaemia. Icterus rare, when present suggests haemolytic anaemia or hepatic disease. Mild icterus may be seen in pernicious anaemia.
(4) Mouth -- (i) Mucous membrane -- Petechiae on palate, cheeks, or tongue in aplastic anaemia and leukaemia. (ii) Cums --Hypertrophy in leukaemia especially monocytic. (iii) Tongue glossitis, or smooth tongue common in megaloblastic anaemia, occasionally in iron deficiency anaemia. (iv) Pharynx -- Ulceration of throat may occur in acute leukaemia , and acute aplastic anemia. (v) Angular cheilitis suggests iron deficiency.
(5) Bones -- Bone tenderness especially sternal tenderness may occur in anaemias secondary to marrow infiltration, e.g., in acute leukaemia, also in metastatic bone carcinomia, muelosclerosis and malignant lymphomas.
(6) Breasts -- for evidence of carcinoma.

In the traditional Chinese medical studies, this disease belongs to the category of xu lao (weakness), wang xue (lost function of blood cells) and xue zheng (blood diseases symptoms). The pathogenesis of this disease is related to congenital under development and imbalance of vital supply after birth. The kidneys host the bones, regeneration of marrow is the root of blood formation; while the spleen gather blood, regulates their circulation and serves as the source of blood formation. If the spleen is weak and cannot circulate the blood properly, it will decrease the ability to form blood and leads to anaemia; if the kidney is weak, it cannot help the spleen to circulate blood, the improper marrow will cause obstruction of blood regeneration function and leads to blood deficit; the heart hosts cardiovascular system, lost function of blood cells will lead to inadequate nutrients to those blood cells; Qi act as the chief of blood, the weakness of Qi will decrease its absorption into the blood thus impaired the blood system. Therefore, anaemia is connected with the heart, spleen and kidneys.
Clinical treatment results Treated 958 cases, among them 723 cases used the western medicine but not effective, they used our remedy after cessation of western medicine and the total effectiveness is 89%. The most effective rate is in cases of decreased of white blood cells- up to 95%, while in decreased of platelets 78% and anaemia 87%. The symptoms such as headache and dizziness became better after the medical therapy.