Journal of Clinical & Experimental Pathology
Open Access

Anemia is a common illness that is defined by a decrease in hemoglobin concentration or red blood cell count, which lowers the blood's ability to carry oxygen. This disorder is an important field of clinical pathology research and has significant clinical implications. Effective patient care requires an understanding of the pathogenesis, categorization, diagnosis, and treatment of anemia. The pathophysiology of anemia involves various mechanisms. Decreased RBC production can result from bone marrow disorders, nutritional deficiencies (e.g., iron, vitamin B12, folate), chronic diseases, and hormonal imbalances. Hemolysis can occur due to intrinsic factors (e.g., hereditary spherocytosis, sickle cell disease) or extrinsic factors (e.g., autoimmune hemolytic anemia, infections). Acute or chronic bleeding from gastrointestinal ulcers, trauma, or menstruation can lead to anemia. Dilutional anemia is seen in conditions like pregnancy or fluid overload, where plasma volume increases disproportionately to RBC mass. Anemia is classified based on the Mean Corpuscular Volume (MCV) into microcytic, normocytic, and macrocytic anemia.

Microcytic anemia

The appearance of tiny, frequently hypochromic red blood cells in a peripheral blood smear is known as microcytic anemia, and it is typically identified by a low MCV. The most frequent cause of microcytic anemia is iron deficiency. The causes of hypochromic microcytic anemia include gastrectomy, low vitamin C intake, pathologies of the small intestines such as hepatitis and chronic diarrhea, and decreased iron content in the diet. Blood loss can occur from malabsorption, chronic infections, inflammatory disorders, or cancers and is linked to insufficient food intake.

Normocytic anemia

This kind of anemia known as normocytic normochromic anemia occurs when the Red Blood Cells (RBCs) in circulation have a normal red color and are the same size (normocytic). A minority of normochromic, normocytic anemias is caused by primary blood disorders, but the majority is the result of other conditions. RBCs are of normal size, but their number is reduced and is often associated with renal disease or chronic inflammation and also bone marrow failure leading to decreased production of all blood cells.

Macrocytic anemia

A blood condition known as macrocytic anemia develops when the bone marrow makes unusually large red blood cells. The nutrients that regular red blood cell function depends on are absent from these aberrant blood cells. The majority is caused by alcohol usage, which is followed by vitamin B12 and folate deficiencies as well as medication. Middle-aged women are more likely to have autoimmune reasons. In older patients, macrocytic anemia is more common in instances of hypothyroidism and primary bone marrow illness.

The clinical presentation of anemia varies based on its severity and underlying cause. The diagnostic workup for anemia includes a comprehensive history, physical examination, and laboratory investigations. Complete Blood Count (CBC) provides information on hemoglobin concentration, hematocrit, RBC count, MCV, Mean Corpuscular Hemoglobin (MCH), and Mean Corpuscular Hemoglobin Concentration (MCHC). Peripheral blood smear examines RBC morphology, which can provide clues to the underlying cause (e.g., microcytic, macrocytic, normocytic, spherocytes, sickle cells). Reticulocyte count measures the number of young RBCs, indicating bone marrow response to anemia. The treatment of anemia focuses on addressing the underlying cause, alleviating symptoms, and preventing complications. Recent advancements in anemia research have led to improved diagnostic techniques and therapeutic options. Genetic testing identifies hereditary anemias like thalassemia and sickle cell anemia, enabling carrier screening and prenatal diagnosis. Stem cell research offers potential for regenerative therapies in bone marrow failure syndromes. Artificial Intelligence (AI) algorithms assist in interpreting complex hematological data and predicting treatment responses. Some patients may not respond adequately to conventional therapies, requiring novel and personalized treatment strategies. In low-resource settings, limited access to diagnostic facilities and treatments poses a significant barrier to effective anemia management.

Anemia can have a variety of effects on people's lives. Certain varieties of this illness have modest symptoms that get better with care. Treatment can alleviate the moderate symptoms of certain kinds of this illness. A severe case of anemia may be fatal. This might also be a sign of more serious illnesses like cancer. Anemia is a multifaceted condition with significant implications in clinical pathology. Advances in research continue to enhance our ability to diagnose and treat anemia, though challenges remain. Addressing these challenges through innovative research and global health initiatives is crucial for improving outcomes for patients with anemia worldwide.