Miscellaneous Causes Of Anemia And Anemic Manifestations In Systemic Diseases

Vitamin C deficiency: Normocytic normochromic anemia may occur in early cases of Vitamin C deficiency. When bleeding complicates the picture, Iron deficiency anemia results.

Protein deficiency per se: It can lead to anemia due to diminished production of erythrocytes and possibly reduced lifespan of these cells. The anemia is mild and hemoglobin levels range from 8 to 10 g/dl.

Thyroxine deficiency: This produces a mild to moderate type of anemia in 20-60% of cases. Thyroxine deficiency per se cause a normocytic normochromic anemia or slightly macrocytic anemia. There is mild hypoplasia of erythroid precursors.

Copper deficiency: This leads to hypochromic microcytic anemia in experimental animals. Copper deficiency may occur in infants fed solely on milk or due to severe malnutrition. In adults, this is not a significant clinical problem.

Anemia in rheumatoid arthritis: There is mild to moderate anemia with hemoglobin levels ranging from 9 to 10 g/dl. Blood picture is usually normocytic hypochromic. Anemia may be partly due to bleeding resulting from excessive ingestion of salicylates or other drugs. In addition to concomitant nutritional deficiencies, rheumatoid arthritis per se produces a resistant type of normocytic hypochromic anemia, which is relatively resistant to oral iron. Parenteral iron therapy results in significant improvement.

In acute renal failure: Normocytic normochromic anemia develops with reticulocytopenia and depression of erythroblasts in bone marrow. Erythropoietin levels are low.

In chronic renal failure: Severity of anemia correlates well with the glomerular filtration rate and to a lesser degree with blood urea nitrogen (BUN). Anemia is mainly due to diminution in erythropoiesis. Blood loss and nutritional deficiency contribute in varying proportions. Hemodialysis aggravates the blood loss. When the blood urea exceeds 280 mg/dl, hemolysis may develop. Generally, the response to therapy is unsatisfactory. Blood transfusion given judiciously may be required to correct the anemia.

In chronic liver disease: There is mild anemia which may be multifactorial in origin. The factors are gastrointestinal bleeding and ineffective erythropoiesis and hemolysis. The anemia may be hypochromic or macrocytic normochromic. Usual hematinics are not very effective. Improvement may take place with improvement of liver function.

These cause significant anemia at some stage or the other during their course. Different types of anemia are encountered since multiple factors operate. There are:

1. Iron deficiency anemia due to gastrointestinal hemorrhage or malabsorption.
2. Folic acid deficiency anemia is due to increased requirement of the vitamin caused by extensive growths or due to chemotherapy or radiation therapy. Folic acid therapy together with vitamin B₁₂ are helpful.
3. Hemolytic anemia may occur in lymphomas or ovarian neoplasms due to development of antibodies.
4. Hypoplastic anemia may result from bone marrow involvement by extensive malignant tissue. Aplasia may also be a complication of aggressive therapy.