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The prevalence of anemia is about 29 to 30 cases per 1,000 females of all ages and six cases per 1,000 males under the age of 45, rising to a peak of 18.5 cases per 1,000 men over age 75. Deficiencies of iron, vitamin B12 and folic acid are the most common causes.

Clinical manifestations. Severe anemia may be tolerated well if it develops gradually. Patients with an Hb of less than 7 g/dL will have symptoms of tissue hypoxia (fatigue, headache, dyspnea, light-headedness, angina). Pallor, syncope and tachycardia may signal hypovolemia and anemia, iron deficiency, vitamin B12, folate deficiency, folic acid, anemea

History and physical examination

The evaluation should determine if the anemia is of acute or chronic onset, and clues to any underlying systemic process should be sought. A history of drug exposure, blood loss, or a family history of anemia should be

Iron deficiency anemia

Iron deficiency is the most common cause of anemia. In children, the deficiency is typically caused by diet. In adults, the cause should be considered to be a result of chronic blood loss until a definitive diagnosis is

Treatment of iron deficiency anemia

Ferrous salts of iron are absorbed much more readily and are generally preferred. Commonly available oral preparations include ferrous sulfate, ferrous gluconate and ferrous fumarate (Hemocyte). All three forms are well absorbed. Ferrous sulfate is the least expensive and most commonly used oral iron supplement.

For iron replacement therapy, a dosage equivalent to 150 to 200 mg of elemental iron per day is recommended.

Ferrous sulfate, 325 mg of three times a day, will provide the necessary elemental iron for replacement therapy. Hematocrit levels should show improvement within one to two months of initiation of therapy.

Injectable iron dextran, containing 50 mg of iron per mL, is supplied in a 2-mL single-dose vial. Adverse reactions include headache, dyspnea, flushing, nausea and vomiting, fever, hypotension, seizures, urticaria, anaphylaxis and

Vitamin B12 deficiency anemia

Since body stores of vitamin B12 are adequate for up to five years, deficiency is generally the result of failure to absorb it. Pernicious anemia, Crohn's disease and other intestinal disorders are the most frequent causes of vitamin B12 deficiency.

Symptoms are attributable primarily to anemia, although glossitis, jaundice, and splenomegaly may be present. Vitamin B12 deficiency may cause decreased vibratory and positional sense, ataxia, paresthesias, confusion, and

Treatment of vitamin B 12 deficiency anemia. Intramuscular, oral or intranasal preparations are available for B 12 replacement. In patients with severe vitamin B12 deficiency, daily IM injections of 1,000 mcg of cyanocobalamin are

Folate deficiency anemia

Folate deficiency is characterized by megaloblastic anemia and low serum folate levels. Most patients with folate deficiency have inadequate intake. Lactate dehydrogenase (LDH) and indirect bilirubin typically are elevated, reflecting ineffective erythropoiesis and premature destruction of RBCs.

RBC folic acid and serum vitamin B12 levels should be measured. RBC folate is a more accurate indicator of body folate stores than is serum folate, particularly if measured after folate therapy has been