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An important percentage of anemias seen in daily practice does not originate from hematologic diseases themselves. Instead they are anemias that appear during other diseases, usually chronic, long lasting ones, leading to a nonspecific reaction known as Anemia of Chronic Disease.It should be suspected when the patient presents complete blood counts showing just anemia, most of the time with normal leucocytes and platelets and normal size and shaped red cells.
Clinical history usually points to symptoms that raise suspicion of an inflamatory or infectious disease or even a neoplasia (malignant tumor) but, many times patients may be asymptomatic, and anemia is just an occasional finding in a routine exam. In such circumstances one should deepen the investigation searching for possible other system diseases, many times in their initial stages, with few relevant symptoms, in such a way that patients may have not looked for medical attention.
So we´ve got the possibility of liver, renal, thyroid, lung, gastroenterologic and bone diseases that may be benign such as inflamatory or infectious ones, or malignant (tumors of any kind).
The treatment of this kind of anemia is the treatment of the disease that originated it. Once the basic process is brought under control the anemia disappears soon after.
Easily found all over the world, mainly among children, the iron deficiency anemia is one of the most common clinical pictures that doctors, of any specialty, have to deal with in the outpatient department.There are two basic reasons for iron deficiency: 1) the reduction of the food mineral ingestion and 2) chronic blood loss, generally in small quantities, but continually during weeks, months or even years (see bellow).The most common cause of iron deficiency in children is poor nutrition, a problem more and more important in underdeveloped countries. To complicate things, children´s iron needs are much bigger than in adults; until they become addolescents, children need iron seven times more than adults. In normal conditions, however, with a diversified, rich food in meats and greens (whicht is not very common most of the time ...), children can live without anemia and stay healthy. Once identified however the deficiency, replacement of iron is necessary by means of medicines, because replacement through only a rich iron diet would take too much time to bring the patient to normality.In adults the commonest cause of iron deficiency is not the decreased ingestion, but the chronic blood loss. The necessity of iron in adults in stable conditions is very low, less than 1 mg/day. In this way, the income even of small quantities of meat or greens during the week is enough to keep iron in normal levels, since the daily loss of iron (also in normal conditions), is also very small, through skin esfoliation and from cell loss in digestive tract mucosa.When a cronic blood loss ensues, anaemia develops generally insidiously. In women the commonest cause is menstrual abundant loss. In men and in postmenopausal women whenever the diagnosis of iron deficiency anaemia is done, it´s MANDATORY the search for a bleeding site, generally in the digestive tract. Endoscopy (to evaluate the esophagus, stomach and duodenum) and / or colonocospy (to evaluate the large intestine) are able to make the diagnosis in more than 80 % of the patients. In these cases one can find simple processes like gastritis, ulcers, diverticular desease, as well as benign or malignant tumors as possible causes of the bleeding.Once identified the bleeding etiology, one must close this “tap” through remedies ou surgery while oral ou parenteral iron supplementation is begun. Intramuscular ou intravenous iron must be administered if the patient presents with intense anaemia symptoms.A hint: because iron deficiency ensues almost allways insidiously, anaemia adaptative mechanisms develop and an important number of patients may experience normal physical acitivity or very few daily limitations, searching for medical attention only when anaemia becomes critical. So if anaemia is detected in your routine exams, even if not important, I advise you to look for a doctor so that an initial screening may be done and treatment begun as soon as possible.See you!Dr. Fernando Monteiro
An important percentage of anemias seen in daily practice does not originate from hematologic diseases themselves. Instead they are anemias that appear during other diseases, usually chronic, long lasting ones, leading to a nonspecific reaction known as Anemia of Chronic Disease.It should be suspected when the patient presents complete blood counts showing just anemia, most of the time with normal leucocytes and platelets and normal size and shaped red cells. 
