Iron Deficiency and Pernicious Anemia Pathogenesis
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Iron Deficiency and Pernicious Anemia Pathogenesis
Anemia
Iron Deficiency and Pernicious Anemia Pathogenesis
The pathophysiological mechanisms for the development of anemia associated with a deficiency of substances that are involved in the synthesis or are a structural part of red blood cells are quite different. The first option is iron deficiency anemia, which develops due to insufficient use or violation of the mechanisms of adsorption in the digestive tract of such a metal (trace element), like iron. This substance is the cornerstone for the functioning of such a part of the hemoglobin molecule (an oxygen-carrying protein concentrated in red blood cells), such as heme (Huether & McCance, 2012). In addition, iron plays an important role in a number of other biochemical processes in the body; therefore, it is important to preserve the depot in the form of ferritin molecules in the solid organs of the abdominal cavity and the bone marrow. With a violation of consumption (for example, when taking only plant food without animal protein), iron stores are reduced due to the constantly occurring erythropoiesis and hemolysis of red blood cells. Another mechanism is problems with the gastrointestinal tract (chronic inflammatory diseases, conditions after extensive surgical resections of the intestines), when iron cannot enter the bloodstream or because of a disturbed mechanism of adsorption.
Another option is the development of anemia caused by a deficiency of a vitamin such as cyanocobalamin. The latter is an extremely important co-enzyme involved in the synthesis of both nucleic acids and amino acid transformation. The latter function is particularly necessary to consider in terms of the development of anemia, since methionine is formed from the essential amino acid homocysteine, which is a key substance for the transformation of folic acid into folic acid (Huether et al., 2012). This biologically active substance is responsible for the normoblastic type of blood formation; therefore, in case of problems with synthesis, erythropoiesis is disturbed and hyperchromic megaloblasts are formed (cells characteristic of pernicious anemia). These cells circulate in the vascular bed in insufficient quantities and perform the function of oxygen transport not incompletely, which is manifested by signs of anemic syndrome.
Comparison of Iron Deficiency and Pernicious Anemia
Iron deficiency and pernicious anemia have a number of similar symptoms, but at the same time differ significantly. The causes of both disorders are either an alimentary deficiency with reduced intake or a violation of the absorption of important substances (iron and vitamin B12). Common signs and symptoms are pallor, general weakness, with severe forms, the development of shortness of breath, or even chest pain. At the same time, iron deficiency anemia is characterized by a distortion of taste sensations (the patient feels the need to use inedible substances), problems with skin appendages (specific structure of nails and brittle hair). Associated neurological disorders are characteristic of pernicious anemia (due to the participation of cyanocobalamin in the synthesis of phosphoidal lipids of the myelitis membrane of the neuruses), most often paresthesias, as well as the appearance of a “lacquered” bright red tongue. The diagnosis of anemia consists in counting the number of red blood cells and hemoglobin level, as well as identifying special markers (ferritin, free serum iron and iron binding capacity in the iron deficient form and cyanocobalamin in the pernicious one).
Genetic factors, such as mutations (for example, in the TMPRSS6 gene) lead to iron-resistant forms of anemia, and in the B8 DR3 coding locus they tend to cause pernicious anemia (Camaschella & Poggiali, 2011). A well-known fact is the more frequent spread of both forms of anemia among women, which is associated with gynecological problems and genetic predisposition (Camaschella, 2015). There is no clear ethnic correlation with the incidence of these diseases, although pernicious anemia is more common in northern Europeans (Bizzaro &Antico, 2014). The effect of age on both diseases is significant, since development is possible at any age due to changes in diet and eating habits, so behavior is one of the key factors, for example, both disorders are more common in vegetarians with an unbalanced dietary supplement.
References
Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious anemia. Autoimmunity Reviews, 13(4), 565-568.
Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19),
Camaschella, C., & Poggiali, E. (2011). Inherited disorders of iron metabolism. Current Opinion in Pediatrics, 23(1), 14-20.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology. St. Louis, MO: Mosby.