Disease diagnosis and treatment | Should iron be supplemented for anemia?

Anemia is a major public health concern. Globally, it is estimated that 40% of all children aged 6–59 months, 37% of pregnant women, and 30% of women 15–49 years of age are affected by anemia, according to the WHO.[1] Tests to measure hemoglobin levels are easy to administer. WHO defines anemia in children aged under 5 years and pregnant women as a hemoglobin concentration <110 g/L at sea level, and anemia in non-pregnant women as a hemoglobin concentration <120 g/L.[2]

PARTⅠ: Identifying the cause is crucial for the treatment

The common treatment methods for anemia include supplementing deficient nutrients (such as iron, folic acid, vitamin B12, etc.), blood transfusion therapy, erythropoiesis therapy, and primary disease treatment. Different types of anemia need to choose appropriate and correct treatment methods, otherwise, not only will the effect of treating anemia not be achieved, but the worsening of anemia will also seriously damage the functions of various systems. Therefore, identifying the nature and cause of anemia is crucial for treatment. Common anemia can be divided into nutritional anemia and chronic disease anemia based on their etiology, as shown in Figure 1.

PART Ⅱ: Four key parameters help to diagnose

1) Ferritin is a significant indicator for IDA

The serum ferritin (SF) criteria for diagnosing iron-deficient anemia (IDA) at different ages provided by the WHO are shown in Table 2.[3] Pregnancy SF<30 μ g/L indicates ID, but levels higher than this cannot exclude the possibility of iron deficiency.

2) FA & VB12 deficiency are the main causes of megaloblastic anemia

Megaloblastic anemia is a macrocytic anemia caused by DNA synthesis disorders and slow replication speed. Nutritional megaloblastic anemia caused by FA and/or VB12 deficiency accounts for more than 90% and is commonly seen in pregnant women and infants [4]. Based on a nutritional history or special medication history, anemia symptoms, digestive and neurological symptoms, and physical signs, if the blood sample shows macrocytic anemia (MCV>100 fl) or excessive neutrophil lobulation (5% or more or 6 lobes), the possibility of megaloblastic anemia is considered, and typical megaloblastic changes in bone marrow cells can be diagnosed. To determine whether it is a deficiency in FA or VB12, further examination is needed, as shown in Table 3 [4].

3) EPO-the final puzzle to clarify renal anemia

Renal anemia refers to anemia caused by the reduction of renal erythropoietin (EPO) production, the interference of some toxic substances in plasma with the production of red blood cells, and the shortening of their life span when renal function decreases in various kidney diseases. After patients with chronic kidney disease (CKD) were diagnosed with anemia through whole blood cell count and other tests, SF, FA, and VB12 were tested to determine the cause. After all were ruled out, further testing was conducted to determine renal anemia if there was no significant increase in serum EPO levels [5].

Part Ⅲ: Applicable population for anemia testing

1) Children

2) Women

3) Elderly people

4) Patients with chronic disease (including chronic kidney disease, tumors, etc.)

Part Ⅳ: MAGLUMI Anemia Solution Panel

Snibe provides Ferritin, FA, VB12, and EPO testing assays to help effectively diagnose the causes of anemia, and assist in the diagnosis, treatment, and timely intervention of anemia.

References:

[1] The World Health Organization, Anaemia, https://www.who.int/news-room/fact-sheets/detail/anaemia

[2] World Health Organization. 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity Accessed August 4, 2017 https://www.who.int/vmnis/indicators/haemoglobin.pdf .

[3] World Health Organization (2020). WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations . Geneva, Switzerland. ISBN ?978-92-4-000012-4 . OCLC ?1265083396

[4] 刘小荣. 儿童慢性肾脏病贫血诊断与治疗专家共识[J]. 中国实用儿科杂志, 2018(7):493-497.

[5] 中国肿瘤相关贫血诊治专家共识(2023版). 中华肿瘤杂志, 2023,45(12): 1032-1040.