Hyperchromic anemia - causes and symptoms of the disease, diagnosis, treatment methods and prevention

Hyperchromic anemia

– a group of blood diseases with a color index above 1.15, characterized by impaired hematopoietic function.

Hyperchromic macrocytic anemia includes the following diseases:

— B12-deficiency anemia;

— Folate deficiency anemia;

— Myeloplastic syndrome.

The role of the CPU color index

If pallor or hypochromia of red blood cells occurs, then they become very pale, and the amount of light color in the center of the red blood cells, and the width of this zone, is significantly increased.
The color index, or a measure of the saturation of red blood cells with hemoglobin, helps to quantify the degree of hypochromia of red blood cells. If the blood color index is less than 0.8, then this morphological diagnosis can be made with confidence. In case if:

• the blood is “healthy” and does not contain hypochromic red blood cells, then the color index value will be above 0.85 and below 1.05. This is an acceptable hemoglobin content that is capable of normal gas exchange;
• the color index is less than 0.8, and there is a normal amount of red blood cells - this means that each of them or almost all of them has less hemoglobin than necessary and there is the presence of hypochromia;
• Sometimes the opposite picture occurs - hyperchromia, when the color index is higher than 1.1.

When the color index is very high and exceeds the norm, amounting to 1.4 or more, then we can talk about a deficiency of cyanocobalamin (vitamin B12). Such hyperchromic anemia is an indicator of vitamin deficiency and is called pernicious.

Diagnostics

The absence of a specific clinical picture for anemia of any type increases the importance of diagnostic measures to clarify the disease. A general blood test is the primary test, the results of which can show changes in the structure of red blood cells (shape and size of cells) and detect nuclear Jolly bodies. If there is a suspicion of hyperchromic anemia, the doctor additionally prescribes:

• biochemical blood test - to determine the level of bilirubin, serum iron level;
• fluoroscopy of the abdominal cavity (abdominal organs);
• Ultrasound of the digestive organs;
• immunological study - helps to identify antibodies that are specific against the cytoplasmic antigens of gastric parietal cells and the internal factor of Castle.

Symptoms

Discomfort in the heart area may indicate anemia

The onset of hyperchromic anemia in most patients is not accompanied by any complaints. The only manifestation of the pathological condition may be pallor and/or fatigue.

As the disease progresses, general symptoms will appear:

• increasing weakness, fatigue, decreased performance;
• headaches, dizziness, tinnitus;
• thinning hair, nails, increased fragility;
• shortness of breath independent of physical activity;
• increased heart rate;
• lability of blood pressure;
• the occurrence of spontaneous pain in the heart area;
• the skin acquires a yellowish tint, the sclera becomes icteric;
• auscultation of a systolic murmur at the apex of the heart. The advanced stages of hyperchromic anemia are indicated by the appearance of a rough systolic-diastolic murmur.

Complaints from the digestive organs are typical. In this case, patients note a perversion of taste, decreased appetite, heaviness and a feeling of fullness in the stomach, alternating constipation and diarrhea, and discomfort in the right hypochondrium.

Varnished tongue for anemia

• Vitamin B12 deficiency anemia. Causes, development of the disease

A distinctive feature is the “varnished” tongue - a change in the color of the tongue to bright crimson with a transformation of its surface, which becomes smooth and shiny. Patients experience almost constant pain in the tongue - during conversation, eating and at rest. Taste buds also undergo changes - sensitivity in them becomes dulled, food becomes tasteless, and habitual gastronomic preferences do not bring satisfaction. The condition worsens with the addition of bleeding gums.

Damage to the nervous system is manifested by numbness in the arms and legs, a crawling sensation, muscle weakness, and periodic cramps.

Prevention

Following the principles of a healthy diet, maintaining a good level of vitamins B9 and B12, and iron is the simplest and most important way to protect against hyperchromic anemia, especially for pregnant women. The diet used to treat it is also preventive in nature. Additionally worth:

• visit a gastroenterologist regularly;
• exercise;
• stop smoking;
• do not contact with pesticides;
• to walk outside;
• promptly treat infectious diseases and remove parasites;
• take vitamin and mineral complexes.

Causes

Deficiency of vitamin B12 (cyanocobalamin) and folic acid are the most common starting points for the development of hyperchromic anemia, but these conditions can occur under the influence of a number of factors. There is a specific list of reasons for each situation. Lack of cyanocobalamin is provoked by:

• pathological processes in the ileum, in which the digestibility of nutrients is impaired due to poor absorption by its walls;
• infectious intestinal pathologies, which also disrupt the absorption of vitamins;
• worms – tapeworms and bacteria actively absorb vitamin B12;
• atrophic gastritis, in which insufficient synthesis of intrinsic Castle factor (an enzyme that converts cyanocobalamin from an inactive form to an absorbable one) is observed in the parietal cells of the stomach.

In hyperchromic anemia, which occurs as a result of folic acid deficiency, the provoking factors look different. Women often encounter this condition during pregnancy, since all the folic acid is used to build the neural tube of the fetus. The influence may also be exerted by:

• alcoholism;
• liver diseases (especially hepatitis, cirrhosis, liver failure).

Separately, doctors mention hyperchromic macrocytic anemia, which is hereditary in nature (autosomal recessive transmission from parents) and develops against the background of genetic mutations, and in women, a prerequisite for its occurrence is the use of hormonal drugs. If we do not consider individual types of anemia, in which hyperchromic nuclei appear in red blood cells, common causes include:

• prolonged fasting or poor nutrition (with a deficiency of vitamins and microelements in food);
• smoking;
• presence of tumors;
• infections (especially HIV) and viruses;
• regular large loss of blood during menstruation;
• stomach cancer, gastrectomy (complete excision);
• hypothyroidism (thyroid hormone deficiency);
• taking medications (Metformin, Neomycin, Difenin);
• frequent intestinal disorders.

Persons who have hyperchromic anemia combined with myeloplastic syndrome often experience dizziness and increased fatigue. Chest pain with strong heartbeat and shortness of breath is possible. If the nervous system is severely damaged, the sensitivity of the fingers (toes and arms) is impaired, and loss of consciousness and convulsions may occur. Blood pressure is predominantly low, the liver is enlarged (palpable by palpation).

Health implications

In childhood, hyperchromic anemia is dangerous due to delayed mental and physical development. The child will be more susceptible to various diseases, his immunity will not be able to cope with infections. Such children get sick for a long time and seriously.

Anemia is dangerous for pregnant women who may experience premature labor. The fetus will suffer from a lack of nutrients, the child may be born with underweight and developmental abnormalities. Therefore, during pregnancy you need to regularly visit an obstetrician-gynecologist.

Other consequences of anemia include: cardiomyopathy, tachycardia, heart failure. Therefore, treatment of this disorder must be timely.

Author of the article:

Shutov Maxim Evgenievich |
Hematologist Education: Graduated from Kursk State Medical University in 2013 and received a diploma in General Medicine. After 2 years, he completed his residency in the specialty “Oncology”. In 2021, she completed postgraduate studies at the National Medical and Surgical Center named after N.I. Pirogov. Our authors

Treatment of hyperchromia

Correcting folate deficiency with medications

• B12 deficiency anemia: symptoms, causes, treatment

There is no isolated treatment for hyperchromic anemia, since treatment of the condition that led to hyperchromatosis is necessary.

Since the most common causes of the pathological syndrome are hypovitaminosis B12 and B9, treatment of these conditions is provided:

• if there is a lack of folic acid, the administration of medications based on B9 is indicated;
• the lack of cyanocobalamin is eliminated by its additional administration;
• good nutrition, refusal of diets, vegetarianism.

Dosages of medications are calculated individually, depending on the severity of the patient’s condition. This applies to the duration of treatment and dosage forms of medications.

In severe conditions, patients are advised to receive red blood cell transfusions.

In patients with myelodysplastic syndrome, the treatment process is long. In addition to vitamin therapy, it is necessary to use not only red blood cells, but also platelets. Immunoglobulins are widely used. One of the most effective treatment methods in such cases is the use of drugs to activate the processes of maturation and division of blood cells. The goal of treatment for myelodysplastic syndrome is to prevent the condition from developing into acute forms of leukemia.

What is hyperchromic anemia

The disease, known to most people as anemia, in official medicine called “anemia”, is associated with a drop in hemoglobin levels. In the hyperchromic form, the number of healthy red blood cells simultaneously decreases and defective ones appear: containing excess iron. Thanks to this substance, the blood cells become saturated with hemoglobin, so their median clearing is covered with a scarlet color (this can be seen in laboratory tests). There are 2 types of hyperchromic anemia:

• Megaloblastic (macrocytic) - characterized by a violation of DNA and RNA synthesis, which leads to the appearance of very large red blood cells (megaloblasts and megalocytes) in the bone marrow. This anemia can be inherited.
• Non-megaloblastic - DNA synthesis is normal, the bone marrow does not produce megaloblasts, but defective red blood cells are present.

Most doctors do not consider anemia to be an independent disease, since it can develop against the background of a primary lesion of the blood system or with other pathologies that are in no way related to this. For this reason, there is no strict nosological classification and, in addition to the already mentioned division of the hyperchromic type into 2 types, there is a grouping according to the conditions to which it corresponds:

• Vitamin B12 deficiency (pernicious) anemia - Addison-Birmer disease, malignant anemia caused by a lack of vitamin B12. It is characterized by the formation of immature megaloblasts in the bone marrow and can manifest as neurological disorders.
• Folate deficiency anemia is also pernicious anemia, but occurs when there is a deficiency of folic acid.
• Myelodysplastic syndrome - characterized by cytopenia (deficiency of one or more types of blood cells) in the peripheral blood, dysplasia (improper development) of the bone marrow. The disease is prone to transition to the acute form of leukemia (poor-quality damage to the hematopoietic system), and is difficult to treat (maintenance therapy is carried out). According to official statistics, 80% of patients with myelodysplastic syndrome are over 60 years of age.

Mechanisms of hematopoietic damage

Vitamin B12 and folates (folic acid salts) perform an important function in the synthesis of cell DNA: they are essential enzymes, without which the biochemical process stops. It is impossible to accumulate a sufficient amount in the liver. The body needs constant replenishment of the necessary components.

Pathology develops gradually when all reserves are exhausted. During the process of hematopoiesis, the division of erythroblast cells is disrupted. They turn into megaloblasts. A similar type of erythrocyte germ was present in humans in the embryonic state.

Definition and classification of cardiotonic drugs.

Cardiac glycosides are substances of plant origin, Spanish. for the treatment of heart failure associated with myocardial dystrophy. Increases the performance of the myocardium, ensures efficient functioning of the heart.

The most commonly used are: digitoxin (from foxglove purpurea), digoxin, celanide (woolly foxglove), strophanthin K (strophanthin Combe), korglykon (lily of the valley), infusion of adonis herb.

Cardiotonic drugs with a non-glycoside structure - adrenergic agonists, dopamine, glucagon, and methylxanthines also have a stimulating effect on the heart. But they cause many unwanted effects.

2.1.Medicines that stimulate β1-adrenergic receptors (dopamine, dobutamine)

2.2. Phosphodiesterase inhibitors (amrinone, milrinone).

Antianginal - drugs used to treat angina pectoris. Coronary insufficiency occurs when there is a mismatch between the heart's need for oxygen and its blood supply. Hence, there are two principles of action of effective substances: either reducing the work of the heart (and reducing its need for oxygen), or increasing blood supply to the heart.

Agents that reduce the myocardial oxygen demand and improve its blood supply.

Organic nitrates (nitroglycerin, nitrong, trinitrolong)

Calcium channel blockers (nifedipine, verapamil, amlodipine)

Potassium channel activators (pinacidil, nicorandil)

Various drugs with antianginal activity (amiodarone)

Drugs that reduce myocardial oxygen demand

β1-blockers (talinolol, metoprolol, atenolol)

bradycardic drugs (alinidine, falipamil)

Agents that increase oxygen delivery to the myocardium

3.1. Myotropic coronary dilators (dipyridamole)

3.2. Reflex agents that eliminate coronary spasm (validol)

Cardioprotective drugs (preductal MV)

Erythropoiesis stimulants include epoetins, cyanocobalamin, folic acid, and iron supplements.

Epoetin alfa and Epoetin beta (Erythrostim, Recormon) are recombinant preparations of human erythropoietin. Used for anemia associated with bone marrow damage and chronic renal failure. Injected subcutaneously or intravenously.

Diuretics are intended mainly to remove excess water from the body and eliminate swelling. They are also used to lower blood pressure.

Substances that have a direct effect on the function of the renal tubular epithelium.

Substances containing sulfonamide group

Thiazides (dichlothiazide, cyclomethiazide)

Compounds of “nethiazide” structure (furosemide, clopamide, oxodoline)

Derivatives of dichlorophenoxyacetic acid (ethacrynic acid)

Pteridine derivatives (triamterene)

Pyrazinoylguanidine derivatives (amiloride)

Aldosterone antagonists (spironolactone)

Osmotically active diuretics (mannitol, urea)