Hypoerythrocytes (HBC) isn’t strictly a medical condition; it’s an abnormal result found on a routine blood test. It generally refers to a red blood cell (RBC) count, hematocrit (Hct), or hemoglobin (Hb) concentration below normal. This represents a decrease in the volume of peripheral red blood cells, below the lower limit of the normal range. Medically, this condition is known as anemia. It can be caused by a variety of factors, primarily decreased erythrocyte production, excessive destruction of red blood cells, and blood loss. Symptoms vary depending on the cause and severity of the condition. Common symptoms include fatigue, pale skin and mucous membranes, difficulty concentrating, dizziness, shortness of breath, and a rapid heart rate. Treatment should be directed at the underlying cause, while symptom relief should include blood transfusions, medication, and, if necessary, surgery.
Epidemiology
Contagious
Not contagious.
Incidence
There are currently no clear data on the incidence rate.
High-risk population
It is more common in patients with chronic diseases, people with long-term blood loss, pregnant women, etc.
Causes
Overview
This disease itself is not a specific disease, but an abnormal manifestation of the human body. It can be caused by many factors, generally including three major reasons: decreased red blood cell production, excessive red blood cell destruction, and blood loss.
Basic cause
1. Insufficient or decreased red blood cell production
The production of red blood cells depends mainly on three factors: hematopoietic cells, hematopoietic microenvironment and regulatory factors, and hematopoietic raw materials. Erythropoiesis originates from multipotent hematopoietic stem cells; bone marrow stromal cells provide the microenvironment for red blood cell production; erythropoietin (Epo) is the most important regulatory factor, acting at the level of erythroid progenitor cells to promote red blood cell production; proteins, lipids, vitamins, and trace elements are all essential hematopoietic raw materials. Common mechanisms of insufficient red blood cell production include:
(1) Bone marrow failure: including a decrease in the number or quality of hematopoietic stem and progenitor cells, such as aplastic anemia (AA), pure red cell aplasia (PRCA) and Fanconi anemia (FA).
(2) Ineffective hematopoiesis: including acquired and hereditary ineffective hematopoiesis, the former such as myelodysplastic syndrome (MDS), the latter such as congenital erythropoietic anemia.
(3) Bone marrow suppression: For example, radiotherapy or chemotherapy for tumors causes damage to hematopoietic cells.
(4) Bone marrow infiltration: Hematological malignancies and tumor bone marrow metastasis can directly cause a decrease in effective hematopoietic tissue in the bone marrow.
(5) Abnormal hematopoietic regulatory factors: such as decreased EPO synthesis caused by chronic renal failure, and increased hematopoietic negative regulatory factors such as tumor necrosis factor, interferon, and iron metabolism regulatory factors in chronic disease anemia.
(6) Abnormal hematopoietic microenvironment: The hematopoietic microenvironment is composed of a variety of stromal cell components, macromolecular bioactive substances, microcirculation, neuroendocrine factors and a complex network between them, providing the necessary conditions and places for the differentiation, development, proliferation and maturation of hematopoietic stem cells. Therefore, it is speculated that abnormal hematopoietic microenvironment can also lead to anemia.
(7) Deficiency of hematopoietic substances: Folic acid and/or vitamin B12 deficiency leads to impaired DNA synthesis in cells, causing megaloblastic anemia. Iron is an important substance for the synthesis of hemoglobin, and iron deficiency can cause iron deficiency anemia.
2. Excessive destruction of red blood cells
Red blood cell destruction mainly involves two mechanisms: intrinsic and extrinsic.
(1) Intrinsic defects of red blood cells: The basic structure of red blood cells includes cell membrane, metabolic enzymes and hemoglobin. Abnormalities or defects in these structures can shorten their lifespan.
(2) External factors of red blood cells: They can be basically divided into immune-related and non-immune-related factors. The former is mainly caused by humoral immune antibodies mediated by red blood cell destruction, while the latter can be caused by a variety of non-immune factors, such as physical (mechanical, temperature, etc.), chemical (chemical poisons, drugs, metabolic and biological toxins, etc.) and biological (microbial infection).
3. Blood loss
Long-term chronic blood loss can lead to anemia, while acute blood loss mainly causes hemodynamic changes.
symptom
Overview
This disease is mainly discovered through routine blood tests. The specific symptoms are related to the patient’s own condition, the cause of the disease, the degree of decrease in blood oxygen carrying capacity, the degree of decrease in blood volume, the speed of anemia occurrence, the compensation and tolerance of various systems (blood, circulation, respiration), and other factors. The most common symptom is fatigue.
Typical symptoms
1. Nervous system
(1) Headache, dizziness, weakness, syncope, insomnia, nightmares, tinnitus, blurred vision, memory loss, and inattention are common symptoms of anemia.
(2) Numbness of the extremities may be caused by peripheral neuritis complicated by anemia, which is particularly common in vitamin B deficiency megaloblastic anemia.
(3) Children suffering from iron deficiency anemia may cry, become restless and agitated.
2. Skin and mucous membranes
(1) Pallor is the main manifestation of anemia in the skin and mucous membranes.
(2) Roughness, lack of luster, and even ulcer formation are related to the reduced blood supply and malnutrition of the skin and mucous membranes caused by anemia, and may also be related to the primary disease of anemia.
(3) Hemolytic anemia can cause yellowing of the skin and mucous membranes.
3. Respiratory system
(1) Mild anemia: The breathing rate may not increase when the patient is at rest, but the breathing may become faster and deeper after activity.
(2) In severe anemia, patients may experience shortness of breath or even sit-up breathing even when they are calm.
(3) Complications of anemia and the primary diseases that cause anemia may also affect the respiratory system, causing corresponding lung symptoms, signs and X-ray manifestations.
4. Circulatory system
(1) In acute hemorrhagic anemia, peripheral vasoconstriction, increased heart rate, and subjective palpitations may occur.
(2) Non-hemorrhagic anemia: The main manifestation is the heart’s response to tissue hypoxia: in mild anemia, there may be no obvious symptoms in a resting state, and palpitations and increased heart rate may occur only after activity; in moderate and severe anemia, palpitations and increased heart rate may occur regardless of the state, and the more severe the anemia, the more obvious the symptoms.
5. Digestive system
(1) Decreased digestive function and indigestion, resulting in abdominal distension, decreased appetite, and changes in bowel movement and characteristics.
(2) Long-term chronic hemolysis may be accompanied by bile duct stones and/or inflammation.
(3) Iron deficiency anemia may cause a foreign body sensation when swallowing. Iron deficiency anemia caused by hookworm disease may be accompanied by pica.
6. Urinary system
(1) Clinical manifestations of primary renal disease.
(2) Oliguria, anuria, and renal insufficiency.
7. Endocrine system
Long-term anemia can affect the functions of the thyroid gland, gonads, adrenal glands, and pancreas, leading to abnormal hormone secretion.
8. Reproductive system
Long-term anemia can affect the secretion of testosterone and weaken male characteristics; for women, anemia can not only affect the secretion of female hormones, but also lead to menstrual abnormalities.
9. Immune System
It can lower the body’s immunity.
complication
1. Long-term anemia, overloaded heart and insufficient blood supply will lead to anemic heart disease. At this time, there will be not only changes in heart rate, but also abnormal heart rhythm, heart structure, and even heart failure.
2. Long-term iron deficiency anemia in children can affect intellectual development and cause intellectual disabilities.
3. Megaloblastic anemia or pernicious anemia can cause glossitis, atrophy of lingual papillae, beef tongue, mirror tongue, etc.
examine
Scheduled inspection
Patients experiencing symptoms such as fatigue, pale skin and mucous membranes, difficulty concentrating, dizziness, shortness of breath, and a rapid heart rate should seek medical attention and undergo examinations promptly. Doctors will perform routine blood tests, bone marrow examinations, and pathogenesis tests to gain a detailed understanding of the patient’s condition, identify the underlying cause, and make a diagnosis.
Laboratory tests
1. Routine blood test
It can indicate the presence and severity of anemia and determine whether there are changes in white blood cell or platelet counts. Parameters such as mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) can be used to classify red blood cell morphology in anemia, providing clues for diagnosis. Reticulocyte count indirectly reflects bone marrow erythroid proliferation and compensation. Peripheral blood smears can be used to observe changes in red blood cell, white blood cell, and platelet counts or morphology, as well as the presence of malarial parasites and abnormal cells.
2. Bone marrow examination
Bone marrow cell smears reflect the degree of proliferation, cell composition, proportion and morphological changes of bone marrow cells, and bone marrow biopsy reflects the structure, degree of proliferation, cell composition and morphological changes of bone marrow hematopoietic tissue, which are valuable for the diagnosis of diseases.
3. Examination of the pathogenesis of anemia
The doctor will select appropriate tests to find the cause of the disease based on the patient’s specific symptoms, such as iron metabolism and primary diseases that cause iron deficiency anemia, serum folic acid and vitamin B12 level determination and primary diseases that cause the lack of such hematopoietic raw materials in megaloblastic anemia , and primary diseases of hemorrhagic anemia.
diagnosis
Diagnostic principles
The doctor will ask about the patient’s medical history, understand the patient’s abnormal manifestations, the time when the symptoms appeared, and whether they have worsened. The doctor will make a comprehensive diagnosis based on the patient’s clinical manifestations and the results of various laboratory tests. Among them, the results of routine blood tests are the main basis for diagnosis.
Diagnostic basis
The domestic standards are:
1. Adult males: Hb＜120g/L, RBC＜4.5×10 12 /L and Hct＜0.42.
2. Adult females: Hb＜110g/L, RBC＜4.0×10 12 /L and Hct＜0.37.
3. Pregnant women experience blood dilution due to increased plasma volume. The standards are: Hb < 100g/L, Hct < 0.30.
treat
Treatment principles
This disease can be caused by a variety of factors and should be treated according to the specific condition. Eliminating the cause is the key to treatment. Doctors will treat based on the cause, aiming to address both the symptoms and the root cause, ultimately achieving a cure.
Treatment of the cause
The doctor will give appropriate treatment according to the patient’s cause of illness to eliminate the cause. The following are some common situations:
1. Iron deficiency anemia: Iron supplementation and treatment of the primary disease that causes iron deficiency.
2. Supplement folic acid or vitamin B12 for megaloblastic anemia .
3. Hemolytic anemia is treated with glucocorticoids or splenectomy.
4. Splenectomy has a definite therapeutic effect on hereditary spherocytosis.
5. Hematopoietic stem cell dysplasia anemia is treated with stem cell transplantation.
Symptomatic treatment
1. Patients with severe anemia, the elderly, or anemia patients with cardiopulmonary insufficiency should receive red blood cell transfusions to correct anemia and improve the body’s hypoxia.
2. Patients with acute massive blood loss should receive blood transfusion or red blood cell and plasma transfusion in time to quickly restore blood volume and correct anemia.
3. For patients with anemia and bleeding, different hemostatic treatments should be adopted according to the different bleeding mechanisms (such as platelet transfusion for severe thrombocytopenia).
4. For patients with anemia and infection, anti-infection treatment should be given as appropriate.
5. For patients with anemia and other organ dysfunction, different supportive treatments should be given according to the different organs and the degree of dysfunction.
6. Patients with congenital hemolytic anemia who have received multiple blood transfusions and are complicated by hemochromatosis should be given iron chelation treatment.
General treatment
Blood transfusion is a symptomatic treatment for anemia, but due to the numerous side effects and complications, its indications should be strictly controlled. Chronic anemia with a hemoglobin level below 60 g/L and acute blood loss exceeding 30% of total blood volume are indications for blood transfusion. Leukocyte-depleted blood should be transfused. Other supportive care includes correcting the patient’s general condition and effectively controlling infection and bleeding. Iron chelation therapy should be administered to patients who develop iron overload secondary to repeated blood transfusions.
Drug treatment
1. Supplement the elements or factors required for hematopoiesis
Anemia caused by lack of hematopoietic elements or factors can achieve good therapeutic effects after reasonable supplementation. For example, megaloblastic anemia caused by iron deficiency anemia, vitamin B12 or folic acid deficiency can quickly improve after supplementing the corresponding hematopoietic elements .
2. Hematopoietic growth factors or hematopoietic stimulating drugs
Renal anemia, characterized by decreased erythropoietin biosynthesis, is an indication for erythropoietin therapy. Furthermore, erythropoietin also has some therapeutic effects in certain chronic anemias. Androgens stimulate bone marrow hematopoiesis and have erythropoietin-like effects, making them effective in chronic aplastic anemia.
3. Immunosuppressants
It is indicated for anemias with immune-related pathogenesis. Glucocorticoids are the mainstay of treatment for autoimmune hemolytic anemia (warm antibody type) or pure red cell aplasia. Antithymocyte globulin or antilymphocyte globulin and cyclosporine can be used to treat aplastic anemia, especially in severe cases. Cyclophosphamide and mycophenolate mofetil are also commonly used in immunosuppressive therapy.
4. Monoclonal Antibodies
Anti-human CD20 monoclonal antibodies can be used as second-line treatment for autoimmune hemolytic anemia. Anti-human complement protein C5 monoclonal antibodies have significantly improved the efficacy of patients with classic paroxysmal hemoglobinuria.
Related drugs
Ferrous sulfate, cyclosporine, cyclophosphamide, mycophenolate mofetil, monoclonal antibodies
Surgical treatment
1. Allogeneic hematopoietic stem cell transplantation
It is suitable for patients with bone marrow hematopoietic failure or certain severe hereditary anemias such as severe aplastic anemia, thalassemia, and sickle cell anemia. The preferred source of stem cells is peripheral blood or bone marrow from human leukocyte antigen (HLA)-matched related or unrelated donors.
2. Splenectomy
The spleen is the primary site of red blood cell destruction. Splenectomy is indicated for certain anemias, including hereditary spherocytosis, hereditary elliptocytosis, autoimmune hemolytic anemia refractory to medical therapy, and hypersplenism.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution, and may vary from person to person.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
The prognosis of this disease varies from person to person. Generally speaking, the prognosis is better after actively identifying the cause and treating the cause. However, some patients may have serious primary diseases, such as malignant tumors, which may also lead to poor prognosis.
Hazards
1. The patient’s mental state, physical strength, cognitive ability, and immunity may be significantly affected, making it impossible for them to work and live normally.
2. Pregnancy complicated by anemia will have short-term and long-term effects on the mother, fetus and newborn. For the mother, it can increase the risk of gestational hypertension, premature rupture of membranes, puerperal infection and postpartum depression; for the fetus and newborn, it can increase the risk of fetal growth restriction, fetal hypoxia, reduced amniotic fluid, stillbirth, neonatal asphyxia and neonatal hypoxic-ischemic encephalopathy.
3. Some patients have serious conditions and the primary disease is difficult to cure, which may lead to adverse outcomes such as death.
Curative
Whether this disease is curable depends on the underlying cause. For example, megaloblastic anemia and iron-deficiency anemia can be cured in most patients with timely diagnosis and treatment. However, anemia caused by hematologic malignancies is difficult to cure and has a poor prognosis.
daily
Overview
Patients should adjust their mentality, develop good living habits in daily life, and actively cooperate with doctors for treatment to achieve a good prognosis.
Life Management
1. Rest
Rest can reduce the burden on the heart and lungs and alleviate hypoxia. Patients with mild anemia can exercise moderately and take care of themselves, but they need more rest. Patients with severe anemia need to stay in bed to meet their basic needs and prevent secondary skin infections.
2. Skin care
Patients with anemia are more susceptible to skin infections. For patients with severe anemia, clean the skin and prevent skin breakdown. Pressure sores are more likely to develop in hypoxic environments, so bedridden patients should be regularly turned to prevent them.
3. Oral care
Rinse your mouth with saline or boric acid solution after eating to remove food debris. For oral mucosal ulcers, perform oral care 2-3 times daily and apply oral ulcer ointment topically. Brush your teeth with a soft-bristled toothbrush. When the air is dry, apply compound peppermint oil to your lips to moisten them and prevent them from drying out.
diet
Dietary adjustment
A reasonable diet has positive significance for the treatment and control of disease development. Patients should strengthen their nutrition, supplement high-quality protein, and ensure the intake of vitamins.
Dietary recommendations
1. Patients should choose a diet high in protein, calories, iron and vitamins, and adjust it according to the cause of the disease.
2. Patients with iron deficiency anemia and anemia caused by folic acid vitamin deficiency should focus on consuming liver, beef, and green vegetables.
3. For patients with oral pain and oral mucosal ulcers, they are encouraged to eat small meals frequently and drink plenty of water. Their diet should mainly consist of light and easily digestible foods.
Dietary taboos
Avoid high-fat foods, soy milk, alkaline foods, tea, coffee, vegetables and fruits rich in tannic acid, such as peach kernels, almonds, kelp, carrots, etc., to remove factors that reduce or inhibit iron absorption.
prevention
Preventive measures
There is currently no clear and effective vaccine for this disease, but appropriate prevention measures can be taken based on the cause of the disease, which has a certain preventive effect.
1. Eat more iron-rich foods, such as lean meat, pork liver, egg yolks, and kelp. Pay attention to a reasonable diet.
2. Many chemical and physical factors can damage the bone marrow. Chemical factors such as benzene, organic arsenic, anti-tumor drugs, and sulfonamides; physical factors such as X-rays and neutrons can damage the bone marrow and are major enemies of hematopoiesis. Therefore, protective measures should be strictly implemented and operating procedures should be followed. In particular, the abuse of drugs that are harmful to hematopoiesis should be avoided. Unnecessary X-ray exposure should also be avoided.
3. Actively treat various hemorrhagic diseases such as hookworm disease and functional uterine bleeding to avoid massive blood loss.
Medical Guide
Outpatient indications
1. Anemia is found during physical examination, or systemic manifestations such as persistent fatigue, drowsiness, pale complexion, weight loss, low immunity, malnutrition, etc.
2. Accompanied by recurrent dizziness, headache, memory loss, inattention, etc.
3. With spoon-shaped nails, the nails become flat, or even concave and spoon-shaped (inverted nails), lack luster, are brittle and easy to crack.
4. Accompanied by bleeding tendency, repeated skin bruises, nose bleeding, gum bleeding, difficult wound healing, bloody stools, etc.
5. Women have heavy menstrual periods or long-term abnormal vaginal bleeding.
6. Those with long-term and recurrent coughing and hemoptysis, accompanied by other lung and tracheal symptoms.
7. People with long-term vomiting of blood, black stools and other gastrointestinal symptoms.
8. Children’s growth and development are slow.
9. Other severe, persistent or progressive symptoms occur.
All of the above require prompt medical consultation.
Treatment department
This disease falls under the diagnosis and treatment of hematology, and patients can go to the hematology department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A blood test may be performed, and it is best to have the visit in the morning on an empty stomach.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. Do you usually feel weak, sleepy, pale, or have a weak immune system? Or do you have dizziness, headaches, memory loss, or difficulty concentrating?
2. Do your symptoms get worse over time?
3. Do you have any bleeding symptoms, such as coughing up blood, vomiting blood, nose bleeding, bleeding gums, blood in the stool, etc.?
4. Have you ever had anemia? What caused it? What treatments did you receive?
5. Have you recently experienced heavy bleeding from trauma, menorrhagia, or blood donation?
6. How has your diet been recently? Is your diet balanced? Are you experiencing any malnutrition or iron deficiency?
7. Do you suffer from diseases such as tuberculosis, peptic ulcer, hemorrhoids, etc. that may cause blood loss?
8. Do you or any of your relatives have genetic blood diseases such as hemophilia?
What questions can patients ask?
1. What is the most likely cause of my anemia?
2. What tests do I need to do?
3. Is my condition serious? Can it be cured?
4. What treatment do I need now? Do I need to be hospitalized?
5. Are there any risks associated with these treatments?
6. If medication is used, what are the usage, dosage, and precautions?
7. I have other diseases. Will they affect my treatment?
8. Will my anemia recur? How should I take care of myself on a daily basis?
9. Do I need follow-up examinations? How often?