hemoglobin anemia

In medicine, the main sign of hemoglobin anemia is a reduced hemoglobin concentration. Hemoglobin, the red blood pigment, is the most important part of the red blood cells (erythrocytes). The oxygen in the lungs can dock onto certain regions of the hemoglobin and is thus transported throughout the body to the cells. In exchange, the hemoglobin absorbs the metabolic product carbon dioxide (CO2) and transports it back to the lungs, where it is exhaled from the body.

In the case of anemia, there is too little hemoglobin in the organism, so that the body's cells cannot be supplied with sufficient amounts of valuable oxygen.

The different types of hemoglobin anemia

Doctors differentiate between several types of anemia, which differ from each other depending on their shape and the microscopic appearance of the erythrocytes.

In addition, the amount of hemoglobin the red blood cells contain also plays a role.

• Microcytic, hypochromic anemia

In such a case, the red blood cells are too small and contain too little hemoglobin. A classic example of this form of anemia is iron deficiency anemia.

• Macrocytic, hyperchromic anemia

The red blood cells are too large and contain too much hemoglobin. Although they are able to transport sufficient oxygen, they are broken down too early in the spleen. This form of anemia can occur due to a vitamin B12 deficiency or a folic acid deficiency.

• Normocytic, normochromic anemia

This form is caused by massive blood loss. However, the blood cells are unremarkable and of normal size.

The blood composition in humans

Over half of the blood consists of what is known as blood plasma. Many different substances are dissolved in it, such as hormones, various messenger substances or nutrients such as proteins, sugar and salts. These substances reach all parts of the body via the bloodstream and supply all important tissues and organs.

The other half of the blood consists of cells. This proportion is measured by the so-called hematocrit value. The cells in the blood can be classified into three large groups:

1. White blood cells (leukocytes): They are part of the body’s defense system and protect the organism from infections.

2. Platelets (thrombocytes): They are involved in stopping bleeding.

3. Red blood cells (erythrocytes): They transport oxygen and carbon dioxide in the body. Erythrocytes make up the majority of blood cells.

Hemoglobin, a molecule found in red blood cells and responsible for the characteristic red color of blood, is essential for the function of red blood cells.

In the ICD-10, the international classification of diseases, anemia can be found in the chapter “Aplastic and other anemias” under the number D64.9.

Symptoms: How do you recognize hemoglobin anemia?

Anemia has many different causes and is also associated with many symptoms that cannot always be clearly identified.

However, all anemias are characterized by symptoms that arise from an insufficient supply of oxygen to the body:

• Dizziness
• Reduced physical and mental performance
• Headache
• Shortness of breath during exertion (in advanced anemia also at rest)
• Pallor of the skin
• Pale appearance of the connective and mucous membrane
• Smooth and red tongue: Doctors speak of a “lacquered tongue” in this context.

Depending on the type of anemia, other symptoms may occur:

• Iron deficiency anemia can cause brittle nails and hair, as well as inflamed mucous membranes and corners of the mouth.

• Pernicious anemia (vitamin B12 deficiency anemia): This can lead to memory problems, burning tongue, digestive problems such as diarrhea or constipation, loss of appetite and even weight loss.

• Hemolytic anemia: Signs of this type of anemia are jaundice with a yellowing of the skin and the whites of the eyes.

• Anemia due to internal bleeding: tarry stools or melena (black stools) or red blood in the stool or urine. Low blood pressure, circulatory collapse or a high heart rate can also occur.

Course: What are the dangers of hemoglobin anemia?

If anemia or its causes are not treated adequately, the symptoms will worsen. The exact health consequences in such a case depend, among other things, on the extent of the anemia.

Severe anemia is generally associated with greater risks than milder anemia. However, research studies have shown that even mild anemia can increase the risk of death after surgery.

The specific consequences of anemia depend primarily on the disease that led to the anemia, because anemia does not occur as a disease in itself. Rather, it is a secondary complication.

There are numerous diseases that can cause anemia. In the most common form of anemia, iron deficiency anemia, the symptoms generally subside once the deficiency has been corrected. If the anemia is only mild, serious health consequences are unlikely. However, if the iron deficiency anemia is severe, it can be dangerous - especially if adequate treatment is not started in time. In older people, heart problems and heart diseases can occur, such as:

• Cardiac arrhythmias
• Angina pectoris
• Heart attack

The second most common form of anemia is anemia in chronic diseases. Anemia can occur in people with rheumatism, diabetes or even cancer. It is not possible to say in general terms how it progresses and what health consequences can be expected. However, some of these diseases can be brought very well under control with adequate medical treatment. In most cases, the anemia then goes away.

Other forms of anemia can also have different consequences. For example, hemolytic anemia can lead to what is known as a hemolytic crisis: this is where red blood cells suddenly die. The trigger can be an infection. A hemolytic crisis can also be a reaction to a blood transfusion. It is noticeable through symptoms such as:

• rapidly falling blood pressure
• brownish urine
• chills
• Fever
• Yellow discoloration of the skin
• stomach pain
• Back pain
• Headache

A hemolytic crisis can lead to circulatory shock, which is life-threatening for those affected. In such a case, patients must be taken to hospital immediately!

Causes and risk factors: How does hemoglobin anemia occur?

The causes of anemia can be quite diverse. Basically, anemia can be present from birth due to certain genetic defects or can develop over the course of life. As already mentioned, anemia can also be a side effect of chronic diseases.

According to their mechanism of development, anemias can be divided into the following groups:

Anemia due to a disorder of blood formation

• Iron deficiency anemia

Chronic bleeding, for example as a result of very long or heavy menstrual bleeding, can lead to iron deficiency. Iron deficiency can also be the result of a bleeding stomach ulcer, but a diet low in iron (deficiencies) can also cause anemia. In addition, iron absorption in the intestines can be impaired. Anemia can also frequently occur during pregnancy and breastfeeding, because the need for iron is increased during these phases of life.

• Vitamin B12 anemia

If the body's absorption of vitamin B12 is impaired, a condition known as macrocytic hypochromic anemia can occur. This vitamin from the B complex group plays a central role in cell regeneration and amino acid metabolism. Chronic inflammation of the gastric mucosa or celiac disease can be the cause of this deficiency.

The so-called pernicious anemia is a special form of vitamin B12 deficiency anemia: Partial removal of the stomach, damage to the gastric mucosa or worm infestation of the intestine can lead to pernicious anemia.

• Folic acid deficiency anemia

An unbalanced diet or alcohol abuse can lead to a folic acid deficiency in the body and thus to macrocytic, hyperchromic anemia. Folic acid is a very important vitamin for blood formation and also for cell division.

• Aplastic anemia

A functional disorder of the bone marrow can cause reduced production of platelets, white and red blood cells.

This dysfunction can be a congenital disease, for example, but an acquired bone marrow dysfunction - for example due to medications, toxins or certain infectious diseases - is also possible.

• Renal anemia

Chronic kidney disease or kidney damage can lead to a weakening of the kidneys. As a result, the kidneys produce too little of the hormone erythropoietin: This is closely linked to the formation of erythrocytes (red blood cells): an erythropoietin deficiency therefore leads to renal anemia.

• Thalassemia

Due to a genetic defect, the formation of hemoglobin is impaired and thus also the production of red blood cells. Existing red blood cells are relatively small and also have a shortened lifespan. This type of anemia belongs to the category of microcytic, hypochromic anemias.

• Anaemia caused by other diseases

Chronic diseases are among the most common causes of anemia. However, viral infections, cancers such as leukemia, inflammations or autoimmune diseases can also cause anemia.

Anemia during pregnancy

Many pregnant women suffer from anemia. In many cases, the cause is an iron deficiency and/or a folic acid deficiency. Expectant mothers need more nutrients than women who are not pregnant. If the additional requirement is not properly met, this can have a negative effect on blood formation.

In addition, the female body retains more water during pregnancy. This leads to blood thinning, so that with each litre of blood fewer red blood cells - and therefore less oxygen - are transported through the organism.

As a rule, pregnant women can meet their increased iron requirements through an iron-rich diet. If there is an acute deficiency, an appropriate iron preparation is generally prescribed to prevent iron deficiency anemia in good time, as this can be dangerous not only for the pregnant woman but also for the unborn baby. Severe iron deficiency anemia increases the risk of premature birth or low birth weight of the child.

A folic acid deficiency during pregnancy can also lead to malformations in the baby, such as spina bifida. In order to avoid such a folic acid deficiency and folic acid deficiency anemia, appropriate folic acid supplements are taken.

Anemia due to severe blood loss

Internal or external injuries can lead to severe blood loss and thus anemia. If, for example, there is massive blood loss in an accident, anemia can occur, but other sources of bleeding are also important: These include, for example, a bleeding, undetected stomach ulcer or hemorrhoids.

Anemia due to increased breakdown of red blood cells

Erythrocytes live for around 120 days, after which the human body breaks them down. In the case of hemolytic anemia (Greek haíma = blood, lýsis = dissolution), erythrocytes are broken down too early. In such a case, their lifespan is less than 100 days. At the same time, the bone marrow no longer produces enough erythrocytes to compensate for the loss.

Many diseases can also lead to premature destruction of red blood cells. Possible causes of hemolytic anemia:

• Autoimmune diseases

The body’s own antibodies target the erythrocytes and destroy them.

• Infections (e.g. malaria)

Malaria pathogens multiply in the erythrocytes and ultimately destroy them.

• Heavy metal poisoning

Poisoning by heavy metals such as copper or lead directly destroys the red blood cells and also inhibits the proteins that are important for the formation of new erythrocytes.

• Obstacles in the blood vessels

Various obstacles in the vessels can damage the blood vessels.

• Hereditary diseases

Congenital genetic defects, for example, lead to the formation of deformed red blood cells. Since these have a sickle-shaped appearance, the condition is referred to as "sickle cell anemia", "thalassemia" or "Mediterranean anemia": the malformed erythrocytes are not as elastic as normal red blood cells and also burst more quickly.

Anaemia due to a distribution disorder

This type of anemia results, for example, when too much blood accumulates in a greatly enlarged spleen, but at the same time there is a lack of red blood cells (erythrocytes) in other parts of the body.