anemia Anemia refers to a clinical syndrome in which the peripheral blood in the human body has a reduced number of red blood cells, leading to an inadequate supply of oxygen to tissues and organs when it falls below the lower limit of the normal range. This can cause a series of symptoms and even lead to further organ damage.

Anemia refers to a condition in which there is a reduction in red blood cells in the peripheral blood of the body. When the count falls below the lower limit of the normal range, tissues and organs do not receive adequate oxygen supply, leading to a series of symptoms and even further organ damage, collectively known as anemia.

Inadequate or reduced red blood cell production

Red blood cell production depends on three major factors: hematopoietic cells, hematopoietic microenvironment and regulating factors, and hematopoietic raw materials.

Anomalies in hematopoietic cells leading to anemia

Reduction in the number or quality defects of hematopoietic stem/progenitor cells, resulting in ineffective hematopoiesis in the bone marrow.

Damage to hematopoietic cells caused by tumor radiation or chemotherapy.

Bone marrow metastasis from various tumors can lead to a reduction in effective hematopoietic cells in the bone marrow.

Anomalies in the hematopoietic microenvironment and regulating factors leading to anemia

The hematopoietic microenvironment provides essential conditions and sites for the differentiation, development, proliferation, and maturation of hematopoietic stem cells. However, due to its complexity, the exact significance of the hematopoietic microenvironment in anemia is currently unknown.

It is known that increased or decreased secretion of various hematopoietic regulating factors such as erythropoietin (EPO), tumor necrosis factor, interferon, and iron metabolism regulating factor hepcidin can lead to anemia.

Deficiency in hematopoietic materials

Deficiency of folic acid and/or vitamin B12 leads to megaloblastic anemia. The deficiency of folic acid and/or vitamin B12 results in inhibition of DNA synthesis within the cells.

Iron deficiency leads to iron-deficiency anemia. The main causes of iron deficiency include reduced iron intake, such as inadequate diet and absorption disorders, excessive iron loss, such as gastrointestinal bleeding, peptic ulcer, and various chronic bleeding diseases, and increased iron demand, such as pregnancy, lactation, and infancy.

Excessive destruction of red blood cells

This category of diseases is characterized by a shortened lifespan of red blood cells, termed hemolytic anemia, primarily caused by inherent defects within red blood cells or external factors.

Loss of blood

Includes acute and chronic blood loss. Acute blood loss mainly causes hemodynamic changes, while chronic blood loss is the most common cause of anemia.

Symptoms of anemia in different systems

Skin, mucous membranes, and their appendages

Pallor of the skin and mucous membranes is the most common sign of anemia.

Neuro-muscular system

Headaches, dizziness, tinnitus, syncope, fatigue, lack of concentration, and decreased memory may be related to cerebral hypoxia.

Muscle weakness, easy fatigue, and other symptoms of muscle tissue hypoxia.

Sensory abnormalities are common symptoms of malignant anemia.

Respiratory and circulatory system

Increased respiratory rate and heart rate, palpitations and dyspnea after activity.

Severe anemia can also lead to dyspnea and difficulty breathing at rest.

Long-term anemia can lead to anemic heart disease.

Digestive system

Loss of appetite, nausea, bloating, abdominal discomfort, constipation, or diarrhea.

Urinary reproductive system

Oliguria, polyuria, low specific gravity of urine.

Menstrual cycle disturbances, increased or decreased menstrual flow, or amenorrhea in women of childbearing age.

Severe anemia can lead to sexual dysfunction.

Endocrine and immune systems

Long-term anemia can affect the function of the thyroid, gonads, adrenal glands, and pancreas.

Low immune function, susceptible to infections.

Other

Anemic patients may sometimes have low-grade fever, which may be related to the increased basal metabolism of anemia.

Specific Considerations for Different Causes of Anemia

In addition to the typical symptoms of anemia mentioned above, different causes of anemia may have their own typical symptoms.

Iron-deficiency anemia

May present with angular stomatitis, glossitis, atrophy of the filiform papillae of the tongue, and chronic atrophic gastritis.

Pica, dysphagia, or a choking sensation during swallowing are specific manifestations of iron-deficiency anemia.

Nails may exhibit koilonychia or spoon-shaped nails.

Iron deficiency can affect the growth and development of children, leading to behavioral and psychological disorders such as irritability and lack of concentration.

Megaloblastic anemia

May present with simultaneous decrease in white blood cells and platelets.

Loss of appetite, bloating, constipation, and some may experience glossitis, atrophy of the filiform papillae of the tongue, and a beefy red tongue.

Numbness in the extremities, sensory disturbances, and ataxia.

Hemolytic anemia

Acute intravascular hemolysis may be accompanied by chills, fever, headache, vomiting, limb and back pain, and abdominal pain, with the appearance of dark tea-colored urine or port-wine urine (bilirubinuria, hemoglobinuria, and hemosiderinuria).

Chronic hemolysis is characterized by anemia, jaundice, and splenomegaly.

Aplastic anemia and hematologic malignancies

Most patients have fever (due to infection) and varying degrees of skin, mucous membrane, and visceral bleeding.

Based on the pathogenesis and clinical manifestations, traditional Chinese medicine has unique advantages in the prevention and treatment of anemia. The principle of supplementing qi and blood, invigorating the spleen, assisting in transportation, and supplementing without stagnation is the foundation of regulating blood deficiency in traditional Chinese medicine. This principle is also the guideline for modern Chinese medicine in improving anemia and is implemented throughout the treatment process.

Iron-deficiency anemia is generally characterized by deficiency, which manifests in the spleen and stomach and in qi and blood. Therefore, treatment should follow the treatment theory of "supplementing deficiency" in the "Lingshu·Jingmai" chapter of traditional Chinese medicine, focusing on invigorating the spleen and stomach and supplementing qi and blood. However, in the treatment process, in addition to regulating the spleen and stomach and supplementing qi and blood, the cause of iron-deficiency anemia should be diagnosed and corresponding treatment should be given, and appropriate supplementation of traditional Chinese medicine or modern iron-supplementing products that are beneficial for blood generation, such as hemoglobin iron, gelatin, turtle shell glue, and deer antler glue, should be provided.

Diet

Anemia patients can refer to the Chinese Resident Balanced Diet Pagoda and arrange their diet reasonably, improving the processing methods of food.

Dietary Recommendations

Increase the intake of foods rich in micronutrients: children, pregnant and lactating women can increase the proportion of animal products and fruits and vegetables rich in vitamin C in their diet to improve iron absorption.

Dietary Restrictions

Eliminate factors that inhibit iron absorption: avoid high-fat foods, soy milk, alkaline foods, tea, coffee, fruits and vegetables with high tannic acid content, peach kernels, apricot kernels, kelp, carrots, etc., to eliminate factors that reduce or inhibit iron absorption.

Lifestyle

Pregnant women are advised to supplement iron and folic acid daily; non-anemic pregnant women should take intermittent iron and folic acid supplements. Postpartum women are advised to take iron supplements alone for 6-12 weeks, or combined with folic acid supplementation.

Avoid long-term exposure to chemicals and drugs, such as benzene, herbicides, insecticides, and long-term hair dyeing.

Avoid long-term exposure to high-energy radiation such as γ-rays and X-rays.

Avoid certain biological factors, such as EB virus, parvovirus B19, cytomegalovirus, and HIV infection.

Rest and avoid vigorous activity when suffering from anemia.

It is not recommended for anemia patients to donate blood.

Avoid the use of drugs that inhibit iron absorption, including tetracyclines, streptomycin, macrolides or quinolones, angiotensin-converting enzyme inhibitors, levodopa, thyroid hormones, calcium or magnesium preparations, drugs that reduce gastric acid, and non-steroidal anti-inflammatory drugs.

For patients with hereditary hemolytic anemia, it is advisable to seek professional genetic counseling at a eugenics and genetics clinic or similar clinic before preparing for reproduction. Different diseases have different genetic patterns, and eugenics and breeding should be carried out under the guidance of professional physicians.

Improve lifestyle, pay attention to a balanced diet, see details in the daily life management section.

Timely add iron-rich foods for infants and young children, such as eggs, liver, etc.

Adolescents should correct picky eating and regularly check and treat parasitic infections.

Pregnant and lactating women can supplement iron supplements.

Women of childbearing age should prevent and treat excessive menstrual bleeding.

Prevent and treat tumor-related diseases and chronic bleeding diseases.