Talk:Anemia

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Thanks to whomever removed the badly written nonsense about sunburns and cancer just ahead of me. Parts of it were just nonsense, and the rest confused cause and effect (e.g., cancer and/or its treatment can cause anemia, but anemia does not cause neoplastic disease). 66.124.70.108 07:05, 18 December 2006 (UTC)[reply]

I am dead serious about this... I have found that many women with Anemia (Iron deficiency type) have a habit of sucking/chewing on ice cubes quite frequently. I am very curious where this comes from any why they have this urge. It is definitely prevolent among them however.

161.225.1.12 00:15, 1 September 2006 (UTC)[reply]

No one can really say what the mechanism is. See pagophagia for some discussion. - Nunh-huh 00:20, 1 September 2006 (UTC)[reply]

Yeah there should be a mention of this here "Pica is the consumption of non-food such as dirt, paper, wax, grass and hair. It is a rare but characteristic sign of iron deficiency anemia." Simply add in "ice" there. 70.101.113.53 21:53, 1 September 2007 (UTC)[reply]

This article uses British and American spellings of 'an(a)emia' inconsistently. Vacuum 23:50, Oct 14, 2004 (UTC)

Please correct to US english accordingly (the title is US). JFW | T@lk 07:34, 15 Oct 2004 (UTC)

Or change all of them to the UK spelling... —Preceding unsigned comment added by 82.27.226.27 (talk) 20:47, 5 March 2008 (UTC)[reply]

The US style of spelling is more widely used and is "more correct" (as it is closely related to the Latin derivative of the word). —Preceding unsigned comment added by 61.68.56.217 (talk) 02:03, 31 July 2008 (UTC)[reply]

I personally favour the English spelling, but as the title is spelt the American way, this article should contain all the American spellings. Therefore, can people please stop changing it? See also Wikipedia:Manual of Style#Consistency Jomunro (talk) 13:49, 24 October 2008 (UTC)[reply]

The only reason the US spelling is more widely used is because America is a bigger place, and the comment about it being 'more correct' is ridiculous as the original word is Greek. VenomousConcept (talk) 15:50, 13 November 2011 (UTC)[reply]

It is a very serious error to equate macrocytic and megaloblastic anaemiae (Let me use commonwealth English here). The latter consists of blasts and not erythrocytes - megaloblasts are formed due to defects in the synthesis of essential macromolecules. Macrocytic essentially means an increase in size, and can be due to a variety of reasons. Balaji Ravichandran (talk · contribs)

{{sofixit}}. JFW | T@lk 15:23, 23 January 2006 (UTC)[reply]

Joewright, what is your source for the terminology? JFW | T@lk 21:17, 23 January 2006 (UTC)[reply]

Up-to-Date article on "approach to the adult patient with anemia" and lectures I've seen--and sorry I did not cite the U-t-D article, as I know that "cite is the new black"! will cite. Looking back I see that I've extended its own version of this kinetic/morphologic split from classification and into clinical approach. I'm not sure this is totally legit in terms of verifiabilility--though I can observe the approaches in action seeing different approaches on the wards. I'll look for a more solid cite. Joewright 21:24, 23 January 2006 (UTC)[reply]

The American literature seems to favor the "kinetic" approach, while the UK literature appears to favour classification by MCV. In the Oxford Textbook of Medicine (22.23.5 General approach to the anaemic patient) reticulocytes are only mentioned in passing and certainly not as a defining feature. JFW | T@lk 21:27, 23 January 2006 (UTC)[reply]

Yes, I know. But, the Oxford Textbook of Medicine is quite out of date compared to the latest edition of Harrison's, Wintrobe's or Hoffman's. In fact, the last edition of Wintrobe's went on to classify anaemia purely on pathogenetic differences, rather than clinically. The concept of 'reticulocyte production index' is relatively new; and was recently found to be better for diagnostic purposes. I don't remember where I read this - probably Ann Intern Med or N Engl J Med. If I come across the source, I'll plug it in.Balaji 08:43, 25 January 2006 (UTC)[reply]

• I found an explanation of the RPI in Harrison's and made a page for reticulocyte production index so if you do find a ref, let's put it in the RPI page also. I wasn't able to find useful references that directly addressed it in a PubMed search. Also, I was curious about whether my impression was correct and asked a 3rd year student friend of mine what her impression was; she says that in her experience people start with MCV--perhaps as a practical matter since it comes back with the CBC--but that they get the retic count before they call for a hematology consult since the hematologists will criticize them if they don't have it. Ah, medicine. Anyway, I'm not sure that this is really an "approach" and anyway it's not citable, but in practical terms I think I'm resolved to continue backing away from my idea that there are really distinct clinical approaches that you can label. Joewright 16:17, 25 January 2006 (UTC)[reply]

I've seen the RPI mentioned on Emedicine. It must have a source. As far as I can say from my UK experience, reticulocyte counts are only useful in specific settings, e.g. ?haemolysis. From a classification perspective, it is appealing to think in terms of production/destruction just like bilirubin can be elevated due to high production, slow conjugation or slow excretion. Still, from a clinician's perspective a reticulocyte count will not narrow down the differential enough - e.g. Hb low & MCV low - is this iron deficiency or thalassaemia? JFW | T@lk 17:38, 25 January 2006 (UTC)[reply]

But wouldn't the retic count be high in thalassemia (sorry, thallassaemia!) and low in iron deficiency? This is the kind of argument people use for the retic count. If you think about this as a production vs destruction issue, then wouldn't the retic count immediately put your two examples into different categories? So if it is thal then the retics are high, then you are led to think of a destruction/loss cause; and since the MCV is low, destruction due to problems of the cells is more likely than simple loss. Obviously then narrowing it down among the potential problems with cells will require smear, examination of hemoglobin, etc. for the final diagnosis--but it leads you quickly to do that instead of a therapeutic trial of iron, and that speed in getting to the right answer would be the argument for getting retics early. This is not my area of expertise (not that I have one), but that's the logic that I use in liking the retic count. Am I wrong? Joewright 19:23, 25 January 2006 (UTC)[reply]

High retics in thalassaemia? JFW | T@lk 00:06, 26 January 2006 (UTC)[reply]

you're right--I'd been writing quickly and had briefly looked at [1] and believed it b/c I was thinking of hemolytic anemias generally but I found other refs that say it's usually normal (b/c despite increased production there is ineffective erythropoiesis and sequestration of retics in spleen)--Joewright 00:56, 26 January 2006 (UTC)[reply]

Should we perhaps mention some of the risk factors for an(a)emia beyond diet and pregnancy, particularly infectious diseases like malaria, hookworm, HIV etc.? Procrastinator supreme 08:49, 2 May 2006 (UTC)[reply]

The risk factors should be mentioned under the type of anemia. E.g. hookworm gives a microcytic picture, while in HIV the causes are multiple (e.g. AZT causing macrocytosis). JFW | T@lk 16:37, 2 May 2006 (UTC)[reply]

Someone wants to create this as a separate article. My sense was that it was subsumed into specific hemolytic anemias (e.g. thalassemia and therefore should be merged into this one. Mangoe 03:39, 7 September 2006 (UTC)[reply]

P.S> if someone knowledgeable could review Heinz body I would appreciate it. Mangoe 03:41, 7 September 2006 (UTC)[reply]

This is an excellent bang-up article. Quite impressed. Learned a lot- this is after having read the Merck manual and all the online sources I could put my hands on. Notes for further inclusion in the article. Normal B12 blood serum is (165-740) pmol/L. And a cinical test for pernicious anemia is Schillings Test. that must be a kinetic test. Best Wishes. Will314159 02:45, 28 September 2006 (UTC)

I'm curious about the candy bar reference. I didn't read the whole article, and the line cites a document that's not listed in the references or "see also" list. What exactly is in candy bars (besides maybe the chocolate) that's bad for iron absorbtion?128.152.20.33 22:41, 2 November 2006 (UTC)[reply]

Anemia from nutritional deficiencies may be rare in North America, but is common in other countries. In many countries, iron fortification or supplementation programs are in place to ensure children receive enough iron, because their diets are chronically deficient. —Preceding unsigned comment added by 74.13.99.221 (talk) 16:02, 15 May 2010 (UTC)[reply]

The term dimorphic is a misnomer and should be deleted, this section belongs under megaloblastic anemia.

-information obtained from Pathology course syllabus, UCCOM

Removed from section on dimorphic anemia. -Joelmills 04:11, 24 February 2007 (UTC)[reply]

I removed the following phrase from the first sentence in the Diet & Anemia section:

"however, the average adult has approximately nine years worth of iron stored in the liver, and it would take four to five years of an iron-deficient diet to create iron-deficiency anemia from diet alone."

This phrase does not have any citation or attribution. I reviewed several encyclopedia entries on anemia and could find no information about this. Please cite a reference. Thanks. Rodrigotorres 22:01, 29 May 2007 (UTC)[reply]

Taken from the section on anemia during pregnancy: "Anemia affects 20% of all females of childbearing age in the United States." This statistic does not represent a worldwide view. A more global statistic should be found, or this should be removed. -007bond aka Matthew G aka codingmasters 11:23, 16 June 2007 (UTC)[reply]

Why are there two reference sections? 66.235.19.122 (talk) 03:29, 19 March 2008 (UTC)[reply]

I have changed one to a "Books" section. Snowman (talk) 10:25, 19 March 2008 (UTC)[reply]

According to this; 74% among children and teens and 44% among adults. Esn (talk) 05:06, 1 April 2008 (UTC)[reply]

i hear this happens in anemia and you get GI problems. Is this in the article anywhere? the article could say, "what kinds of problems arise from this shunting" - because that is my question. Thanks. —Preceding unsigned comment added by 207.151.228.9 (talk) 23:09, 6 July 2008 (UTC)[reply]

We have a new stub at Refractory anemia. I think it could be profitably merged into this article, but I couldn't decide where. Diagnosis (relates to the underlying cause)? Treatment? Prognosis? Something else? What do you think? WhatamIdoing (talk) 20:00, 18 December 2008 (UTC)[reply]

Under a section on classification I think would be best. Doc James (talk · contribs · email) 14:28, 8 November 2010 (UTC)[reply]

This is just a small detail, but it looks like someone has messed up the description of the hands at the top of the article. Could someone clarify this or correct it? The healthy hand to me appears to be on the right, and Not the left. —Preceding unsigned comment added by 155.100.187.91 (talk) 16:20, 21 May 2010 (UTC)[reply]

It really just looks like his hand is exceptionally red. We need a new image. Maddie ^talk 08:14, 24 August 2010 (UTC)[reply]

Indeed, skin colour alone is not always a useful indicator of anaemia. I suggest removal of the picture altogether. Spudgun (talk) 11:58, 21 May 2011 (UTC)[reply]

His hand where normal. Here Hb was low. After you see enough people these images will make sense. One takes into accound many things.. Doc James (talk · contribs · email) 12:03, 21 May 2011 (UTC)[reply]

Where are the references to malaria as a major cause worldwide of anemia??? Can someone with free time on his/her hands contribute? Lsflo (talk) 13:50, 30 August 2010 (UTC)[reply]

I have anemia..and it is so true about chewing ice. Lately it has been an urge! —Preceding unsigned comment added by 71.140.98.10 (talk) 23:05, 3 May 2011 (UTC)[reply]

Today I have removed the "needs more sources" tag, which has been here since 2008. As with many top-level articles in health, this topic is so huge that this article can only really serve as a container and address the main issues.

We are already following WP:MEDMOS, except the "classification" section has been moved down for the obvious reasons that you need more information before you can classify it. Perhaps we should try not to have an exhaustive list of causes, but a "broad strokes" list of groups of causes (e.g. hemolytic anaemia). On the other hand, we may need to bring back into this article the subarticles microcytic anemia, normocytic anemia and macrocytic anemia. JFW | T@lk 09:08, 3 July 2011 (UTC)[reply]

In my opinion, the last paragraph of the intro should be removed all together. Methods of diagnosis are not introductory material. Particularly, a description as technical as the one appearing in the intro of this article. The same material is covered adequately in the diagnosis section.

However, if paragraph on diagnosis is to remain, it should be rewritten. It needs to be less technical, and the following changes should be incorporated:

The paragraph provides no indication as to what the topic is that is being discussed. The first sentence talks about 2 approaches, but two major approaches to what? I am assuming diagnosis, but I could not find this information when examining the provided reference. I don't want to change it since I am not sure what exactly is being discussed, but this needs to be qualified so readers know what is being approached. Also, the part of the first sentence stating the following needs to be qualified: "evaluating, production, destruction and loss". Again, I assume this is referring to red blood cells, but it needs to be made clear to the reader.

NigelEd (talk) 22:51, 2 September 2011 (UTC)[reply]

Why does the "Anemia (genus)" page redirect here? AFAIK the disease doesn't qualify as a "genus" whereas there is an actual fern genus and a beetle genus with this name--so even if the disease somehow qualifies, it's just one out of three articles to which the name applies. So shouldn't it redirect to the disambiguation page instead? 98.65.165.111 (talk) 17:00, 13 October 2011 (UTC)[reply]

Is the caption correct about which hand is anaemic? To me the woman's hand on the right looks weirder. It's yellow. VenomousConcept (talk) 15:54, 13 November 2011 (UTC)[reply]

It (now) says the yellow hand is anemic, and the other hand normal. But the fingernails on that red hand do not look normal to me! 76.113.25.252 (talk) 22:57, 15 November 2011 (UTC)[reply]

My hand looks closer to the 'anemic' one than the 'healthy' one, and I don't have anemia. I took the image out. 18.248.6.155 (talk) 08:33, 19 November 2011 (UTC)[reply]

This image is confusing. The right hand clearly looks diseased. If the left hand is an example of anemia, the right hand would should be croped. — Preceding unsigned comment added by 85.228.243.57 (talk) 01:47, 21 May 2023 (UTC)[reply]

Does anybody think Diphyllobothrium latum should be included in the article? I thought it was a major cause of anemia. I am hesitant to do it myself as most parasitology texts says it causes pernicious anemia, but this article states pernicious anemia is due to lack of intrinsic factor. Maybe it is a separate type of megablastic anemia. — Preceding unsigned comment added by 68.47.217.4 (talk) 15:01, 3 March 2012 (UTC)[reply]

Why isn't "chills" included in "Signs and Symptoms"? Isn't it common, or does everyone here have very warm offices? GentleMiant (talk) 16:25, 21 October 2012 (UTC)[reply]

Chills as a symptom of anaemia? I'd love to see that supported by evidence. JFW | T@lk 12:00, 31 March 2013 (UTC)[reply]

This was posted in "external links", but should be a reference:

• Am. Fam. Physician - Anemia in Older Persons

JFW | T@lk 12:00, 31 March 2013 (UTC)[reply]

Ancient Greek ἀναιμία anaimia font too small, probably does not belong in first sentence.

I suspect anyone who understands this article doesn't need it. After a promising first paragraph it descends into medical jargon that the layman is excluded from.

Like so many Wikipedia articles, give the initiated their head and they will produce an article that is no help to people seeking information.

I will go back to http://www.mayoclinic.org/ who understand how to write for the ordinary person

Cannonmc (talk) 02:36, 21 January 2014 (UTC)[reply]

doi:10.1182/blood-2013-06-508325 reviews the global burden of anaemia. It seems useful. JFW | T@lk 16:36, 5 February 2014 (UTC)[reply]

UK guideline on deficiency: doi: 10.1111/bjh.12959 JFW | T@lk 19:58, 23 June 2014 (UTC)[reply]

Term not used in article. 86.130.41.222 (talk) 13:12, 16 September 2014 (UTC)[reply]

Erythrocytes are the formal medical name for red blood cells. Erythropenia is a lowered number of erythrocytes (i.e. anaemia). It's just another name and a possible search term which is why it exists as a redirect, I don't think redirect names have to be used in the article. Sarahj2107 (talk) 13:22, 16 September 2014 (UTC)[reply]

Thanks. Unfortunately when a word is not used in the article it is hard for the average Joe to tell whether it's a synonym or merely somehow related to the topic. 86.130.41.222 (talk) 15:55, 16 September 2014 (UTC)[reply]

Don't know who the LEGEND is to thank for this - but the person who replaced "syncope" with "feeling like one is going to pass out" is a blooming legend! Feel free to identify yourself! It is an excellent idea, because no non-medical person actually has any blooming idea what "syncope" is. 182.255.99.214 (talk) 08:01, 25 February 2015 (UTC)[reply]

I've actually noticed this being done to lots of other medical related pages - good stuff whoever's to thank :) ! 182.255.99.214 (talk) 08:01, 25 February 2015 (UTC)[reply]

I am glad that you appreciate it [2]. There are a few of use doing this. We would really love help if you are interested :-) It is easy to do. You can simply search for "syncope" and start replacing as appropriate. Doc James (talk · contribs · email) 08:11, 25 February 2015 (UTC)[reply]

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There are some studies that suggest a link between Vitamin D deficiency and anemia. One particular study finds that Anemia was present in 49% of Vitamin D-deficient subjects compared with 36% with normal Vitamin D levels. Keep in mind that the article defines deficient as <30 ng/mL whereas the main Wikipedia article on Vitamin D deficiency classifies <30 ng/mL as insufficiency and <10 ng/mL as deficiency.

Is this notable enough to add on the article? --Flycatchr 10:03, 23 August 2016 (UTC)[reply]

From my source, which is a textbook used in a medical school in Hong Kong, anemia is defined as a reduction in the haemoglobin concentration of the blood. I thought it was an international definition but when I look up here I found it is not. Should this be included in the first paragraph as well?

Source: Hoffbrand, AV & Moss, PAH. Essential Haematology, 6th Ed. 2011 (Wiley-Blackwell) p 20 Lichunhon (talk) 18:18, 24 February 2014 (UTC)[reply]

This source says "Any condition in which the number of red blood cells/mm3, the amount of hemoglobin in 100 mL of blood, and/or the volume of packed red blood cells/100 mL of blood are less than normal" [3]

We state "usually defined as a decrease in the amount of red blood cells (RBCs) or hemoglobin in the blood."

The first bit covers 1 and 3 and the 2nd covers 2. Doc James (talk · contribs · email) 21:00, 6 October 2016 (UTC)[reply]

@Doc James: Hi! I was just wondering if there was a special reason why we use the word "amount" when talking about the number of red blood cells in a specific volume of blood. I didn't quite understand what you meant by "it is partly the amount of RBCs yes" in your edit summary – please do take a look at this diff if you'd like. Looking forward to hearing from you when you're free. –Ntmamgtw (talk) 19:35, 21 February 2019 (UTC)[reply]

Sure so we have "number of red blood cells/mm3, amount of hemoglobin in 100 mL of blood, or the volume of packed red blood cells"

The volume of RBCs is summarized by the amount of RBCs. Amount also can refer to the number. Amount is more flexible IMO. Doc James (talk · contribs · email) 19:58, 21 February 2019 (UTC)[reply]

Thanks for the clarification, Doc James. Very helpful! –Ntmamgtw (talk) 20:04, 21 February 2019 (UTC)[reply]

A lower Hb in pregnancy is often a normal physiological change and not anemia per [4]. Doc James (talk · contribs · email) 20:42, 15 October 2016 (UTC)[reply]

What ref supports this "They are surrogates because each one is concentration dependent; There are clinical scenarios where a direct correlation can be misleading. For example pregnancy, during which the woman's RBC mass is normal but because of an increase in blood volume the hemoglobin and hematocrit are diluted and thus decreased. Another example would be hemorrhage where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit would remain normal. In this case the anemia would only manifest in the hemoglobin or hematocrit once the patient is given fluids which would dilute the blood and thus show a decrease in both lab values."? Doc James (talk · contribs · email) 10:56, 30 October 2016 (UTC)[reply]

In essence, the IP is correct, but it's too much detail for the Lead. See p. 19 and others here: [5].Graham Beards (talk) 12:00, 30 October 2016 (UTC)[reply]

Yes we have this ref [6] that says anemia is "defined as a reduction in the hemoglobin concentration of the blood below normal for age and sex" Other refs say "Anemia is a condition in which... blood has a lower than normal number of red blood cells" or "red blood cells don't contain enough hemoglobin"[7] And others say "a functional definition of anemia is a decrease in the oxygen carrying capacity of the blood. It can arise if there is too little Hb or the Hb is nonfunctional"[8] So we have various definitions. I guess the question is how should we summarize these? Doc James (talk · contribs · email) 12:12, 30 October 2016 (UTC)[reply]

Our current definition include

a) too little hemoglobin in the blood (which covers the first ref)

b) a small volume of red blood cells

c) lowered ability of the blood to carry oxygen

Doc James (talk · contribs · email) 12:14, 30 October 2016 (UTC)[reply]

I agree it's tricky to get right because "anaemia" is a general term that includes several different causes. Point C helps to explain the thalassaemias and, to a lesser extent, sickle cell. Point B should be a reduced volume. As I said above, the IP's edits were valid but too much for the Lead. Graham Beards (talk) 12:36, 30 October 2016 (UTC)[reply]

PS. I think the IP's valid contribution should be taken into account. They clearly have a deep understanding of this subject, and we should encourage them rather than dismiss their contribution with an unhelpful edit summary.[9] Graham Beards (talk) 20:50, 30 October 2016 (UTC)[reply]

So "Another example would be hemorrhage where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit would remain normal" is both a and b Pregnancy is a physiological change and not really classified as anemia. Agree these details belong in the body of the article with references. Doc James (talk · contribs · email) 23:14, 30 October 2016 (UTC)[reply]

Have moved to the body here [10] Doc James (talk · contribs · email) 23:40, 30 October 2016 (UTC)[reply]

This bit "In this case the anemia would only manifest in the hemoglobin or hematocrit once the patient is given fluids which would dilute the blood and thus show a decrease in both lab values." is not really true. People show anemia when fluid shifts from extravascular spaces to intravascular spaces even when no iv fluids are given. This shift however takes some time to occur. Doc James (talk · contribs · email) 23:56, 30 October 2016 (UTC)[reply]

Two to three hours. Graham Beards (talk) 06:55, 31 October 2016 (UTC)[reply]

Would be good to add that with a ref. Doc James (talk · contribs · email) 00:15, 20 November 2016 (UTC)[reply]

The cause of anemia and classification are somewhat separate. Restored that clarity. Doc James (talk · contribs · email) 21:09, 21 June 2019 (UTC)[reply]

Were does the ref support "Dietary supplementation with iron, vitamin B12, and folate in the general population is not recommended without measuring blood levels of these substances."

This was more specific and useful "Dietary supplementation, without determining the specific cause, is not recommended."

If 75 old is anemic, you find that they have low iron in their blood, simple giving them iron supplements is still not recommended because you have not determined that they have colon cancer from which they are bleeding yet.

Doc James (talk · contribs · email) 19:52, 22 June 2019 (UTC)[reply]

I just reverted https://en.wikipedia.org/w/index.php?title=Anemia&type=revision&diff=1007945618&oldid=1007489117 which claimed that anemia has a five-year survival rate 58%. This kind of number might be plausible for particularly severe kinds of anemia, but doesn't make sense for anemia itself, given that 2.63 billion people have it and I haven't heard of billions of anemia deaths.

The user https://en.wikipedia.org/wiki/Special:Contributions/178.149.215.244 has made several edits adding five-year survival rate figures, most of them unsourced, including:

• https://en.wikipedia.org/w/index.php?title=Aplastic_anemia&diff=prev&oldid=1007946843
• https://en.wikipedia.org/w/index.php?title=Iron-deficiency_anemia&diff=prev&oldid=1007945947

I am going to revert the Iron-deficiency_anemia one as well since it seems similarly implausible.

If you're that user, can you tell us where you got these numbers from? Can someone who knows something about anemia please go over the other edits to see if they make any sense? Baum42 (talk) 04:00, 24 March 2021 (UTC)[reply]

Shouldn't methemoglobinemia be mentioned and discussed? Crawiki (talk) 17:46, 30 May 2021 (UTC)[reply]

Hi, if you share some sources and evidence to consider here let's try to tackle it! @Crawiki: JenOttawa (talk) 16:48, 22 November 2021 (UTC)[reply]

...needs to be added. 81.154.169.158 (talk) 02:57, 21 January 2022 (UTC)[reply]

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