Anemia / Low blood count and rheumatic disease 4.5/5 (14)

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Anemia is low blood percentage

Anemia causes fatigue and often occurs in rheumatic diseases, but can have many causes

ICD-10 D64.9 (unspecified anemia)


Too few red blood cells (blood cells)

  • Hemoglobin which is an important part of the red blood cells, is below 11.5 g / dl in women, below 13,5 g / dl in men
  • Africans of both sexes have 0,5 to 1.0 g / dL lower hemoglobin
  • There are several forms and different causes, including rheumatic diseases
  • Blood tests are investigated, among other things

Disease Causes

The four main causes of anemia:

  1. Bleeding

    1. The underlying cause is to be clarified
  2. Blood cells are spoiled quickly

    1. The reason should be clearified
  3. The production of blood (in bone marrow) is too low

    1. Iron Deficiency?
    2. Vitamin B12 or Folic acid / folate-lack?
    3. Illness in bone marrow?
  4. Distribution Error

    1. Dilution by increased amount of fluid in the body
    2. Accumulation of blood cells in spleen


Tiredness, exhaustion, dizziness, increased sleep need

  • Heavy breathing and fast pulse when stressed
  • Cold hands and feet
  • Headache
  • Hair loss, mouth ulcer

Investigational Findings

  • Bleach skin color
  • Fast heart rate
  • Blood samples show low hemoglobin
    • Further interpretation and investigation, please see separate page here


Symptoms may suspect anemia, blood tests are essential

  • Important for the treatment (please see below), however, is the type of anemia present and what is the triggering cause

1 Iron deficiency anemia / bleeding

  1. Bleeding

Menstruation (frequent or severe) among women

Detection of iron deficiency chemistry

  • Blood
    • Microcytic anemia
      • MCV low <80 fl (femtoliter)
    • Reticulocytes in normal or low numbers (<20 × 109/ L)
      • The reticulocyte count should increase one week by successful iron therapy
    • Soluble transferin receptor (elevated by iron deficiency)
    • Ferritin below the reference areas (Note: false elevated values ​​in rheumatoid inflammation or infection)

Differential diagnosis of iron deficiency

  • thalassemia
    • Microcytic anemia with normal transferin receptor / ferritin
    • Reticulocytes are elevated
    • Beta-thalassemia is detected by hemoglobin electrophoresis (high hemoglobin A)2)
    • Alpha-thalassemia is detected by molecular methods
  • Other hemoglobin variants (most common among people from tropical and subtropical regions)

Treatment of iron deficiency anemia

  • Supplement of iron
    • Classic iron tablets (dual iron)
    • Injections if reduced uptake from the intestine
    • Maintenance with iron-rich diet and / or (three-valent) iron or Compiron (via online shop or pharmacy)

2 Blood cells destroyed too fast (Hemolytic anemia)

Detection of hemolytic anemia

  • Fever and sweat
  • Rapidly decreasing hemoglobin
  • Blood tests

3 Production is too low

Aplastic anemia

  • Divided into congenital and acquired type. Acquired type is caused by autoimmune condition with destruction of hematopoietic stem cells in 60% (Wang L, 2019).
  • Same reasons as above but more serious

Detection of anemia by production failure

  • Blood
    • Anemia + leukopenia (low white blood cell count) + thrombocytopenia (low blood platelet count) suspect acute leukemia or other cause (see above)
    • MCV increased in the absence of Vitamin B12 or Folic acid. Soluble transferrin receptor normal
    • Ferritin normal
    • Reticulocytes (immature red blood cells) normal or low
  • Bone marrow examination (Hematologist)
    • Macrocytic anemia (Macrocytic anemia when MCV is over 100 fL)
    • Reduced intake from the intestine if at the same time low transferin / ferritin
  • Differential diagnoses at elevated MCV

4 Distribution Error


Hagestande S, 2020 (aplastic anemia)

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