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</a> <ul id="toc-Fluid_overload-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Intestinal_inflammation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intestinal_inflammation"> <div class="vector-toc-text"> 2.5 Intestinal inflammation </div> </a> <ul id="toc-Intestinal_inflammation-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 3 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Definitions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Definitions"> <div class="vector-toc-text"> 3.1 Definitions </div> </a> <ul id="toc-Definitions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Testing"> <div class="vector-toc-text"> 3.2 Testing </div> </a> <ul id="toc-Testing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Red_blood_cell_size" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Red_blood_cell_size"> <div class="vector-toc-text"> 3.3 Red blood cell size </div> </a> <ul id="toc-Red_blood_cell_size-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Production_vs._destruction_or_loss" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Production_vs._destruction_or_loss"> <div class="vector-toc-text"> 3.4 Production vs. destruction or loss </div> </a> <ul id="toc-Production_vs._destruction_or_loss-sublist" class="vector-toc-list"> <li id="toc-Microcytic" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Microcytic"> <div class="vector-toc-text"> 3.4.1 Microcytic </div> </a> <ul id="toc-Microcytic-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Macrocytic" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Macrocytic"> <div class="vector-toc-text"> 3.4.2 Macrocytic </div> </a> <ul id="toc-Macrocytic-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Normocytic" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Normocytic"> <div class="vector-toc-text"> 3.4.3 Normocytic </div> </a> <ul id="toc-Normocytic-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dimorphic" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Dimorphic"> <div class="vector-toc-text"> 3.4.4 Dimorphic </div> </a> <ul id="toc-Dimorphic-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Heinz_body_anemia" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Heinz_body_anemia"> <div class="vector-toc-text"> 3.4.5 Heinz body anemia </div> </a> <ul id="toc-Heinz_body_anemia-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Hyperanemia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hyperanemia"> <div class="vector-toc-text"> 3.5 Hyperanemia </div> </a> <ul id="toc-Hyperanemia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Refractory_anemia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Refractory_anemia"> <div class="vector-toc-text"> 3.6 Refractory anemia </div> </a> <ul id="toc-Refractory_anemia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transfusion_dependent" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transfusion_dependent"> <div class="vector-toc-text"> 3.7 Transfusion dependent </div> </a> <ul id="toc-Transfusion_dependent-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> 4 Treatment </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Treatment subsection </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Oral_iron" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Oral_iron"> <div class="vector-toc-text"> 4.1 Oral iron </div> </a> <ul id="toc-Oral_iron-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Injectable_iron" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Injectable_iron"> <div class="vector-toc-text"> 4.2 Injectable iron </div> </a> <ul id="toc-Injectable_iron-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Blood_transfusions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Blood_transfusions"> <div class="vector-toc-text"> 4.3 Blood transfusions </div> </a> <ul id="toc-Blood_transfusions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Vitamin_B12_intramuscular_injections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Vitamin_B12_intramuscular_injections"> <div class="vector-toc-text"> 4.4 Vitamin B12 intramuscular injections </div> </a> <ul id="toc-Vitamin_B12_intramuscular_injections-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Erythropoiesis-stimulating_agents" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Erythropoiesis-stimulating_agents"> <div class="vector-toc-text"> 4.5 Erythropoiesis-stimulating agents </div> </a> <ul id="toc-Erythropoiesis-stimulating_agents-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hyperbaric_oxygen" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hyperbaric_oxygen"> <div class="vector-toc-text"> 4.6 Hyperbaric oxygen </div> </a> <ul id="toc-Hyperbaric_oxygen-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Preoperative_anemia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Preoperative_anemia"> <div class="vector-toc-text"> 4.7 Preoperative anemia </div> </a> <ul id="toc-Preoperative_anemia-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 5 Epidemiology </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 6 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 7 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 8 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Anemia</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 103 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-103" aria-hidden="true" > 103 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Anemie" title="Anemie – Afrikaans" lang="af" hreflang="af" data-title="Anemie" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target">Afrikaans</a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%81%D9%82%D8%B1_%D8%A7%D9%84%D8%AF%D9%85" title="فقر الدم – Arabic" lang="ar" hreflang="ar" data-title="فقر الدم" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-hyw mw-list-item"><a href="https://hyw.wikipedia.org/wiki/%D5%8D%D5%A1%D5%AF%D5%A1%D6%82%D5%A1%D6%80%D5%AB%D6%82%D5%B6%D5%B8%D6%82%D5%A9%D5%AB%D6%82%D5%B6" title="Սակաւարիւնութիւն – Western Armenian" lang="hyw" hreflang="hyw" data-title="Սակաւարիւնութիւն" data-language-autonym="Արեւմտահայերէն" data-language-local-name="Western Armenian" class="interlanguage-link-target">Արեւմտահայերէն</a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/Anemia" title="Anemia – Asturian" lang="ast" hreflang="ast" data-title="Anemia" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target">Asturianu</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Anemiya" title="Anemiya – Azerbaijani" lang="az" hreflang="az" data-title="Anemiya" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%A2%D9%86%D8%A6%D9%85%DB%8C%D8%A7" title="آنئمیا – South Azerbaijani" lang="azb" hreflang="azb" data-title="آنئمیا" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target">تۆرکجه</a></li><li class="interlanguage-link interwiki-ban mw-list-item"><a href="https://ban.wikipedia.org/wiki/An%C3%A9mia" title="Anémia – Balinese" lang="ban" hreflang="ban" data-title="Anémia" data-language-autonym="Basa Bali" data-language-local-name="Balinese" class="interlanguage-link-target">Basa Bali</a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%B0%E0%A6%95%E0%A7%8D%E0%A6%A4%E0%A6%B6%E0%A7%82%E0%A6%A8%E0%A7%8D%E0%A6%AF%E0%A6%A4%E0%A6%BE" title="রক্তশূন্যতা – Bangla" lang="bn" hreflang="bn" data-title="রক্তশূন্যতা" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target">বাংলা</a></li><li class="interlanguage-link interwiki-zh-min-nan mw-list-item"><a href="https://zh-min-nan.wikipedia.org/wiki/Khi%C3%A0m-hoeh" title="Khiàm-hoeh – Minnan" lang="nan" hreflang="nan" data-title="Khiàm-hoeh" data-language-autonym="閩南語 / Bân-lâm-gú" data-language-local-name="Minnan" class="interlanguage-link-target">閩南語 / Bân-lâm-gú</a></li><li class="interlanguage-link interwiki-ba mw-list-item"><a href="https://ba.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%8F" title="Анемия – Bashkir" lang="ba" hreflang="ba" data-title="Анемия" data-language-autonym="Башҡортса" data-language-local-name="Bashkir" class="interlanguage-link-target">Башҡортса</a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D1%96%D1%8F" title="Анемія – Belarusian" lang="be" hreflang="be" data-title="Анемія" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target">Беларуская</a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%9C%D0%B0%D0%BB%D0%B0%D0%BA%D1%80%D0%BE%D1%9E%D0%B5" title="Малакроўе – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Малакроўе" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target">Беларуская (тарашкевіца)</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%8F" title="Анемия – Bulgarian" lang="bg" hreflang="bg" data-title="Анемия" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Anemija" title="Anemija – Bosnian" lang="bs" hreflang="bs" data-title="Anemija" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/An%C3%A8mia" title="Anèmia – Catalan" lang="ca" hreflang="ca" data-title="Anèmia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Chudokrevnost" title="Chudokrevnost – Czech" lang="cs" hreflang="cs" data-title="Chudokrevnost" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Anaemia" title="Anaemia – Welsh" lang="cy" hreflang="cy" data-title="Anaemia" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/An%C3%A6mi" title="Anæmi – Danish" lang="da" hreflang="da" data-title="Anæmi" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://de.wikipedia.org/wiki/An%C3%A4mie" title="Anämie – German" lang="de" hreflang="de" data-title="Anämie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%8D%DE%AD%DE%89%DE%A6%DE%8B%DE%AA%DE%88%DE%AA%DE%82%DE%B0" title="ލޭމަދުވުން – Divehi" lang="dv" hreflang="dv" data-title="ލޭމަދުވުން" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Aneemia" title="Aneemia – Estonian" lang="et" hreflang="et" data-title="Aneemia" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%91%CE%BD%CE%B1%CE%B9%CE%BC%CE%AF%CE%B1" title="Αναιμία – Greek" lang="el" hreflang="el" data-title="Αναιμία" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Anemia" title="Anemia – Spanish" lang="es" hreflang="es" data-title="Anemia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Anemio" title="Anemio – Esperanto" lang="eo" hreflang="eo" data-title="Anemio" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Anemia" title="Anemia – Basque" lang="eu" hreflang="eu" data-title="Anemia" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%DA%A9%D9%85%E2%80%8C%D8%AE%D9%88%D9%86%DB%8C" title="کم‌خونی – Persian" lang="fa" hreflang="fa" data-title="کم‌خونی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/An%C3%A9mie" title="Anémie – French" lang="fr" hreflang="fr" data-title="Anémie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Ain%C3%A9ime" title="Ainéime – Irish" lang="ga" hreflang="ga" data-title="Ainéime" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Anemia" title="Anemia – Galician" lang="gl" hreflang="gl" data-title="Anemia" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%B9%88%ED%98%88" title="빈혈 – Korean" lang="ko" hreflang="ko" data-title="빈혈" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Rashin_jini" title="Rashin jini – Hausa" lang="ha" hreflang="ha" data-title="Rashin jini" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target">Hausa</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8D%D5%A1%D5%AF%D5%A1%D5%BE%D5%A1%D6%80%D5%B5%D5%B8%D6%82%D5%B6%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6" title="Սակավարյունություն – Armenian" lang="hy" hreflang="hy" data-title="Սակավարյունություն" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B0%E0%A4%95%E0%A5%8D%E0%A4%A4%E0%A4%BE%E0%A4%B2%E0%A5%8D%E0%A4%AA%E0%A4%A4%E0%A4%BE" title="रक्ताल्पता – Hindi" lang="hi" hreflang="hi" data-title="रक्ताल्पता" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Anemija" title="Anemija – Croatian" lang="hr" hreflang="hr" data-title="Anemija" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-io mw-list-item"><a href="https://io.wikipedia.org/wiki/Anemio" title="Anemio – Ido" lang="io" hreflang="io" data-title="Anemio" data-language-autonym="Ido" data-language-local-name="Ido" class="interlanguage-link-target">Ido</a></li><li class="interlanguage-link interwiki-ig mw-list-item"><a href="https://ig.wikipedia.org/wiki/%E1%BB%8Ad%E1%BB%8B_%E1%BB%A5k%E1%BB%8D_%E1%BB%8Dbara" title="Ịdị ụkọ ọbara – Igbo" lang="ig" hreflang="ig" data-title="Ịdị ụkọ ọbara" data-language-autonym="Igbo" data-language-local-name="Igbo" class="interlanguage-link-target">Igbo</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Anemia" title="Anemia – Indonesian" lang="id" hreflang="id" data-title="Anemia" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-ia mw-list-item"><a href="https://ia.wikipedia.org/wiki/Anemia" title="Anemia – Interlingua" lang="ia" hreflang="ia" data-title="Anemia" data-language-autonym="Interlingua" data-language-local-name="Interlingua" class="interlanguage-link-target">Interlingua</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Anemia" title="Anemia – Italian" lang="it" hreflang="it" data-title="Anemia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%90%D7%A0%D7%9E%D7%99%D7%94" title="אנמיה – Hebrew" lang="he" hreflang="he" data-title="אנמיה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-jv mw-list-item"><a href="https://jv.wikipedia.org/wiki/An%C3%A9mia" title="Anémia – Javanese" lang="jv" hreflang="jv" data-title="Anémia" data-language-autonym="Jawa" data-language-local-name="Javanese" class="interlanguage-link-target">Jawa</a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%B0%E0%B2%95%E0%B3%8D%E0%B2%A4%E0%B2%B9%E0%B3%80%E0%B2%A8%E0%B2%A4%E0%B3%86" title="ರಕ್ತಹೀನತೆ – Kannada" lang="kn" hreflang="kn" data-title="ರಕ್ತಹೀನತೆ" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target">ಕನ್ನಡ</a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%90%E1%83%9C%E1%83%94%E1%83%9B%E1%83%98%E1%83%90" title="ანემია – Georgian" lang="ka" hreflang="ka" data-title="ანემია" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target">ქართული</a></li><li class="interlanguage-link interwiki-ks mw-list-item"><a href="https://ks.wikipedia.org/wiki/%D8%A7%DB%8C%D9%86%DB%8C%D9%96%D9%85%D9%90%DB%8C%D8%A7" title="اینیٖمِیا – Kashmiri" lang="ks" hreflang="ks" data-title="اینیٖمِیا" data-language-autonym="कॉशुर / کٲشُر" data-language-local-name="Kashmiri" class="interlanguage-link-target">कॉशुर / کٲشُر</a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%8F" title="Анемия – Kazakh" lang="kk" hreflang="kk" data-title="Анемия" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target">Қазақша</a></li><li class="interlanguage-link interwiki-rw mw-list-item"><a href="https://rw.wikipedia.org/wiki/Anemie" title="Anemie – Kinyarwanda" lang="rw" hreflang="rw" data-title="Anemie" data-language-autonym="Ikinyarwanda" data-language-local-name="Kinyarwanda" class="interlanguage-link-target">Ikinyarwanda</a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Anemia" title="Anemia – Swahili" lang="sw" hreflang="sw" data-title="Anemia" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target">Kiswahili</a></li><li class="interlanguage-link interwiki-ku mw-list-item"><a href="https://ku.wikipedia.org/wiki/Anem%C3%AE" title="Anemî – Kurdish" lang="ku" hreflang="ku" data-title="Anemî" data-language-autonym="Kurdî" data-language-local-name="Kurdish" class="interlanguage-link-target">Kurdî</a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%90%D0%B7_%D0%BA%D0%B0%D0%BD%D0%B4%D1%83%D1%83%D0%BB%D1%83%D0%BA" title="Аз кандуулук – Kyrgyz" lang="ky" hreflang="ky" data-title="Аз кандуулук" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target">Кыргызча</a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Anaemia" title="Anaemia – Latin" lang="la" hreflang="la" data-title="Anaemia" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target">Latina</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/An%C4%93mija" title="Anēmija – Latvian" lang="lv" hreflang="lv" data-title="Anēmija" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Anemija" title="Anemija – Lithuanian" lang="lt" hreflang="lt" data-title="Anemija" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-lg mw-list-item"><a href="https://lg.wikipedia.org/wiki/Okuggwamu_omusaayi" title="Okuggwamu omusaayi – Ganda" lang="lg" hreflang="lg" data-title="Okuggwamu omusaayi" data-language-autonym="Luganda" data-language-local-name="Ganda" class="interlanguage-link-target">Luganda</a></li><li class="interlanguage-link interwiki-mad mw-list-item"><a href="https://mad.wikipedia.org/wiki/An%C3%A8mia" title="Anèmia – Madurese" lang="mad" hreflang="mad" data-title="Anèmia" data-language-autonym="Madhurâ" data-language-local-name="Madurese" class="interlanguage-link-target">Madhurâ</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%98%D0%B0" title="Анемија – Macedonian" lang="mk" hreflang="mk" data-title="Анемија" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%85%E0%B4%A8%E0%B5%80%E0%B4%AE%E0%B4%BF%E0%B4%AF" title="അനീമിയ – Malayalam" lang="ml" hreflang="ml" data-title="അനീമിയ" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%AA%E0%A4%82%E0%A4%A1%E0%A5%81%E0%A4%B0%E0%A5%8B%E0%A4%97" title="पंडुरोग – Marathi" lang="mr" hreflang="mr" data-title="पंडुरोग" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target">मराठी</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D8%A7%D9%86%D9%8A%D9%85%D9%8A%D8%A7" title="انيميا – Egyptian Arabic" lang="arz" hreflang="arz" data-title="انيميا" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Penyakit_anemia" title="Penyakit anemia – Malay" lang="ms" hreflang="ms" data-title="Penyakit anemia" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-mn mw-list-item"><a href="https://mn.wikipedia.org/wiki/%D0%A6%D1%83%D1%81_%D0%B1%D0%B0%D0%B3%D0%B0%D0%B4%D0%B0%D0%BB%D1%82" title="Цус багадалт – Mongolian" lang="mn" hreflang="mn" data-title="Цус багадалт" data-language-autonym="Монгол" data-language-local-name="Mongolian" class="interlanguage-link-target">Монгол</a></li><li class="interlanguage-link interwiki-my mw-list-item"><a href="https://my.wikipedia.org/wiki/%E1%80%9E%E1%80%BD%E1%80%B1%E1%80%B8%E1%80%A1%E1%80%AC%E1%80%B8%E1%80%94%E1%80%8A%E1%80%BA%E1%80%B8%E1%80%9B%E1%80%B1%E1%80%AC%E1%80%82%E1%80%AB" title="သွေးအားနည်းရောဂါ – Burmese" lang="my" hreflang="my" data-title="သွေးအားနည်းရောဂါ" data-language-autonym="မြန်မာဘာသာ" data-language-local-name="Burmese" class="interlanguage-link-target">မြန်မာဘာသာ</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Bloedarmoede" title="Bloedarmoede – Dutch" lang="nl" hreflang="nl" data-title="Bloedarmoede" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ne mw-list-item"><a href="https://ne.wikipedia.org/wiki/%E0%A4%B0%E0%A4%95%E0%A5%8D%E0%A4%A4_%E0%A4%85%E0%A4%B2%E0%A5%8D%E0%A4%AA%E0%A4%A4%E0%A4%BE" title="रक्त अल्पता – Nepali" lang="ne" hreflang="ne" data-title="रक्त अल्पता" data-language-autonym="नेपाली" data-language-local-name="Nepali" class="interlanguage-link-target">नेपाली</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E8%B2%A7%E8%A1%80" title="貧血 – Japanese" lang="ja" hreflang="ja" data-title="貧血" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Anemi" title="Anemi – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Anemi" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Anemi" title="Anemi – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Anemi" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target">Norsk nynorsk</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B0%E0%AC%95%E0%AD%8D%E0%AC%A4%E0%AC%B9%E0%AD%80%E0%AC%A8%E0%AC%A4%E0%AC%BE" title="ରକ୍ତହୀନତା – Odia" lang="or" hreflang="or" data-title="ରକ୍ତହୀନତା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Anemiya" title="Anemiya – Uzbek" lang="uz" hreflang="uz" data-title="Anemiya" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target">Oʻzbekcha / ўзбекча</a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%85%E0%A8%A8%E0%A9%80%E0%A8%AE%E0%A9%80%E0%A8%86" title="ਅਨੀਮੀਆ – Punjabi" lang="pa" hreflang="pa" data-title="ਅਨੀਮੀਆ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target">ਪੰਜਾਬੀ</a></li><li class="interlanguage-link interwiki-ps mw-list-item"><a href="https://ps.wikipedia.org/wiki/%D9%88%D9%8A%D9%86%D9%87_%D9%84%DA%96%DB%8C" title="وينه لږی – Pashto" lang="ps" hreflang="ps" data-title="وينه لږی" data-language-autonym="پښتو" data-language-local-name="Pashto" class="interlanguage-link-target">پښتو</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Niedokrwisto%C5%9B%C4%87" title="Niedokrwistość – Polish" lang="pl" hreflang="pl" data-title="Niedokrwistość" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Anemia" title="Anemia – Portuguese" lang="pt" hreflang="pt" data-title="Anemia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Anemie" title="Anemie – Romanian" lang="ro" hreflang="ro" data-title="Anemie" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%8F" title="Анемия – Russian" lang="ru" hreflang="ru" data-title="Анемия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%A5%D0%B0%D0%B0%D0%BD_%D0%B0%D2%95%D1%8B%D0%B9%D0%B0%D0%B0%D2%BB%D1%8B%D0%BD%D0%B0_(%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%8F)" title="Хаан аҕыйааһына (Анемия) – Yakut" lang="sah" hreflang="sah" data-title="Хаан аҕыйааһына (Анемия)" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target">Саха тыла</a></li><li class="interlanguage-link interwiki-sc mw-list-item"><a href="https://sc.wikipedia.org/wiki/Anemia" title="Anemia – Sardinian" lang="sc" hreflang="sc" data-title="Anemia" data-language-autonym="Sardu" data-language-local-name="Sardinian" class="interlanguage-link-target">Sardu</a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Anemia" title="Anemia – Albanian" lang="sq" hreflang="sq" data-title="Anemia" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target">Shqip</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Anemia" title="Anemia – Simple English" lang="en-simple" hreflang="en-simple" data-title="Anemia" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/An%C3%A9mia" title="Anémia – Slovak" lang="sk" hreflang="sk" data-title="Anémia" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target">Slovenčina</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Slabokrvnost" title="Slabokrvnost – Slovenian" lang="sl" hreflang="sl" data-title="Slabokrvnost" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-so mw-list-item"><a href="https://so.wikipedia.org/wiki/Dhiig_Yari_(aneemiyo)" title="Dhiig Yari (aneemiyo) – Somali" lang="so" hreflang="so" data-title="Dhiig Yari (aneemiyo)" data-language-autonym="Soomaaliga" data-language-local-name="Somali" class="interlanguage-link-target">Soomaaliga</a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%DA%A9%DB%95%D9%85%D8%AE%D9%88%DB%8E%D9%86%DB%8C" title="کەمخوێنی – Central Kurdish" lang="ckb" hreflang="ckb" data-title="کەمخوێنی" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target">کوردی</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%90%D0%BD%D0%B5%D0%BC%D0%B8%D1%98%D0%B0" title="Анемија – Serbian" lang="sr" hreflang="sr" data-title="Анемија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Anemija" title="Anemija – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Anemija" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-su mw-list-item"><a href="https://su.wikipedia.org/wiki/An%C3%A9mia" title="Anémia – Sundanese" lang="su" hreflang="su" data-title="Anémia" data-language-autonym="Sunda" data-language-local-name="Sundanese" class="interlanguage-link-target">Sunda</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Anemia" title="Anemia – Finnish" lang="fi" hreflang="fi" data-title="Anemia" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Anemi" title="Anemi – Swedish" lang="sv" hreflang="sv" data-title="Anemi" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Anemia" title="Anemia – Tagalog" lang="tl" hreflang="tl" data-title="Anemia" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target">Tagalog</a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%95%E0%AF%81%E0%AE%B0%E0%AF%81%E0%AE%A4%E0%AE%BF%E0%AE%9A%E0%AF%8D%E0%AE%9A%E0%AF%8B%E0%AE%95%E0%AF%88" title="குருதிச்சோகை – Tamil" lang="ta" hreflang="ta" data-title="குருதிச்சோகை" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target">தமிழ்</a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a 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class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Reduced ability of blood to carry oxygen</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For other uses, see <a href="/wiki/Anemia_(disambiguation)" class="mw-disambig" title="Anemia (disambiguation)">Anemia (disambiguation)</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Anemia</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Anaemia, erythrocytopenia</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Iron_deficiency_anemia_blood_film.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Iron_deficiency_anemia_blood_film.jpg/220px-Iron_deficiency_anemia_blood_film.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Iron_deficiency_anemia_blood_film.jpg/330px-Iron_deficiency_anemia_blood_film.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Iron_deficiency_anemia_blood_film.jpg/440px-Iron_deficiency_anemia_blood_film.jpg 2x" data-file-width="2560" data-file-height="1920" /></a></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Blood_smear" title="Blood smear">Blood smear</a> showing <a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">iron-deficiency anemia</a>, with small, pale <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a></td></tr><tr><th scope="row" class="infobox-label">Pronunciation</th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"><ul><li><a href="/wiki/Help:IPA/English" title="Help:IPA/English">/əˈniːmiə/</a> </li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Hematology" title="Hematology">Hematology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Fatigue" title="Fatigue">Feeling tired</a>, <a href="/wiki/Pallor" title="Pallor">pale skin</a>, weakness, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, feeling faint<a href="#cite_note-EBM2013-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Blood_loss" class="mw-redirect" title="Blood loss">Blood loss</a>, decreased red blood cell production, increased red blood cell breakdown<a href="#cite_note-EBM2013-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Hemoglobin#Diagnostic_uses" title="Hemoglobin">Blood hemoglobin measurement</a><a href="#cite_note-EBM2013-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">1.92 billion / 24% (2021)<a href="#cite_note-GBD2021-2">[2]</a></td></tr></tbody></table> Anemia or anaemia (<a href="/wiki/British_English" title="British English">British English</a>) is a <a href="/wiki/Blood_disorder" class="mw-redirect" title="Blood disorder">blood disorder</a> in which the <a href="/wiki/Blood" title="Blood">blood</a> has a reduced ability to carry <a href="/wiki/Oxygen" title="Oxygen">oxygen</a>. This can be due to a lower than normal number of <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a>, a reduction in the amount of <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a> available for oxygen transport, or abnormalities in hemoglobin that impair its function.<a href="#cite_note-EMed-3">[3]</a><a href="#cite_note-nhlbi-4">[4]</a> The name is derived from <a href="/wiki/Ancient_Greek_language" class="mw-redirect" title="Ancient Greek language">Ancient Greek</a> ἀν- (an-) 'not' and αἷμα (haima) 'blood'.<a href="#cite_note-5">[5]</a> When anemia comes on slowly, the symptoms are often vague, such as <a href="/wiki/Fatigue" title="Fatigue">tiredness</a>, <a href="/wiki/Weakness" title="Weakness">weakness</a>, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, <a href="/wiki/Headache" title="Headache">headaches</a>, and a <a href="/wiki/Exercise_intolerance" title="Exercise intolerance">reduced ability to exercise</a>.<a href="#cite_note-EBM2013-1">[1]</a> When anemia is acute, symptoms may include <a href="/wiki/Confusion" title="Confusion">confusion</a>, <a href="/wiki/Lightheadedness" title="Lightheadedness">feeling like one is going to pass out</a>, <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">loss of consciousness</a>, and <a href="/wiki/Polydipsia" title="Polydipsia">increased thirst</a>.<a href="#cite_note-EBM2013-1">[1]</a> Anemia must be significant before a person becomes noticeably <a href="/wiki/Pallor" title="Pallor">pale</a>.<a href="#cite_note-EBM2013-1">[1]</a> Additional symptoms may occur depending on the underlying cause.<a href="#cite_note-EBM2013-1">[1]</a> Anemia can be temporary or long term and can range from mild to severe.<a href="#cite_note-6">[6]</a> Anemia can be caused by <a href="/wiki/Blood_loss" class="mw-redirect" title="Blood loss">blood loss</a>, decreased red blood cell production, and increased <a href="/wiki/Hemolysis" title="Hemolysis">red blood cell breakdown</a>.<a href="#cite_note-EBM2013-1">[1]</a> Causes of blood loss include <a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">bleeding due to inflammation of the stomach or intestines</a>, bleeding from <a href="/wiki/Surgery" title="Surgery">surgery</a>, serious <a href="/wiki/Injury" title="Injury">injury</a>, or <a href="/wiki/Blood_donation" title="Blood donation">blood donation</a>.<a href="#cite_note-EBM2013-1">[1]</a> Causes of decreased production include <a href="/wiki/Iron_deficiency" title="Iron deficiency">iron deficiency</a>, <a href="/wiki/Folate_deficiency" title="Folate deficiency">folate deficiency</a>, <a href="/wiki/Vitamin_B12_deficiency" title="Vitamin B12 deficiency">vitamin B12 deficiency</a>, <a href="/wiki/Thalassemia" title="Thalassemia">thalassemia</a> and a number of <a href="/wiki/Neoplasms_of_the_bone_marrow" class="mw-redirect" title="Neoplasms of the bone marrow">bone marrow tumors</a>.<a href="#cite_note-EBM2013-1">[1]</a> Causes of increased breakdown include <a href="/wiki/Genetic_disorder" title="Genetic disorder">genetic disorders</a> such as <a href="/wiki/Sickle_cell_anemia" class="mw-redirect" title="Sickle cell anemia">sickle cell anemia</a>, infections such as <a href="/wiki/Malaria" title="Malaria">malaria</a>, and certain <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune diseases</a> like <a href="/wiki/Autoimmune_hemolytic_anemia" title="Autoimmune hemolytic anemia">autoimmune hemolytic anemia</a>.<a href="#cite_note-EBM2013-1">[1]</a> Anemia can also be classified based on the <a href="/wiki/Mean_corpuscular_volume" title="Mean corpuscular volume">size of the red blood cells</a> and <a href="/wiki/Mean_corpuscular_hemoglobin" title="Mean corpuscular hemoglobin">amount of hemoglobin in each cell</a>.<a href="#cite_note-EBM2013-1">[1]</a> If the cells are small, it is called <a href="/wiki/Microcytic_anemia" title="Microcytic anemia">microcytic anemia</a>; if they are large, it is called <a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">macrocytic anemia</a>; and if they are normal sized, it is called <a href="/wiki/Normocytic_anemia" title="Normocytic anemia">normocytic anemia</a>.<a href="#cite_note-EBM2013-1">[1]</a> The diagnosis of anemia in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dL); in women, it is less than 120 to 130 g/L (12 to 13 g/dL).<a href="#cite_note-EBM2013-1">[1]</a><a href="#cite_note-Smith2010-7">[7]</a> Further testing is then required to determine the cause.<a href="#cite_note-EBM2013-1">[1]</a><a href="#cite_note-Stat2019-8">[8]</a> Treatment depends on the specific cause. Certain groups of individuals, such as pregnant women, can benefit from the use of <a href="/wiki/Iron_pill" class="mw-redirect" title="Iron pill">iron pills</a> for prevention.<a href="#cite_note-EBM2013-1">[1]</a><a href="#cite_note-9">[9]</a> <a href="/wiki/Dietary_supplement" title="Dietary supplement">Dietary supplementation</a>, without determining the specific cause, is not recommended.<a href="#cite_note-EBM2013-1">[1]</a> The use of <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusions</a> is typically based on a person's signs and symptoms.<a href="#cite_note-EBM2013-1">[1]</a> In those without symptoms, they are not recommended unless hemoglobin levels are less than 60 to 80 g/L (6 to 8 g/dL).<a href="#cite_note-EBM2013-1">[1]</a><a href="#cite_note-Amir2013-10">[10]</a> These recommendations may also apply to some people with acute bleeding.<a href="#cite_note-EBM2013-1">[1]</a> <a href="/wiki/Erythropoiesis-stimulating_agent" title="Erythropoiesis-stimulating agent">Erythropoiesis-stimulating agents</a> are only recommended in those with severe anemia.<a href="#cite_note-Amir2013-10">[10]</a> Anemia is the most common blood disorder, affecting about a fifth to a third of the global population.<a href="#cite_note-EBM2013-1">[1]</a><a href="#cite_note-GBD2015-11">[11]</a><a href="#cite_note-12">[12]</a><a href="#cite_note-2019MarketStudy-13">[13]</a> <a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">Iron-deficiency anemia</a> is the most common cause of anemia worldwide, and affects nearly one billion people.<a href="#cite_note-LancetEpi2012-14">[14]</a> In 2013, anemia due to iron deficiency resulted in about 183,000 deaths – down from 213,000 deaths in 1990.<a href="#cite_note-GBD2013-15">[15]</a> This condition is most prevalent in children<a href="#cite_note-16">[16]</a><a href="#cite_note-17">[17]</a> with also an above average prevalence in elderly<a href="#cite_note-EBM2013-1">[1]</a> and women of reproductive age (especially during pregnancy).<a href="#cite_note-LancetEpi2012-14">[14]</a> Anemia is one of the six <a href="/wiki/WHO" class="mw-redirect" title="WHO">WHO</a> global nutrition targets for 2025 and for diet-related global targets endorsed by <a href="/wiki/World_Health_Assembly" title="World Health Assembly">World Health Assembly</a> in 2012 and 2013. Efforts to reach global targets contribute to reaching <a href="/wiki/Sustainable_Development_Goals" title="Sustainable Development Goals">Sustainable Development Goals</a> (SDGs),<a href="#cite_note-18">[18]</a> with anemia as one of the targets in <a href="/wiki/SDG_2" class="mw-redirect" title="SDG 2">SDG 2</a> for achieving zero world hunger.<a href="#cite_note-19">[19]</a><style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=1" title="Edit section: Signs and symptoms">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Symptoms_of_anemia.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Symptoms_of_anemia.png/260px-Symptoms_of_anemia.png" decoding="async" width="260" height="245" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Symptoms_of_anemia.png/390px-Symptoms_of_anemia.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/91/Symptoms_of_anemia.png/520px-Symptoms_of_anemia.png 2x" data-file-width="3273" data-file-height="3085" /></a><figcaption>Main symptoms that may appear in anemia<a href="#cite_note-:4-20">[20]</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Anemia.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Anemia.JPG/260px-Anemia.JPG" decoding="async" width="260" height="185" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Anemia.JPG/390px-Anemia.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/47/Anemia.JPG/520px-Anemia.JPG 2x" data-file-width="2976" data-file-height="2112" /></a><figcaption>The hand of a person with severe anemia (on the left, with ring) compared to one without (on the right)</figcaption></figure> A person with anemia may not have any symptoms, depending on the underlying cause, and no symptoms may be noticed, as the anemia is initially mild, and then the symptoms become worse as the anemia worsens. A patient with anemia may report <a href="/wiki/Fatigue" title="Fatigue">feeling tired</a>, weak, decreased ability to concentrate, and sometimes <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a> on <a href="/wiki/Exertion" title="Exertion">exertion</a>.<a href="#cite_note-21">[21]</a> These symptoms are unspecific and none of the symptoms alone or in combination show a good predictive value for the presence of anemia in non-clinical patients.<a href="#cite_note-22">[22]</a> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Symptoms_of_anemia_are_written_in_Bengali,_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg/220px-Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg" decoding="async" width="220" height="328" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg/330px-Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg/440px-Symptoms_of_anemia_are_written_in_Bengali%2C_Hindi_and_English_language_on_a_board_at_AIIMS_Kalyani_-_1.jpg 2x" data-file-width="1595" data-file-height="2378" /></a><figcaption>Symptoms of anemia are written in <a href="/wiki/Bengali_language" title="Bengali language">Bengali</a>, Hindi and English language on a board at <a href="/wiki/All_India_Institute_of_Medical_Sciences,_Kalyani" title="All India Institute of Medical Sciences, Kalyani">AIIMS Kalyani</a>, <a href="/wiki/West_Bengal" title="West Bengal">West Bengal</a>.</figcaption></figure> Symptoms of anemia can come on quickly or slowly.<a href="#cite_note-:0-23">[23]</a> Early on there may be few or no symptoms.<a href="#cite_note-:0-23">[23]</a> If the anemia continues slowly (chronic), the body may adapt and compensate for this change. In this case, no symptoms may appear until the anemia becomes more severe.<a href="#cite_note-:4-20">[20]</a><a href="#cite_note-:7-24">[24]</a> Symptoms can include feeling tired, weak, <a href="/wiki/Dizziness" title="Dizziness">dizziness</a>, headaches, <a href="/wiki/Exercise_intolerance" title="Exercise intolerance">intolerance to physical exertion</a>, shortness of breath, difficulty concentrating, <a href="/wiki/Arrhythmia" title="Arrhythmia">irregular</a> or <a href="/wiki/Tachycardia" title="Tachycardia">rapid</a> heartbeat, cold hands and feet, <a href="/wiki/Cold_sensitivity" title="Cold sensitivity">cold intolerance</a>, <a href="/wiki/Pallor" title="Pallor">pale</a> or <a href="/wiki/Jaundice" title="Jaundice">yellow</a> skin, <a href="/wiki/Poor_appetite" class="mw-redirect" title="Poor appetite">poor appetite</a>, easy bruising and bleeding, and <a href="/wiki/Muscle_weakness" title="Muscle weakness">muscle weakness</a>.<a href="#cite_note-:0-23">[23]</a> Anemia that develops quickly, often, has more severe symptoms, including, <a href="/wiki/Lightheadedness" title="Lightheadedness">feeling faint</a>, <a href="/wiki/Angina" title="Angina">chest pain</a>, sweating, increased thirst, and confusion.<a href="#cite_note-:0-23">[23]</a><a href="#cite_note-25">[25]</a><a href="#cite_note-26">[26]</a><a href="#cite_note-27">[27]</a> There may be also additional symptoms depending on the underlying cause.<a href="#cite_note-EBM2013-1">[1]</a> In more severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing <a href="/wiki/Cardiac_output" title="Cardiac output">cardiac output</a>. The person may have symptoms related to this, such as <a href="/wiki/Palpitations" title="Palpitations">palpitations</a>, <a href="/wiki/Angina" title="Angina">angina</a> (if pre-existing <a href="/wiki/Heart_disease" class="mw-redirect" title="Heart disease">heart disease</a> is present), intermittent <a href="/wiki/Claudication" title="Claudication">claudication</a> of the legs, and symptoms of <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a>.<a href="#cite_note-28">[28]</a> On examination, the signs exhibited may include <a href="/wiki/Pallor" title="Pallor">pallor</a> (pale skin, <a href="/wiki/Mucosa" class="mw-redirect" title="Mucosa">mucosa</a>, <a href="/wiki/Conjunctiva" title="Conjunctiva">conjunctiva</a> and <a href="/wiki/Nail_beds" class="mw-redirect" title="Nail beds">nail beds</a>), but this is not a reliable sign. A blue coloration of the <a href="/wiki/Sclera" title="Sclera">sclera</a> may be noticed in some cases of iron-deficiency anemia.<a href="#cite_note-29">[29]</a> There may be signs of specific causes of anemia, e.g. <a href="/wiki/Koilonychia" title="Koilonychia">koilonychia</a> (in iron deficiency), <a href="/wiki/Jaundice" title="Jaundice">jaundice</a> (when anemia results from abnormal break down of <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a> – in <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a>), <a href="/wiki/Nerve_cell" class="mw-redirect" title="Nerve cell">nerve cell</a> damage (vitamin B12 deficiency), bone deformities (found in <a href="/wiki/Thalassemia" title="Thalassemia">thalassemia</a> major) or leg <a href="/wiki/Ulcers" class="mw-redirect" title="Ulcers">ulcers</a> (seen in <a href="/wiki/Sickle-cell_disease" class="mw-redirect" title="Sickle-cell disease">sickle-cell disease</a>). In severe anemia, there may be signs of a <a href="/wiki/Hyperdynamic_circulation" title="Hyperdynamic circulation">hyperdynamic circulation</a>: <a href="/wiki/Tachycardia" title="Tachycardia">tachycardia</a> (a fast heart rate), <a href="/wiki/Bounding_pulse" class="mw-redirect" title="Bounding pulse">bounding pulse</a>, <a href="/wiki/Functional_murmur" title="Functional murmur">flow murmurs</a>, and <a href="/wiki/Cardiac" class="mw-redirect" title="Cardiac">cardiac</a> <a href="/wiki/Ventricular_hypertrophy" title="Ventricular hypertrophy">ventricular hypertrophy</a> (enlargement). There may be signs of <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a>. <a href="/wiki/Pica_(disorder)" title="Pica (disorder)">Pica</a>, the consumption of non-food items such as ice, paper, wax, grass, hair or dirt, may be a symptom of iron deficiency;<a href="#cite_note-30">[30]</a> although it occurs often in those who have normal levels of <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a>. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced academic performance in children of school age. <a href="/wiki/Restless_legs_syndrome" title="Restless legs syndrome">Restless legs syndrome</a> is more common in people with <a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">iron-deficiency anemia</a> than in the general population.<a href="#cite_note-31">[31]</a> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=2" title="Edit section: Causes">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Modified_sickle_cell_01.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1f/Modified_sickle_cell_01.jpg/220px-Modified_sickle_cell_01.jpg" decoding="async" width="220" height="169" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1f/Modified_sickle_cell_01.jpg/330px-Modified_sickle_cell_01.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/1/1f/Modified_sickle_cell_01.jpg 2x" data-file-width="378" data-file-height="291" /></a><figcaption>Figure shows normal red blood cells flowing freely in a blood vessel. The inset image shows a cross-section of a normal red blood cell with normal hemoglobin.<a href="#cite_note-32">[32]</a></figcaption></figure> The causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (hemolytic anemia), blood loss and fluid overload (<a href="/wiki/Hypervolemia" title="Hypervolemia">hypervolemia</a>). Several of these may interplay to cause anemia. The most common cause of anemia is blood loss, but this usually does not cause any lasting symptoms unless a relatively impaired RBC production develops, in turn, most commonly by <a href="/wiki/Iron_deficiency" title="Iron deficiency">iron deficiency</a>.<a href="#cite_note-nhlbi-4">[4]</a> <div class="mw-heading mw-heading3"><h3 id="Impaired_production">Impaired production</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=3" title="Edit section: Impaired production">edit</a>]</div> <ul><li>Disturbance of proliferation and differentiation of stem cells <ul><li><a href="/wiki/Pure_red_cell_aplasia" title="Pure red cell aplasia">Pure red cell aplasia</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li><a href="/wiki/Aplastic_anemia" title="Aplastic anemia">Aplastic anemia</a><a href="#cite_note-Robbins12-1-33">[33]</a> affects all kinds of <a href="/wiki/Blood_cell" title="Blood cell">blood cells</a>. <a href="/wiki/Fanconi_anemia" title="Fanconi anemia">Fanconi anemia</a> is a hereditary disorder or defect featuring aplastic anemia and various other abnormalities.</li> <li>Anemia of <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a><a href="#cite_note-Robbins12-1-33">[33]</a> due to insufficient production of the <a href="/wiki/Hormone" title="Hormone">hormone</a> <a href="/wiki/Erythropoietin" title="Erythropoietin">erythropoietin</a></li> <li>Anemia of <a href="/wiki/Endocrine_disease" title="Endocrine disease">endocrine disease</a><a href="#cite_note-34">[34]</a></li></ul></li> <li>Disturbance of proliferation and maturation of <a href="/wiki/Erythroblast" class="mw-redirect" title="Erythroblast">erythroblasts</a> <ul><li><a href="/wiki/Pernicious_anemia" title="Pernicious anemia">Pernicious anemia</a><a href="#cite_note-Robbins12-1-33">[33]</a> is a form of <a href="/wiki/Megaloblastic_anemia" title="Megaloblastic anemia">megaloblastic anemia</a> due to <a href="/wiki/Vitamin_B12_deficiency" title="Vitamin B12 deficiency">vitamin B12 deficiency</a> dependent on impaired absorption of <a href="/wiki/Vitamin_B12" title="Vitamin B12">vitamin B12</a>. Lack of dietary B12 causes non-pernicious megaloblastic anemia.</li> <li>Anemia of <a href="/wiki/Folic_acid_deficiency" class="mw-redirect" title="Folic acid deficiency">folate deficiency</a>,<a href="#cite_note-Robbins12-1-33">[33]</a> as with vitamin B12, causes <a href="/wiki/Megaloblastic_anemia" title="Megaloblastic anemia">megaloblastic anemia</a></li> <li><a href="/wiki/Anemia_of_prematurity" title="Anemia of prematurity">Anemia of prematurity</a>, by diminished erythropoietin response to declining <a href="/wiki/Hematocrit" title="Hematocrit">hematocrit</a> levels, combined with blood loss from laboratory testing, generally occurs in premature infants at two to six weeks of age.</li> <li>Iron-deficiency anemia, resulting in deficient heme synthesis<a href="#cite_note-Robbins12-1-33">[33]</a></li> <li><a href="/wiki/Thalassemia" title="Thalassemia">Thalassemias</a>, causing deficient globin synthesis<a href="#cite_note-Robbins12-1-33">[33]</a></li> <li><a href="/wiki/Congenital_dyserythropoietic_anemia" title="Congenital dyserythropoietic anemia">Congenital dyserythropoietic anemias</a>, causing ineffective erythropoiesis</li> <li>Anemia of kidney failure<a href="#cite_note-Robbins12-1-33">[33]</a> (also causing stem cell dysfunction)</li></ul></li> <li>Other mechanisms of impaired RBC production <ul><li><a href="/wiki/Myelophthisic_anemia" title="Myelophthisic anemia">Myelophthisic anemia</a><a href="#cite_note-Robbins12-1-33">[33]</a> or <a href="/wiki/Myelophthisis" class="mw-redirect" title="Myelophthisis">myelophthisis</a> is a severe type of anemia resulting from the replacement of bone marrow by other materials, such as malignant tumors, fibrosis, or granulomas.</li> <li><a href="/wiki/Myelodysplastic_syndrome" title="Myelodysplastic syndrome">Myelodysplastic syndrome</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li>anemia of <a href="/wiki/Chronic_inflammation" class="mw-redirect" title="Chronic inflammation">chronic inflammation</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li>Leukoerythroblastic anemia is caused by space-occupying lesions in the <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a> that prevent normal production of blood cells.<a href="#cite_note-35">[35]</a></li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Increased_destruction">Increased destruction</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=4" title="Edit section: Increased destruction">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic anemia</a></div> Anemias of increased <a href="/wiki/Hemolysis" title="Hemolysis">red blood cell destruction</a> are generally classified as <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemias</a>. These types generally feature <a href="/wiki/Jaundice" title="Jaundice">jaundice</a>, and elevated levels of <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</a>.<a href="#cite_note-36">[36]</a><a href="#cite_note-37">[37]</a> <ul><li>Intrinsic (intracorpuscular) abnormalities<a href="#cite_note-Robbins12-1-33">[33]</a> cause premature destruction. All of these, except <a href="/wiki/Paroxysmal_nocturnal_hemoglobinuria" title="Paroxysmal nocturnal hemoglobinuria">paroxysmal nocturnal hemoglobinuria</a>, are hereditary <a href="/wiki/Genetic_disorder" title="Genetic disorder">genetic disorders</a>.<a href="#cite_note-Robbins432-38">[38]</a> <ul><li><a href="/wiki/Hereditary_spherocytosis" title="Hereditary spherocytosis">Hereditary spherocytosis</a><a href="#cite_note-Robbins12-1-33">[33]</a> is a hereditary defect that results in defects in the RBC cell membrane, causing the erythrocytes to be sequestered and destroyed by the <a href="/wiki/Spleen" title="Spleen">spleen</a>.</li> <li><a href="/wiki/Hereditary_elliptocytosis" title="Hereditary elliptocytosis">Hereditary elliptocytosis</a><a href="#cite_note-Robbins12-1-33">[33]</a> is another defect in membrane skeleton proteins.</li> <li><a href="/wiki/Abetalipoproteinemia" title="Abetalipoproteinemia">Abetalipoproteinemia</a>,<a href="#cite_note-Robbins12-1-33">[33]</a> causing defects in membrane lipids</li> <li>Enzyme deficiencies <ul><li><a href="/wiki/Pyruvate_kinase" title="Pyruvate kinase">Pyruvate kinase</a> and <a href="/wiki/Hexokinase" title="Hexokinase">hexokinase</a> deficiencies,<a href="#cite_note-Robbins12-1-33">[33]</a> causing defect <a href="/wiki/Glycolysis" title="Glycolysis">glycolysis</a></li> <li><a href="/wiki/Glucose-6-phosphate_dehydrogenase_deficiency" title="Glucose-6-phosphate dehydrogenase deficiency">Glucose-6-phosphate dehydrogenase deficiency</a> and <a href="/wiki/Glutathione_synthetase" title="Glutathione synthetase">glutathione synthetase</a> deficiency,<a href="#cite_note-Robbins12-1-33">[33]</a> causing increased <a href="/wiki/Oxidative_stress" title="Oxidative stress">oxidative stress</a></li></ul></li> <li><a href="/wiki/Hemoglobinopathies" class="mw-redirect" title="Hemoglobinopathies">Hemoglobinopathies</a> <ul><li><a href="/wiki/Sickle_cell_anemia" class="mw-redirect" title="Sickle cell anemia">Sickle cell anemia</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li>Hemoglobinopathies causing unstable hemoglobins<a href="#cite_note-Robbins12-1-33">[33]</a></li></ul></li> <li><a href="/wiki/Paroxysmal_nocturnal_hemoglobinuria" title="Paroxysmal nocturnal hemoglobinuria">Paroxysmal nocturnal hemoglobinuria</a><a href="#cite_note-Robbins12-1-33">[33]</a></li></ul></li> <li>Extrinsic (extracorpuscular) abnormalities <ul><li><a href="/wiki/Antibody" title="Antibody">Antibody</a>-mediated <ul><li><a href="/wiki/Warm_autoimmune_hemolytic_anemia" class="mw-redirect" title="Warm autoimmune hemolytic anemia">Warm autoimmune hemolytic anemia</a> is caused by autoimmune attack against red blood cells, primarily by IgG. It is the most common of the <a href="/wiki/Autoimmune_diseases" class="mw-redirect" title="Autoimmune diseases">autoimmune</a> <a href="/wiki/Hemolysis" title="Hemolysis">hemolytic</a> diseases.<a href="#cite_note-isbn0-7216-0187-1-39">[39]</a> It can be <a href="/wiki/Idiopathic" class="mw-redirect" title="Idiopathic">idiopathic</a>, that is, without any known cause, drug-associated or secondary to another disease such as <a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">systemic lupus erythematosus</a>, or a malignancy, such as <a href="/wiki/Chronic_lymphocytic_leukemia" title="Chronic lymphocytic leukemia">chronic lymphocytic leukemia</a>.<a href="#cite_note-Jenkins-40">[40]</a></li> <li><a href="/wiki/Cold_agglutinin_hemolytic_anemia" class="mw-redirect" title="Cold agglutinin hemolytic anemia">Cold agglutinin hemolytic anemia</a> is primarily mediated by IgM. It can be idiopathic<a href="#cite_note-pmid17891600-41">[41]</a> or result from an underlying condition.</li> <li><a href="/wiki/Rh_disease" title="Rh disease">Rh disease</a>,<a href="#cite_note-Robbins12-1-33">[33]</a> one of the causes of <a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">hemolytic disease of the newborn</a></li> <li><a href="/wiki/Transfusion_reaction" class="mw-redirect" title="Transfusion reaction">Transfusion reaction</a> to <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusions</a><a href="#cite_note-Robbins12-1-33">[33]</a></li></ul></li> <li>Mechanical trauma to red blood cells <ul><li><a href="/wiki/Microangiopathic_hemolytic_anemia" title="Microangiopathic hemolytic anemia">Microangiopathic hemolytic anemias</a>, including <a href="/wiki/Thrombotic_thrombocytopenic_purpura" title="Thrombotic thrombocytopenic purpura">thrombotic thrombocytopenic purpura</a> and <a href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">disseminated intravascular coagulation</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li>Infections, including <a href="/wiki/Malaria" title="Malaria">malaria</a><a href="#cite_note-Robbins12-1-33">[33]</a></li> <li><a href="/wiki/Heart_surgery" class="mw-redirect" title="Heart surgery">Heart surgery</a>[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>]</li> <li><a href="/wiki/Haemodialysis" class="mw-redirect" title="Haemodialysis">Haemodialysis</a>[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>]</li></ul></li> <li>Parasitic <ul><li><a href="/wiki/Trypanosoma_congolense" title="Trypanosoma congolense">Trypanosoma congolense</a> alters the surfaces of RBCs of its host and this may explain T. c. induced anemia<a href="#cite_note-Stijlemans-et-al-2007-42">[42]</a></li></ul></li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Blood_loss">Blood loss</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=5" title="Edit section: Blood loss">edit</a>]</div> <ul><li><a href="/wiki/Anemia_of_prematurity" title="Anemia of prematurity">Anemia of prematurity</a>, from frequent blood sampling for laboratory testing, combined with insufficient RBC production</li> <li><a href="/wiki/Physical_trauma" class="mw-redirect" title="Physical trauma">Trauma</a><a href="#cite_note-Robbins12-1-33">[33]</a> or <a href="/wiki/Surgery" title="Surgery">surgery</a>, causing acute blood loss</li> <li>Gastrointestinal tract lesions,<a href="#cite_note-Robbins12-1-33">[33]</a> causing either acute bleeds (e.g. variceal lesions, <a href="/wiki/Peptic_ulcers" class="mw-redirect" title="Peptic ulcers">peptic ulcers</a>, <a href="/wiki/Hemorrhoid" title="Hemorrhoid">hemorrhoids</a><a href="#cite_note-43">[43]</a>) or chronic blood loss (e.g. <a href="/wiki/Angiodysplasia" title="Angiodysplasia">angiodysplasia</a>)</li> <li>Gynecologic disturbances,<a href="#cite_note-Robbins12-1-33">[33]</a> also generally causing chronic blood loss</li> <li>From <a href="/wiki/Menstruation" title="Menstruation">menstruation</a>, mostly among young women or older women who have <a href="/wiki/Fibroma" title="Fibroma">fibroids</a></li> <li>Many type of cancers, including colorectal <a href="/wiki/Cancer" title="Cancer">cancer</a> and cancer of the <a href="/wiki/Urinary_bladder" class="mw-redirect" title="Urinary bladder">urinary bladder</a>, may cause acute or chronic blood loss, especially at advanced stages</li> <li>Infection by intestinal <a href="/wiki/Nematodes" class="mw-redirect" title="Nematodes">nematodes</a> feeding on blood, such as <a href="/wiki/Hookworm" title="Hookworm">hookworms</a><a href="#cite_note-44">[44]</a> and the whipworm <a href="/wiki/Trichuris_trichiura" title="Trichuris trichiura">Trichuris trichiura</a> <a href="#cite_note-45">[45]</a></li> <li><a href="/wiki/Iatrogenic_anemia" title="Iatrogenic anemia">Iatrogenic anemia</a>, blood loss from repeated blood draws and medical procedures.<a href="#cite_note-Whitehead2019-46">[46]</a><a href="#cite_note-MartinScantling2015-47">[47]</a></li></ul> The roots of the words anemia and ischemia both refer to the basic idea of "lack of blood", but anemia and <a href="/wiki/Ischemia" title="Ischemia">ischemia</a> are not the same thing in modern medical terminology. The word anemia used alone implies <a href="/wiki/Systemic_effect" class="mw-redirect" title="Systemic effect">widespread</a> effects from blood that either is too scarce (e.g., blood loss) or is dysfunctional in its oxygen-supplying ability (due to whatever type of hemoglobin or erythrocyte problem). In contrast, the word ischemia refers solely to the lack of blood (poor <a href="/wiki/Perfusion" title="Perfusion">perfusion</a>). Thus ischemia in a body part can cause localized anemic effects within those tissues.<a href="#cite_note-48">[48]</a> <div class="mw-heading mw-heading3"><h3 id="Fluid_overload">Fluid overload</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=6" title="Edit section: Fluid overload">edit</a>]</div> Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia:<a href="#cite_note-49">[49]</a> <ul><li>General causes of hypervolemia include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space.<a href="#cite_note-Hagerstwon-50">[50]</a></li> <li>From the 6th week of pregnancy, hormonal changes cause an increase in the mother's blood volume due to an increase in plasma.<a href="#cite_note-51">[51]</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Intestinal_inflammation">Intestinal inflammation</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=7" title="Edit section: Intestinal inflammation">edit</a>]</div> Certain gastrointestinal disorders can cause anemia. The mechanisms involved are multifactorial and not limited to malabsorption but mainly related to chronic intestinal inflammation, which causes dysregulation of <a href="/wiki/Hepcidin" title="Hepcidin">hepcidin</a> that leads to decreased access of iron to the circulation.<a href="#cite_note-VermaCherayil2017-52">[52]</a><a href="#cite_note-GuagnozziLucendo2014-53">[53]</a><a href="#cite_note-LefflerGreen2015-54">[54]</a> <ul><li><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a> infection.<a href="#cite_note-SteinConnor2016-55">[55]</a></li> <li>Gluten-related disorders: untreated <a href="/wiki/Celiac_disease" class="mw-redirect" title="Celiac disease">celiac disease</a><a href="#cite_note-LefflerGreen2015-54">[54]</a><a href="#cite_note-SteinConnor2016-55">[55]</a> and <a href="/wiki/Non-celiac_gluten_sensitivity" title="Non-celiac gluten sensitivity">non-celiac gluten sensitivity</a>.<a href="#cite_note-CatassiBai2013-56">[56]</a> Anemia can be the only manifestation of celiac disease, in absence of gastrointestinal or any other symptoms.<a href="#cite_note-NIHConsensus2004-57">[57]</a></li> <li><a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">Inflammatory bowel disease</a>.<a href="#cite_note-Lomer2011-58">[58]</a><a href="#cite_note-Gerasimidis2011-59">[59]</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=8" title="Edit section: Diagnosis">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Iron_deficiency_anemia.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Iron_deficiency_anemia.jpg/220px-Iron_deficiency_anemia.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Iron_deficiency_anemia.jpg/330px-Iron_deficiency_anemia.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Iron_deficiency_anemia.jpg/440px-Iron_deficiency_anemia.jpg 2x" data-file-width="2048" data-file-height="1536" /></a><figcaption>Peripheral blood smear microscopy of a patient with <a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">iron-deficiency anemia</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Fe-_deficient_anemia.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Fe-_deficient_anemia.jpg/220px-Fe-_deficient_anemia.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Fe-_deficient_anemia.jpg/330px-Fe-_deficient_anemia.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/20/Fe-_deficient_anemia.jpg/440px-Fe-_deficient_anemia.jpg 2x" data-file-width="4800" data-file-height="3200" /></a><figcaption>A Giemsa-stained blood film from a person with iron-deficiency anemia. This person also had hemoglobin Kenya.</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Definitions">Definitions</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=9" title="Edit section: Definitions">edit</a>]</div> There are a number of definitions of anemia; <a href="/wiki/Review_article" title="Review article">reviews</a> provide comparison and contrast of them.<a href="#cite_note-pmid_16189263-60">[60]</a> A strict but broad definition is an absolute decrease in red blood cell mass,<a href="#cite_note-61">[61]</a> however, a broader definition is a lowered ability of the blood to carry <a href="/wiki/Oxygen" title="Oxygen">oxygen</a>.<a href="#cite_note-Ber2007-62">[62]</a> An <a href="/wiki/Operational_definition" title="Operational definition">operational definition</a> is a decrease in whole-blood <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a> concentration of more than 2 <a href="/wiki/Standard_deviation" title="Standard deviation">standard deviations</a> below the <a href="/wiki/Mean" title="Mean">mean</a> of an age- and sex-matched <a href="/wiki/Reference_ranges_for_blood_tests#Hematology" title="Reference ranges for blood tests">reference range</a>.<a href="#cite_note-PDMS2-63">[63]</a> It is difficult to directly measure RBC mass,<a href="#cite_note-64">[64]</a> so the <a href="/wiki/Hematocrit" title="Hematocrit">hematocrit</a> (amount of RBCs) or the hemoglobin (Hb) in the <a href="/wiki/Blood" title="Blood">blood</a> are often used instead to indirectly estimate the value.<a href="#cite_note-65">[65]</a> Hematocrit; however, is concentration dependent and is therefore not completely accurate. For example, during pregnancy a 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 bleeding where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit initially remains normal until fluids shift from other areas of the body to the intravascular space.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] The anemia is also classified by severity into mild (110 g/L to normal), moderate (80 g/L to 110 g/L), and severe anemia (less than 80 g/L) in adults.<a href="#cite_note-WHODefSeverity-66">[66]</a> Different values are used in pregnancy and children.<a href="#cite_note-WHODefSeverity-66">[66]</a> <div class="mw-heading mw-heading3"><h3 id="Testing">Testing</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=10" title="Edit section: Testing">edit</a>]</div> Anemia is typically diagnosed on a <a href="/wiki/Complete_blood_count" title="Complete blood count">complete blood count</a>. Apart from reporting the number of <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a> and the hemoglobin level, the <a href="/wiki/Automated_analyser" title="Automated analyser">automatic counters</a> also measure the size of the red blood cells by <a href="/wiki/Flow_cytometry" title="Flow cytometry">flow cytometry</a>, which is an important tool in distinguishing between the causes of anemia. Examination of a stained <a href="/wiki/Blood_smear" title="Blood smear">blood smear</a> using a <a href="/wiki/Microscope" title="Microscope">microscope</a> can also be helpful, and it is sometimes a necessity in regions of the world where automated analysis is less accessible.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <table class="wikitable"> <caption>WHO's Hemoglobin thresholds used to define anemia<a href="#cite_note-67">[67]</a> (1 g/dL = 0.6206 mmol/L) </caption> <tbody><tr> <th>Age or gender group </th> <th>Hb threshold (g/dL) </th> <th>Hb threshold (mmol/L) </th></tr> <tr> <td>Children (0.5–5.0 yrs) </td> <td>11.0 </td> <td>6.8 </td></tr> <tr> <td>Children (5–12 yrs) </td> <td>11.5 </td> <td>7.1 </td></tr> <tr> <td>Teens (12–15 yrs) </td> <td>12.0 </td> <td>7.4 </td></tr> <tr> <td>Women, non-pregnant (>15yrs) </td> <td>12.0 </td> <td>7.4 </td></tr> <tr> <td>Women, pregnant </td> <td>11.0 </td> <td>6.8 </td></tr> <tr> <td>Men (>15yrs) </td> <td>13.0 </td> <td>8.1 </td></tr></tbody></table> A blood test will provide counts of white blood cells, red blood cells and platelets. If anemia appears, further tests may determine what type it is, and whether it has a serious cause. although of that, it is possible to refer to the genetic history and physical diagnosis.<a href="#cite_note-68">[68]</a> These tests may also include <a href="/wiki/Ferritin" title="Ferritin">serum ferritin</a>, <a href="/wiki/Serum_iron" title="Serum iron">iron studies</a>, <a href="/wiki/Serum_vitamin_B12" title="Serum vitamin B12">vitamin B12</a>, genetic testing, and a <a href="/wiki/Bone_marrow_examination" title="Bone marrow examination">bone marrow sample</a>, if needed.<a href="#cite_note-:2-69">[69]</a><a href="#cite_note-:3-70">[70]</a> Reticulocyte counts, and the "kinetic" approach to anemia, have become more common than in the past in the large medical centers of the United States and some other wealthy nations, in part because some automatic counters now have the capacity to include reticulocyte counts. A <a href="/wiki/Reticulocyte" title="Reticulocyte">reticulocyte</a> count is a quantitative measure of the <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a>'s production of new red blood cells. The <a href="/wiki/Reticulocyte_production_index" title="Reticulocyte production index">reticulocyte production index</a> is a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a "normal" reticulocyte count actually may reflect an inadequate response. If an automated count is not available, a reticulocyte count can be done manually following special staining of the blood film. In manual examination, activity of the bone marrow can also be gauged qualitatively by subtle changes in the numbers and the morphology of young RBCs by examination under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation of <a href="/wiki/Erythropoiesis" title="Erythropoiesis">erythropoiesis</a> can help assess whether the bone marrow will be able to compensate for the loss and at what rate. When the cause is not obvious, clinicians use other tests, such as: <a href="/wiki/Erythrocyte_sedimentation_rate" title="Erythrocyte sedimentation rate">ESR</a>, serum iron, <a href="/wiki/Transferrin" title="Transferrin">transferrin</a>, <a href="/wiki/Folate" title="Folate">RBC folate level</a>, <a href="/wiki/Hemoglobin_electrophoresis" title="Hemoglobin electrophoresis">hemoglobin electrophoresis</a>, <a href="/wiki/Renal_function" class="mw-redirect" title="Renal function">renal function</a> tests (e.g. <a href="/wiki/Serum_creatinine" class="mw-redirect" title="Serum creatinine">serum creatinine</a>) although the tests will depend on the clinical hypothesis that is being investigated. When the diagnosis remains difficult, a <a href="/wiki/Bone_marrow_examination" title="Bone marrow examination">bone marrow examination</a> allows direct examination of the precursors to red cells, although is rarely used as is painful, invasive and is hence reserved for cases where severe pathology needs to be determined or excluded.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Red_blood_cell_size">Red blood cell size</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=11" title="Edit section: Red blood cell size">edit</a>]</div> In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in the <a href="/wiki/Mean_corpuscular_volume" title="Mean corpuscular volume">mean corpuscular volume</a> (MCV). If the cells are smaller than normal (under 80 <a href="/wiki/Femtolitre" class="mw-redirect" title="Femtolitre">fl</a>), the anemia is said to be <a href="/wiki/Microcytic_anemia" title="Microcytic anemia">microcytic</a>; if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified as <a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">macrocytic</a>. This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of <a href="/wiki/Iron_deficiency_(medicine)" class="mw-redirect" title="Iron deficiency (medicine)">iron deficiency</a>. In clinical workup, the MCV will be one of the first pieces of information available, so even among clinicians who consider the "kinetic" approach more useful philosophically, morphology will remain an important element of classification and diagnosis. Limitations of MCV include cases where the underlying cause is due to a combination of factors – such as iron deficiency (a cause of microcytosis) and vitamin <a href="/wiki/B12_deficiency" class="mw-redirect" title="B12 deficiency">B12 deficiency</a> (a cause of macrocytosis) where the net result can be normocytic cells.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Production_vs._destruction_or_loss">Production vs. destruction or loss</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=12" title="Edit section: Production vs. destruction or loss">edit</a>]</div> The "kinetic" approach to anemia yields arguably the most clinically relevant classification of anemia. This classification depends on evaluation of several hematological parameters, particularly the blood reticulocyte (precursor of mature RBCs) count. This then yields the classification of defects by decreased RBC production versus increased RBC destruction or loss. Clinical signs of loss or destruction include abnormal <a href="/wiki/Peripheral_blood_smear" class="mw-redirect" title="Peripheral blood smear">peripheral blood smear</a> with signs of hemolysis; elevated <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">LDH</a> suggesting cell destruction; or clinical signs of bleeding, such as guaiac-positive stool, radiographic findings, or frank bleeding.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] The following is a simplified schematic of this approach:[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] <table style="border-spacing: 0px; border-collapse: separate;"> <tbody><tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">Anemia</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td style="height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td rowspan="2" style="height:2em;width:1em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Reticulocyte_production_index" title="Reticulocyte production index">Reticulocyte production index</a> shows inadequate production response to anemia.</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Reticulocyte_production_index" title="Reticulocyte production index">Reticulocyte production index</a> shows appropriate response to anemia = ongoing hemolysis or blood loss without RBC production problem.</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td style="height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td rowspan="2" style="height:2em;width:1em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">No clinical findings consistent with hemolysis or blood loss: pure disorder of production.</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">Clinical findings and abnormal MCV: hemolysis or loss and chronic disorder of production*.</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">Clinical findings and normal MCV= acute hemolysis or loss without adequate time for <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a> production to compensate**.</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td style="height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td rowspan="2" style="height:2em;width:1em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td></tr> <tr style="height:1px;text-align:center"><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">Macrocytic anemia</a> (MCV>100)</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Normocytic_anemia" title="Normocytic anemia">Normocytic anemia</a> (80<MCV<100)</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Microcytic_anemia" title="Microcytic anemia">Microcytic anemia</a> (MCV<80)</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> </tbody></table> * For instance, sickle cell anemia with superimposed iron deficiency; chronic gastric bleeding with B12 and folate deficiency; and other instances of anemia with more than one cause. ** Confirm by repeating reticulocyte count: ongoing combination of low reticulocyte production index, normal MCV and hemolysis or loss may be seen in bone marrow failure or anemia of chronic disease, with superimposed or related hemolysis or blood loss. Here is a schematic representation of how to consider anemia with MCV as the starting point: <table style="border-spacing: 0px; border-collapse: separate;"> <tbody><tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">Anemia</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td style="height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td rowspan="2" style="height:2em;width:1em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">Macrocytic anemia</a> (MCV>100)</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Normocytic_anemia" title="Normocytic anemia">Normocytic anemia</a> (MCV 80–100)</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em"><a href="/wiki/Microcytic_anemia" title="Microcytic anemia">Microcytic anemia</a> (MCV<80)</td></tr><tr style="height:1px;text-align:center"></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td style="height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="border-right:1px solid;border-bottom:1px solid;height:1em;width:1em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td colspan="2" style="height:1em;border-bottom:1px solid;width:2em"></td><td style="height:1em;border-bottom:1px solid;width:1em"></td><td rowspan="2" style="height:2em;width:1em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"><td style="border-right:1px solid;height:1em;width:1em"></td><td style="height:1em;width:1em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td colspan="2" style="height:1em;width:2em"></td><td style="border-right:1px solid;height:1em;width:1em"></td></tr> <tr style="height:1px;text-align:center"><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">High <a href="/wiki/Reticulocyte" title="Reticulocyte">reticulocyte</a> count</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="6" rowspan="2" style="border:2px solid;padding:0.2em">Low <a href="/wiki/Reticulocyte" title="Reticulocyte">reticulocyte</a> count</td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td><td colspan="2" rowspan="2" style="height:2em;width:2em"></td></tr><tr style="height:1px;text-align:center"></tr> </tbody></table> Other characteristics visible on the peripheral smear may provide valuable clues about a more specific diagnosis; for example, abnormal <a href="/wiki/White_blood_cell" title="White blood cell">white blood cells</a> may point to a cause in the <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a>. <div class="mw-heading mw-heading4"><h4 id="Microcytic">Microcytic</h4>[<a href="/w/index.php?title=Anemia&action=edit&section=13" title="Edit section: Microcytic">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Microcytic_anemia" title="Microcytic anemia">Microcytic anemia</a></div> Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies: <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Heme" title="Heme">Heme</a> synthesis defect <ul><li><a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">Iron-deficiency anemia</a> (microcytosis is not always present)</li> <li><a href="/wiki/Anemia_of_chronic_disease" title="Anemia of chronic disease">Anemia of chronic disease</a> (more commonly presenting as normocytic anemia)</li></ul></li> <li><a href="/wiki/Globin" title="Globin">Globin</a> synthesis defect <ul><li>Alpha-, and beta-<a href="/wiki/Thalassemia" title="Thalassemia">thalassemia</a></li> <li>HbE syndrome</li> <li>HbC syndrome</li> <li>Various other unstable hemoglobin diseases</li></ul></li> <li><a href="/wiki/Sideroblastic" class="mw-redirect" title="Sideroblastic">Sideroblastic</a> defect <ul><li>Hereditary sideroblastic anemia</li> <li>Acquired sideroblastic anemia, including <a href="/wiki/Lead_poisoning" title="Lead poisoning">lead toxicity</a><a href="#cite_note-71">[71]</a></li> <li>Reversible sideroblastic anemia</li></ul></li></ul></div> Iron-deficiency anemia is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope. <ul><li>Iron-deficiency anemia is due to insufficient dietary intake or absorption of <a href="/wiki/Iron" title="Iron">iron</a> to meet the body's needs. Infants, toddlers, and pregnant women have higher than average needs. Increased iron intake is also needed to offset blood losses due to digestive tract issues, frequent blood donations, or <a href="/wiki/Menorrhagia" class="mw-redirect" title="Menorrhagia">heavy menstrual periods</a>.<a href="#cite_note-irond-72">[72]</a> Iron is an essential part of hemoglobin, and low iron levels result in decreased incorporation of hemoglobin into red blood cells. In the United States, 12% of all women of childbearing age have iron deficiency, compared with only 2% of adult men. The incidence is as high as 20% among African American and Mexican American women.<a href="#cite_note-73">[73]</a> In India it is even more than 50%.<a href="#cite_note-74">[74]</a> Studies have linked iron deficiency without anemia to poor school performance and lower <a href="/wiki/IQ" class="mw-redirect" title="IQ">IQ</a> in teenage girls, although this may be due to socioeconomic factors.<a href="#cite_note-halterman1-75">[75]</a><a href="#cite_note-mcgregor1-76">[76]</a> Iron deficiency is the most prevalent deficiency state on a worldwide basis. It is sometimes the cause of abnormal fissuring of the angular (corner) sections of the lips (<a href="/wiki/Angular_stomatitis" class="mw-redirect" title="Angular stomatitis">angular stomatitis</a>).</li> <li>In the United States, the most common cause of iron deficiency is bleeding or blood loss, usually from the <a href="/wiki/Gastrointestinal_tract" title="Gastrointestinal tract">gastrointestinal tract</a>. <a href="/wiki/Fecal_occult_blood" title="Fecal occult blood">Fecal occult blood testing</a>, <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">upper endoscopy</a> and <a href="/wiki/Colonoscopy" title="Colonoscopy">lower endoscopy</a> should be performed to identify bleeding lesions. In older men and women, the chances are higher that bleeding from the gastrointestinal tract could be due to <a href="/wiki/Polyp_(medicine)" title="Polyp (medicine)">colon polyps</a> or <a href="/wiki/Colorectal_cancer" title="Colorectal cancer">colorectal cancer</a>.</li> <li>Worldwide, the most common cause of iron-deficiency anemia is parasitic infestation (<a href="/wiki/Hookworm" title="Hookworm">hookworms</a>, <a href="/wiki/Amebiasis" class="mw-redirect" title="Amebiasis">amebiasis</a>, <a href="/wiki/Schistosomiasis" title="Schistosomiasis">schistosomiasis</a> and <a href="/wiki/Trichuris_trichiura" title="Trichuris trichiura">whipworms</a>).<a href="#cite_note-77">[77]</a></li></ul> The <a href="/wiki/Mentzer_index" title="Mentzer index">Mentzer index</a> (mean cell volume divided by the RBC count) predicts whether microcytic anemia may be due to iron deficiency or thalassemia, although it requires confirmation.<a href="#cite_note-78">[78]</a>[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading4"><h4 id="Macrocytic">Macrocytic</h4>[<a href="/w/index.php?title=Anemia&action=edit&section=14" title="Edit section: Macrocytic">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">Macrocytic anemia</a></div> <ul><li><a href="/wiki/Megaloblastic_anemia" title="Megaloblastic anemia">Megaloblastic anemia</a>, the most common cause of macrocytic anemia, is due to a deficiency of either <a href="/wiki/Vitamin_B12" title="Vitamin B12">vitamin B12</a>, <a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folic acid</a>, or both.<a href="#cite_note-79">[79]</a> Deficiency in folate or vitamin B12 can be due either to inadequate intake or <a href="/wiki/Malabsorption" title="Malabsorption">insufficient absorption</a>. Folate deficiency normally does not produce neurological symptoms, while B12 deficiency does. <ul><li><a href="/wiki/Pernicious_anemia" title="Pernicious anemia">Pernicious anemia</a> is caused by a lack of <a href="/wiki/Intrinsic_factor" title="Intrinsic factor">intrinsic factor</a>, which is required to absorb vitamin B12 from food. A lack of intrinsic factor may arise from an <a href="/wiki/Autoimmune" class="mw-redirect" title="Autoimmune">autoimmune</a> condition targeting the <a href="/wiki/Parietal_cell" title="Parietal cell">parietal cells</a> (atrophic gastritis) that produce intrinsic factor or against intrinsic factor itself. These lead to poor absorption of vitamin B12.</li> <li>Macrocytic anemia can also be caused by the removal of the functional portion of the stomach, such as during <a href="/wiki/Gastric_bypass" class="mw-redirect" title="Gastric bypass">gastric bypass</a> surgery, leading to reduced vitamin B12/folate absorption. Therefore, one must always be aware of anemia following this procedure.</li></ul></li> <li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a></li> <li><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a> commonly causes a <a href="/wiki/Macrocytosis" title="Macrocytosis">macrocytosis</a>, although not specifically anemia. Other types of <a href="/wiki/Liver_disease" title="Liver disease">liver disease</a> can also cause macrocytosis.</li> <li>Drugs such as <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Zidovudine" title="Zidovudine">zidovudine</a>, and other substances may inhibit <a href="/wiki/DNA_replication" title="DNA replication">DNA replication</a> such as <a href="/wiki/Heavy_metals" class="mw-redirect" title="Heavy metals">heavy metals</a></li></ul> Macrocytic anemia can be further divided into "megaloblastic anemia" or "nonmegaloblastic macrocytic anemia". The cause of megaloblastic anemia is primarily a failure of DNA synthesis with preserved RNA synthesis, which results in restricted cell division of the progenitor cells. The megaloblastic anemias often present with neutrophil hypersegmentation (six to 10 lobes). The nonmegaloblastic macrocytic anemias have different etiologies (i.e. unimpaired DNA globin synthesis,) which occur, for example, in alcoholism. In addition to the nonspecific symptoms of anemia, specific features of vitamin B12 deficiency include <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">peripheral neuropathy</a> and <a href="/wiki/Subacute_combined_degeneration_of_the_cord" class="mw-redirect" title="Subacute combined degeneration of the cord">subacute combined degeneration of the cord</a> with resulting balance difficulties from posterior column spinal cord pathology.<a href="#cite_note-80">[80]</a> Other features may include a smooth, red tongue and <a href="/wiki/Glossitis" title="Glossitis">glossitis</a>. The treatment for vitamin B12-deficient anemia was first devised by <a href="/wiki/William_Murphy_(scientist)" class="mw-redirect" title="William Murphy (scientist)">William Murphy</a>, who bled dogs to make them anemic, and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure the disease. <a href="/wiki/George_Richards_Minot" class="mw-redirect" title="George Richards Minot">George Minot</a> and <a href="/wiki/George_Whipple" title="George Whipple">George Whipple</a> then set about to isolate the curative substance chemically and ultimately were able to isolate the <a href="/wiki/Vitamin_B12" title="Vitamin B12">vitamin B12</a> from the liver. All three shared the 1934 <a href="/wiki/Nobel_Prize_in_Physiology_or_Medicine" title="Nobel Prize in Physiology or Medicine">Nobel Prize in Medicine</a>.<a href="#cite_note-81">[81]</a> <div class="mw-heading mw-heading4"><h4 id="Normocytic">Normocytic</h4>[<a href="/w/index.php?title=Anemia&action=edit&section=15" title="Edit section: Normocytic">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Normocytic_anemia" title="Normocytic anemia">Normocytic anemia</a></div> Normocytic anemia occurs when the overall hemoglobin levels are decreased, but the red blood cell size (<a href="/wiki/Mean_corpuscular_volume" title="Mean corpuscular volume">mean corpuscular volume</a>) remains normal. Causes include: <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115"><div class="div-col" style="column-width: 30em;"> <ul><li>Acute <a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">blood loss</a></li> <li><a href="/wiki/Anemia_of_chronic_disease" title="Anemia of chronic disease">Anemia of chronic disease</a></li> <li><a href="/wiki/Aplastic_anemia" title="Aplastic anemia">Aplastic anemia</a> (bone marrow failure)</li> <li><a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic anemia</a></li></ul></div> <div class="mw-heading mw-heading4"><h4 id="Dimorphic">Dimorphic</h4>[<a href="/w/index.php?title=Anemia&action=edit&section=16" title="Edit section: Dimorphic">edit</a>]</div> A dimorphic appearance on a peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content (this last feature affecting the color of the red blood cell on a stained peripheral blood smear). For example, a person recently transfused for iron deficiency would have small, pale, iron deficient red blood cells (RBCs) and the donor RBCs of normal size and color. Similarly, a person transfused for severe folate or vitamin B12 deficiency would have two cell populations, but, in this case, the patient's RBCs would be larger and paler than the donor's RBCs. A person with sideroblastic anemia (a defect in heme synthesis, commonly caused by alcoholism, but also drugs/toxins, nutritional deficiencies, a few acquired and rare congenital diseases) can have a dimorphic smear from the sideroblastic anemia alone. Evidence for multiple causes appears with an elevated RBC distribution width (RDW), indicating a wider-than-normal range of red cell sizes, also seen in common nutritional anemia.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading4"><h4 id="Heinz_body_anemia">Heinz body anemia</h4>[<a href="/w/index.php?title=Anemia&action=edit&section=17" title="Edit section: Heinz body anemia">edit</a>]</div> <a href="/wiki/Heinz_body" title="Heinz body">Heinz bodies</a> form in the cytoplasm of RBCs and appear as small dark dots under the microscope. In animals, Heinz body anemia has many causes. It may be drug-induced, for example in cats and dogs by <a href="/wiki/Acetaminophen" class="mw-redirect" title="Acetaminophen">acetaminophen</a> (paracetamol),<a href="#cite_note-Harvey_2012-82">[82]</a> or may be caused by eating various plants or other substances: <ul><li>In <a href="/wiki/Cat" title="Cat">cats</a> and dogs after eating either raw or cooked plants from the genus <a href="/wiki/Allium" title="Allium">Allium</a>, for example, <a href="/wiki/Onion" title="Onion">onions</a> or garlic.<a href="#cite_note-83">[83]</a></li> <li>In <a href="/wiki/Dog" title="Dog">dogs</a> after ingestion of <a href="/wiki/Zinc" title="Zinc">zinc</a>, for example, after eating <a href="/wiki/Penny_(United_States_coin)" title="Penny (United States coin)">U.S. pennies</a> minted after 1982.<a href="#cite_note-Harvey_2012-82">[82]</a></li> <li>In <a href="/wiki/Horse" title="Horse">horses</a> which eat dry or wilted <a href="/wiki/Acer_rubrum" title="Acer rubrum">red maple</a> leaves.<a href="#cite_note-84">[84]</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Hyperanemia">Hyperanemia</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=18" title="Edit section: Hyperanemia">edit</a>]</div> Hyperanemia is a severe form of anemia, in which the <a href="/wiki/Hematocrit" title="Hematocrit">hematocrit</a> is below 10%.<a href="#cite_note-85">[85]</a> <div class="mw-heading mw-heading3"><h3 id="Refractory_anemia">Refractory anemia</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=19" title="Edit section: Refractory anemia">edit</a>]</div> Refractory anemia, an anemia which does not respond to <a href="/wiki/Therapy" title="Therapy">treatment</a>,<a href="#cite_note-86">[86]</a> is often seen secondary to myelodysplastic syndromes.<a href="#cite_note-87">[87]</a> Iron-deficiency anemia may also be refractory as a manifestation of gastrointestinal problems which disrupt <a href="/wiki/Human_iron_metabolism" title="Human iron metabolism">iron absorption</a> or cause <a href="/wiki/Occult_bleeding" class="mw-redirect" title="Occult bleeding">occult bleeding</a>. <a href="#cite_note-pmid12571473-88">[88]</a> <div class="mw-heading mw-heading3"><h3 id="Transfusion_dependent">Transfusion dependent</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=20" title="Edit section: Transfusion dependent">edit</a>]</div> Transfusion dependent anemia is a form of anemia where ongoing blood transfusion are required.<a href="#cite_note-89">[89]</a> Most people with myelodysplastic syndrome develop this state at some point in time.<a href="#cite_note-Mel2007-90">[90]</a> <a href="/wiki/Beta_thalassemia" title="Beta thalassemia">Beta thalassemia</a> may also result in transfusion dependence.<a href="#cite_note-91">[91]</a><a href="#cite_note-92">[92]</a> Concerns from repeated blood transfusions include <a href="/wiki/Iron_overload" title="Iron overload">iron overload</a>.<a href="#cite_note-Mel2007-90">[90]</a> This iron overload may require <a href="/wiki/Chelation_therapy" title="Chelation therapy">chelation therapy</a>.<a href="#cite_note-93">[93]</a> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=21" title="Edit section: Treatment">edit</a>]</div> The global market for anemia treatments is estimated at more than USD 23 billion per year and is fast growing because of the rising prevalence and awareness of anemia. The types of anemia treated with drugs are iron-deficiency anemia, <a href="/wiki/Thalassemia" title="Thalassemia">thalassemia</a>, aplastic anemia, <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a>, <a href="/wiki/Sickle_cell_disease" title="Sickle cell disease">sickle cell anemia</a>, and pernicious anemia, the most important of them being deficiency and sickle cell anemia with together 60% of market share because of highest prevalence as well as higher treatment costs compared with other types.<a href="#cite_note-2019MarketStudy-13">[13]</a> Treatment for anemia depends on cause and severity. Vitamin supplements given orally (<a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folic acid</a> or vitamin B12) or intramuscularly (<a href="/wiki/Cyanocobalamin" title="Cyanocobalamin">vitamin B12</a>) will replace specific deficiencies.<a href="#cite_note-EBM2013-1">[1]</a> Apart from that, iron supplements, antibiotics, immunosuppressant, bone marrow stimulants, corticosteroids, gene therapy and iron chelating agents are forms of anemia treatment drugs, with immunosuppressants and corticosteroids accounting for 58% of the market share. A paradigm shift towards gene therapy and monoclonal antibody therapies is observed.<a href="#cite_note-2019MarketStudy-13">[13]</a> <div class="mw-heading mw-heading3"><h3 id="Oral_iron">Oral iron</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=22" title="Edit section: Oral iron">edit</a>]</div> Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to have iron deficiency without anemia with one-third of them having an iron deficiency with anemia.<a href="#cite_note-pmid8901803-94">[94]</a> Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with <a href="/wiki/Iron(II)_sulfate" title="Iron(II) sulfate">ferrous sulfate</a>, <a href="/wiki/Ferrous_fumarate" class="mw-redirect" title="Ferrous fumarate">ferrous fumarate</a>, or <a href="/wiki/Ferrous_gluconate" class="mw-redirect" title="Ferrous gluconate">ferrous gluconate</a>. Daily iron supplements have been shown to be effective in reducing anemia in women of childbearing age.<a href="#cite_note-95">[95]</a> When taking iron supplements, stomach upset or darkening of the feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. <a href="/wiki/Vitamin_C" title="Vitamin C">Vitamin C</a> aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit.<a href="#cite_note-96">[96]</a> In the anemia of chronic kidney disease, <a href="/wiki/Recombinant_protein" class="mw-redirect" title="Recombinant protein">recombinant</a> <a href="/wiki/Erythropoietin" title="Erythropoietin">erythropoietin</a> or <a href="/wiki/Epoetin_alfa" title="Epoetin alfa">epoetin alfa</a> is recommended to stimulate RBC production, and if iron deficiency and inflammation are also present, concurrent <a href="/wiki/Parenteral_iron" class="mw-redirect" title="Parenteral iron">parenteral iron</a> is also recommended.<a href="#cite_note-97">[97]</a> <div class="mw-heading mw-heading3"><h3 id="Injectable_iron">Injectable iron</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=23" title="Edit section: Injectable iron">edit</a>]</div> In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively), or where absorption is impeded (for example in cases of inflammation), <a href="/wiki/Parenteral_iron" class="mw-redirect" title="Parenteral iron">parenteral iron</a> preparations can be used. Parenteral iron can improve iron stores rapidly and is also effective for treating people with postpartum haemorrhage, inflammatory bowel disease, and chronic heart failure.<a href="#cite_note-Ng_Keeler_Mishra_et_al_2019-98">[98]</a> The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases, the patient has a deficit of over 1,000 mg of iron which would require several months to replace. This can be given concurrently with <a href="/wiki/Erythropoietin" title="Erythropoietin">erythropoietin</a> to ensure sufficient iron for increased rates of <a href="/wiki/Erythropoiesis" title="Erythropoiesis">erythropoiesis</a>.<a href="#cite_note-99">[99]</a> <div class="mw-heading mw-heading3"><h3 id="Blood_transfusions">Blood transfusions</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=24" title="Edit section: Blood transfusions">edit</a>]</div> Blood transfusions in those without symptoms is not recommended until the hemoglobin is below 60 to 80 g/L (6 to 8 g/dL).<a href="#cite_note-EBM2013-1">[1]</a> In those with <a href="/wiki/Coronary_artery_disease" title="Coronary artery disease">coronary artery disease</a> who are not actively bleeding transfusions are only recommended when the hemoglobin is below 70 to 80g/L (7 to 8 g/dL).<a href="#cite_note-Amir2013-10">[10]</a> Transfusing earlier does not improve survival.<a href="#cite_note-Kan2013-100">[100]</a> Transfusions otherwise should only be undertaken in cases of cardiovascular instability.<a href="#cite_note-101">[101]</a> A 2012 review concluded that when considering blood transfusions for anaemia in people with advanced cancer who have fatigue and breathlessness (not related to cancer treatment or haemorrhage), consideration should be given to whether there are alternative strategies can be tried before a blood transfusion.<a href="#cite_note-102">[102]</a> <div class="mw-heading mw-heading3"><h3 id="Vitamin_B12_intramuscular_injections">Vitamin B12 intramuscular injections</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=25" title="Edit section: Vitamin B12 intramuscular injections">edit</a>]</div> In many cases, vitamin B12 is used by <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular injection</a> in severe cases or cases of malabsorption of dietary-B12. Pernicious anemia caused by loss of intrinsic factor cannot be prevented.<a href="#cite_note-103">[103]</a> If there are other, reversible causes of low vitamin B12 levels, the cause must be treated.<a href="#cite_note-104">[104]</a> Vitamin B12 deficiency anemia is usually easily treated by providing the necessary level of vitamin B12 supplementation.<a href="#cite_note-:1-105">[105]</a> The injections are quick-acting, and symptoms usually go away within one to two weeks.<a href="#cite_note-:1-105">[105]</a> As the condition improves, doses are reduced to weeks and then can be given monthly. Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe <a href="/wiki/Neurological_disorder" title="Neurological disorder">neurologic</a> symptoms.<a href="#cite_note-:1-105">[105]</a> Treatment should begin rapidly for severe neurological symptoms, as some changes can become permanent.<a href="#cite_note-:5-106">[106]</a> In some individuals lifelong treatment may be needed.<a href="#cite_note-:5-106">[106]</a> <div class="mw-heading mw-heading3"><h3 id="Erythropoiesis-stimulating_agents">Erythropoiesis-stimulating agents</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=26" title="Edit section: Erythropoiesis-stimulating agents">edit</a>]</div> The objective for the administration of an <a href="/wiki/Erythropoiesis-stimulating_agent" title="Erythropoiesis-stimulating agent">erythropoiesis-stimulating agent</a> (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual person's needs.<a href="#cite_note-2007anemiaESA-107">[107]</a> They should not be used for mild or moderate anemia.<a href="#cite_note-Kan2013-100">[100]</a> They are not recommended in people with <a href="/wiki/Chronic_kidney_disease" title="Chronic kidney disease">chronic kidney disease</a> unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with parenteral iron.<a href="#cite_note-2007anemiaESA-107">[107]</a><a href="#cite_note-ASNfive-108">[108]</a> The 2020 Cochrane Anaesthesia Review Group review of erythropoietin (EPO) plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery <a href="#cite_note-109">[109]</a> demonstrated that patients were much less likely to require red cell transfusion and in those transfused, the volumes were unchanged (mean difference -0.09, 95% CI -0.23 to 0.05). Pre-operative hemoglobin concentration was increased in those receiving 'high dose' EPO, but not 'low dose'.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Hyperbaric_oxygen">Hyperbaric oxygen</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=27" title="Edit section: Hyperbaric oxygen">edit</a>]</div> Treatment of exceptional blood loss (anemia) is recognized as an indication for <a href="/wiki/Hyperbaric_oxygen" class="mw-redirect" title="Hyperbaric oxygen">hyperbaric oxygen</a> (HBO) by the <a href="/wiki/Undersea_and_Hyperbaric_Medical_Society" title="Undersea and Hyperbaric Medical Society">Undersea and Hyperbaric Medical Society</a>.<a href="#cite_note-uhms-110">[110]</a><a href="#cite_note-111">[111]</a> The use of HBO is indicated when <a href="/wiki/Oxygen" title="Oxygen">oxygen</a> delivery to tissue is not sufficient in patients who cannot be given <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusions</a> for <a href="/wiki/Medical" class="mw-redirect" title="Medical">medical</a> or <a href="/wiki/Religious" class="mw-redirect" title="Religious">religious</a> reasons. HBO may be used for medical reasons when threat of <a href="/wiki/Blood_product" title="Blood product">blood product</a> incompatibility or concern for <a href="/wiki/Transmission_(medicine)" class="mw-redirect" title="Transmission (medicine)">transmissible disease</a> are factors.<a href="#cite_note-uhms-110">[110]</a> The beliefs of some religions (ex: <a href="/wiki/Jehovah%27s_Witnesses_and_blood_transfusions" title="Jehovah's Witnesses and blood transfusions">Jehovah's Witnesses</a>) may require they use the HBO method.<a href="#cite_note-uhms-110">[110]</a> A 2005 review of the use of HBO in severe anemia found all publications reported positive results.<a href="#cite_note-112">[112]</a> <div class="mw-heading mw-heading3"><h3 id="Preoperative_anemia">Preoperative anemia</h3>[<a href="/w/index.php?title=Anemia&action=edit&section=28" title="Edit section: Preoperative anemia">edit</a>]</div> An estimated 30% of adults who require non-cardiac surgery have anemia.<a href="#cite_note-Kaufner_von_Heymann_Henkelmann_et_al_2020-113">[113]</a> In order to determine an appropriate preoperative treatment, it is suggested that the cause of anemia be first determined.<a href="#cite_note-114">[114]</a> There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have preoperative anemia.<a href="#cite_note-Kaufner_von_Heymann_Henkelmann_et_al_2020-113">[113]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=29" title="Edit section: Epidemiology">edit</a>]</div> Anemia affects 27% of the world's population with iron-deficiency anemia accounting for more than 60% of it.<a href="#cite_note-Science_Direct-115">[115]</a> A moderate degree of iron-deficiency anemia affected approximately 610 million people worldwide or 8.8% of the population.<a href="#cite_note-LancetEpi2012-14">[14]</a> It is somewhat more common in females (9.9%) than males (7.8%).<a href="#cite_note-LancetEpi2012-14">[14]</a> Mild iron-deficiency anemia affects another 375 million.<a href="#cite_note-LancetEpi2012-14">[14]</a> Severe anaemia is prevalent globally, and especially in sub-Saharan Africa<a href="#cite_note-116">[116]</a> where it is associated with infections including malaria and invasive bacterial infections.<a href="#cite_note-117">[117]</a> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=30" title="Edit section: History">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Expand_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-image"><a href="/wiki/File:Wiki_letter_w_cropped.svg" class="mw-file-description"><img alt="[icon]" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/20px-Wiki_letter_w_cropped.svg.png" decoding="async" width="20" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/30px-Wiki_letter_w_cropped.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png 2x" data-file-width="44" data-file-height="31" /></a></td><td class="mbox-text"><div class="mbox-text-span">This section needs expansion. You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Anemia&action=edit&section=">adding to it</a>. (August 2020)</div></td></tr></tbody></table> Signs of severe anemia in human bones from 4000 years ago have been uncovered in Thailand.<a href="#cite_note-118">[118]</a> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Anemia&action=edit&section=31" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-EBM2013-1">^ <a href="#cite_ref-EBM2013_1-0">a</a> <a href="#cite_ref-EBM2013_1-1">b</a> <a href="#cite_ref-EBM2013_1-2">c</a> <a href="#cite_ref-EBM2013_1-3">d</a> <a href="#cite_ref-EBM2013_1-4">e</a> <a href="#cite_ref-EBM2013_1-5">f</a> <a href="#cite_ref-EBM2013_1-6">g</a> <a href="#cite_ref-EBM2013_1-7">h</a> <a href="#cite_ref-EBM2013_1-8">i</a> <a href="#cite_ref-EBM2013_1-9">j</a> <a href="#cite_ref-EBM2013_1-10">k</a> <a href="#cite_ref-EBM2013_1-11">l</a> <a href="#cite_ref-EBM2013_1-12">m</a> <a href="#cite_ref-EBM2013_1-13">n</a> <a href="#cite_ref-EBM2013_1-14">o</a> <a href="#cite_ref-EBM2013_1-15">p</a> <a href="#cite_ref-EBM2013_1-16">q</a> <a href="#cite_ref-EBM2013_1-17">r</a> <a href="#cite_ref-EBM2013_1-18">s</a> <a href="#cite_ref-EBM2013_1-19">t</a> <a href="#cite_ref-EBM2013_1-20">u</a> <a href="#cite_ref-EBM2013_1-21">v</a> <a href="#cite_ref-EBM2013_1-22">w</a> <a href="#cite_ref-EBM2013_1-23">x</a> <a href="#cite_ref-EBM2013_1-24">y</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFJanzJohnsonRubenstein2013" class="citation journal cs1">Janz TG, Johnson RL, Rubenstein SD (November 2013). <a rel="nofollow" class="external text" href="http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=385">"Anemia in the emergency department: evaluation and treatment"</a>. 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title="wiktionary:Special:Search/anemia">anemia</a> in Wiktionary, the free dictionary.</div></div> </div> <ul><li><a rel="nofollow" class="external text" href="https://www.who.int/news-room/fact-sheets/detail/anaemia">WHO fact sheet on anaemia</a></li> <li><a rel="nofollow" class="external text" href="https://medlineplus.gov/anemia.html">Anemia, U.S. National Library of Medicine</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 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href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/D50">D50</a>-<a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/D64">D64</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=280">280</a>-<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=285">285</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D000740">D000740</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb663.htm">663</a></li><li><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a>: <a rel="nofollow" class="external text" href="http://snomed.info/id/271737000">271737000</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm">000560</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/132-overview">med/132</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/emerg/topic808.htm#">emerg/808</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/emerg/topic734.htm#">emerg/734</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_red_blood_cells" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output 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.navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Diseases_of_RBCs" title="Template:Diseases of RBCs"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Diseases_of_RBCs" title="Template talk:Diseases of RBCs"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Diseases_of_RBCs" title="Special:EditPage/Template:Diseases of RBCs"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_red_blood_cells" style="font-size:114%;margin:0 4em"><a href="/wiki/Hematologic_disease" title="Hematologic disease">Diseases</a> of <a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">↑</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Polycythemia" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Polycythemia" title="Polycythemia">Polycythemia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Polycythemia_vera" title="Polycythemia vera">Polycythemia vera</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">↓</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Anemia" scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Anemia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nutritional_anemia" title="Nutritional anemia">Nutritional</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Microcytic_anemia" title="Microcytic anemia">Micro-</a>: <a href="/wiki/Iron-deficiency_anemia" title="Iron-deficiency anemia">Iron-deficiency anemia</a> <ul><li><a href="/wiki/Plummer%E2%80%93Vinson_syndrome" title="Plummer–Vinson syndrome">Plummer–Vinson syndrome</a></li></ul></li></ul> <ul><li><a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">Macro-</a>: <a href="/wiki/Megaloblastic_anemia" title="Megaloblastic anemia">Megaloblastic anemia</a> <ul><li><a href="/wiki/Pernicious_anemia" title="Pernicious anemia">Pernicious anemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic</a> (mostly <a href="/wiki/Normocytic_anemia" title="Normocytic anemia">normo-</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Congenital_hemolytic_anemia" title="Congenital hemolytic anemia">Hereditary</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Enzymopathy" class="mw-redirect" title="Enzymopathy">enzymopathy</a>: <a href="/wiki/Glucose-6-phosphate_dehydrogenase_deficiency" title="Glucose-6-phosphate dehydrogenase deficiency">Glucose-6-phosphate dehydrogenase deficiency</a></li> <li><a href="/wiki/Glycolysis" title="Glycolysis">glycolysis</a> <ul><li><a href="/wiki/Pyruvate_kinase_deficiency" title="Pyruvate kinase deficiency">pyruvate kinase deficiency</a></li> <li><a href="/wiki/Triosephosphate_isomerase_deficiency" title="Triosephosphate isomerase deficiency">triosephosphate isomerase deficiency</a></li> <li><a href="/wiki/Hexokinase_deficiency" title="Hexokinase deficiency">hexokinase deficiency</a></li></ul></li></ul> <ul><li><a href="/wiki/Hemoglobinopathy" title="Hemoglobinopathy">hemoglobinopathy</a>: <a href="/wiki/Thalassemia" title="Thalassemia">Thalassemia</a> <ul><li><a href="/wiki/Alpha-thalassemia" title="Alpha-thalassemia">alpha</a></li> <li><a href="/wiki/Beta_thalassemia" title="Beta thalassemia">beta</a></li> <li><a href="/wiki/Delta-thalassemia" class="mw-redirect" title="Delta-thalassemia">delta</a></li></ul></li> <li><a href="/wiki/Sickle_cell_disease" title="Sickle cell disease">Sickle cell disease</a>/<a href="/wiki/Sickle_cell_trait" title="Sickle cell trait">trait</a></li> <li><a href="/wiki/Hemoglobin_C_disease" class="mw-redirect" title="Hemoglobin C disease">Hemoglobin C disease</a></li> <li><a href="/wiki/Red_blood_cell#Membranes_and_surface_proteins" title="Red blood cell">membrane</a>: <a href="/wiki/Hereditary_spherocytosis" title="Hereditary spherocytosis">Hereditary spherocytosis</a> <ul><li><a href="/wiki/Minkowski%E2%80%93Chauffard_syndrome" class="mw-redirect" title="Minkowski–Chauffard syndrome">Minkowski–Chauffard syndrome</a></li></ul></li> <li><a href="/wiki/Hereditary_elliptocytosis" title="Hereditary elliptocytosis">Hereditary elliptocytosis</a> <ul><li><a href="/wiki/Southeast_Asian_ovalocytosis" title="Southeast Asian ovalocytosis">Southeast Asian ovalocytosis</a></li></ul></li> <li><a href="/wiki/Hereditary_stomatocytosis" title="Hereditary stomatocytosis">Hereditary stomatocytosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Acquired_hemolytic_anemia" title="Acquired hemolytic anemia">Acquired</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="AIHA" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Autoimmune_hemolytic_anemia" title="Autoimmune hemolytic anemia">AIHA</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Warm_antibody_autoimmune_hemolytic_anemia" title="Warm antibody autoimmune hemolytic anemia">Warm antibody autoimmune hemolytic anemia</a></li> <li><a href="/wiki/Cold_agglutinin_disease" title="Cold agglutinin disease">Cold agglutinin disease</a></li> <li><a href="/wiki/Donath%E2%80%93Landsteiner_hemolytic_anemia" class="mw-redirect" title="Donath–Landsteiner hemolytic anemia">Donath–Landsteiner hemolytic anemia</a> <ul><li><a href="/wiki/Paroxysmal_cold_hemoglobinuria" title="Paroxysmal cold hemoglobinuria">Paroxysmal cold hemoglobinuria</a></li></ul></li> <li><a href="/wiki/Mixed_autoimmune_hemolytic_anemia" title="Mixed autoimmune hemolytic anemia">Mixed autoimmune hemolytic anemia</a></li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Red_blood_cell#Membranes_and_surface_proteins" title="Red blood cell">membrane</a> <ul><li><a href="/wiki/Paroxysmal_nocturnal_hemoglobinuria" title="Paroxysmal nocturnal hemoglobinuria">paroxysmal nocturnal hemoglobinuria</a></li></ul></li></ul> <ul><li><a href="/wiki/Microangiopathic_hemolytic_anemia" title="Microangiopathic hemolytic anemia">Microangiopathic hemolytic anemia</a></li> <li><a href="/wiki/Thrombotic_microangiopathy" title="Thrombotic microangiopathy">Thrombotic microangiopathy</a> <ul><li><a href="/wiki/Hemolytic%E2%80%93uremic_syndrome" title="Hemolytic–uremic syndrome">Hemolytic–uremic syndrome</a></li></ul></li></ul> <ul><li><a href="/wiki/Drug-induced_autoimmune_hemolytic_anemia" title="Drug-induced autoimmune hemolytic anemia">Drug-induced autoimmune</a></li> <li><a href="/wiki/Drug-induced_nonautoimmune_hemolytic_anemia" title="Drug-induced nonautoimmune hemolytic anemia">Drug-induced nonautoimmune</a></li></ul> <ul><li><a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">Hemolytic disease of the newborn</a></li></ul></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aplastic_anemia" title="Aplastic anemia">Aplastic</a> (mostly <a href="/wiki/Normocytic_anemia" title="Normocytic anemia">normo-</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Congenital_hypoplastic_anemia" title="Congenital hypoplastic anemia">Hereditary</a>: <a href="/wiki/Fanconi_anemia" title="Fanconi anemia">Fanconi anemia</a></li> <li><a href="/wiki/Diamond%E2%80%93Blackfan_anemia" title="Diamond–Blackfan anemia">Diamond–Blackfan anemia</a></li> <ul><li>Acquired: <a href="/wiki/Pure_red_cell_aplasia" title="Pure red cell aplasia">Pure red cell aplasia</a></li> <li><a href="/wiki/Sideroblastic_anemia" title="Sideroblastic anemia">Sideroblastic anemia</a></li> <li><a href="/wiki/Myelophthisic_anemia" title="Myelophthisic anemia">Myelophthisic</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Red_blood_cell_indices" title="Red blood cell indices">Blood tests</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Mean_corpuscular_volume" title="Mean corpuscular volume">Mean corpuscular volume</a> <ul><li><a href="/wiki/Normocytic_anemia" title="Normocytic anemia">normocytic</a></li> <li><a href="/wiki/Microcytic_anemia" title="Microcytic anemia">microcytic</a></li> <li><a href="/wiki/Macrocytic_anemia" title="Macrocytic anemia">macrocytic</a></li></ul></li> <li><a href="/wiki/Mean_corpuscular_hemoglobin_concentration" title="Mean corpuscular hemoglobin concentration">Mean corpuscular hemoglobin concentration</a> <ul><li><a href="/wiki/Normochromic_anemia" title="Normochromic anemia">normochromic</a></li> <li><a href="/wiki/Hypochromic_anemia" title="Hypochromic anemia">hypochromic</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Methemoglobinemia" title="Methemoglobinemia">Methemoglobinemia</a></li> <li><a href="/wiki/Sulfhemoglobinemia" title="Sulfhemoglobinemia">Sulfhemoglobinemia</a></li> <li><a href="/wiki/Reticulocytopenia" title="Reticulocytopenia">Reticulocytopenia</a></li> <li><a href="/wiki/Hereditary_persistence_of_fetal_hemoglobin" title="Hereditary persistence of fetal hemoglobin">Hereditary persistence of fetal hemoglobin</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medicine" title="Template:Medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medicine" title="Template talk:Medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medicine" title="Special:EditPage/Template:Medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Medicine" style="font-size:114%;margin:0 4em"><a href="/wiki/Medicine" title="Medicine">Medicine</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialties</a> and <a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal surgery</a></li> <li><a href="/wiki/Digestive_system_surgery" title="Digestive system surgery">Digestive system surgery</a></li></ul></li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgery</a></li> <li><a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">Oral and maxillofacial surgery</a></li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedic surgery</a></li> <li><a href="/wiki/Hand_surgery" title="Hand surgery">Hand surgery</a></li> <li><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otolaryngology</a> <ul><li>ENT</li></ul></li> <li><a href="/wiki/Pediatric_surgery" title="Pediatric surgery">Pediatric surgery</a></li> <li><a href="/wiki/Plastic_surgery" title="Plastic surgery">Plastic surgery</a></li> <li><a href="/wiki/Reproductive_surgery" title="Reproductive surgery">Reproductive surgery</a></li> <li><a href="/wiki/Surgical_oncology" title="Surgical oncology">Surgical oncology</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplant surgery</a></li> <li><a href="/wiki/Trauma_surgery" title="Trauma surgery">Trauma surgery</a></li> <li><a href="/wiki/Urology" title="Urology">Urology</a> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li></ul></li> <li><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Internal_medicine" title="Internal medicine">Internal medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a> / <a href="/wiki/Immunology" title="Immunology">Immunology</a></li> <li><a href="/wiki/Angiology" title="Angiology">Angiology</a></li> <li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></li> <li><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <ul><li><a href="/wiki/Hepatology" title="Hepatology">Hepatology</a></li></ul></li> <li><a href="/wiki/Geriatrics" title="Geriatrics">Geriatrics</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">Infectious diseases</a></li> <li><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Radiology" title="Radiology">Radiology</a> <ul><li><a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a></li> <li><a href="/wiki/Neuroradiology" title="Neuroradiology">Neuroradiology</a></li> <li><a href="/wiki/Nuclear_medicine" title="Nuclear medicine">Nuclear medicine</a></li></ul></li> <li><a href="/wiki/Pathology" title="Pathology">Pathology</a> <ul><li><a href="/wiki/Anatomical_pathology" title="Anatomical pathology">Anatomical</a></li> <li><a href="/wiki/Clinical_pathology" title="Clinical pathology">Clinical pathology</a></li> <li><a href="/wiki/Clinical_chemistry" title="Clinical chemistry">Clinical chemistry</a></li> <li><a href="/wiki/Cytopathology" title="Cytopathology">Cytopathology</a></li> <li><a href="/wiki/Medical_microbiology" title="Medical microbiology">Medical microbiology</a></li> <li><a href="/wiki/Transfusion_medicine" title="Transfusion medicine">Transfusion medicine</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Adolescent_medicine" title="Adolescent medicine">Adolescent medicine</a></li> <li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a> <ul><li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric anesthesiology</a></li> <li><a href="/wiki/Neurosurgical_anesthesia" title="Neurosurgical anesthesia">Neurosurgical anesthesiology</a></li></ul></li> <li><a href="/wiki/Aviation_medicine" title="Aviation medicine">Aviation medicine</a></li> <li><a href="/wiki/Dermatology" title="Dermatology">Dermatology</a></li> <li><a href="/wiki/Disaster_medicine" title="Disaster medicine">Disaster medicine</a></li> <li><a href="/wiki/Diving_medicine" title="Diving medicine">Diving medicine</a></li> <li><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a> <ul><li><a href="/wiki/Mass_gathering_medicine" title="Mass gathering medicine">Mass gathering medicine</a></li></ul></li> <li><a href="/wiki/Evolutionary_medicine" title="Evolutionary medicine">Evolutionary medicine</a></li> <li><a href="/wiki/Family_medicine" title="Family medicine">Family medicine</a> / <a href="/wiki/General_practice" title="General practice">General practice</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></li> <li><a href="/wiki/Medical_genetics" title="Medical genetics">Medical genetics</a></li> <li><a href="/wiki/Narcology" title="Narcology">Narcology</a></li> <li><a href="/wiki/Neurology" title="Neurology">Neurology</a> <ul><li><a href="/wiki/Clinical_neurophysiology" title="Clinical neurophysiology">Clinical neurophysiology</a></li></ul></li> <li><a href="/wiki/Occupational_medicine" title="Occupational medicine">Occupational medicine</a></li> <li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmology</a></li> <li><a href="/wiki/Oral_medicine" title="Oral medicine">Oral medicine</a></li> <li><a href="/wiki/Pain_management" title="Pain management">Pain management</a></li> <li><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a></li> <li><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a> <ul><li><a href="/wiki/Neonatology" title="Neonatology">Neonatology</a></li></ul></li> <li><a href="/wiki/Phlebologist" class="mw-redirect" title="Phlebologist">Phlebology</a></li> <li><a href="/wiki/Physical_medicine_and_rehabilitation" title="Physical medicine and rehabilitation">Physical medicine and rehabilitation</a> (PM&R)</li> <li><a href="/wiki/Preventive_healthcare" title="Preventive healthcare">Preventive medicine</a></li> <li><a href="/wiki/Prison_healthcare" title="Prison healthcare">Prison healthcare</a></li> <li><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a> <ul><li><a href="/wiki/Addiction_psychiatry" title="Addiction psychiatry">Addiction psychiatry</a></li></ul></li> <li><a href="/wiki/Radiation_therapy" title="Radiation therapy">Radiation oncology</a></li> <li><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Reproductive medicine</a></li> <li><a href="/wiki/Sexual_medicine" title="Sexual medicine">Sexual medicine</a> <ul><li><a href="/wiki/Venereology" title="Venereology">Venereology</a></li></ul></li> <li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a></li> <li><a href="/wiki/Sports_medicine" title="Sports medicine">Sports medicine</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplantation medicine</a></li> <li><a href="/wiki/Tropical_medicine" title="Tropical medicine">Tropical medicine</a> <ul><li><a href="/wiki/Travel_medicine" title="Travel medicine">Travel medicine</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_education" title="Medical education">Medical education</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Medical_school" title="Medical school">Medical school</a></li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a></li> <li><a href="/wiki/Bachelor_of_Medical_Sciences" title="Bachelor of Medical Sciences">Bachelor of Medical Sciences</a></li> <li><a href="/wiki/Master_of_Medicine" title="Master of Medicine">Master of Medicine</a></li> <li><a href="/wiki/Master_of_Surgery" title="Master of Surgery">Master of Surgery</a></li> <li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a></li> <li><a href="/wiki/Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">Doctor of Osteopathic Medicine</a></li> <li><a href="/wiki/MD%E2%80%93PhD" title="MD–PhD">MD–PhD</a> <ul><li><a href="/wiki/Medical_Scientist_Training_Program" title="Medical Scientist Training Program">Medical Scientist Training Program</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alternative_medicine" title="Alternative medicine">Alternative medicine</a></li> <li><a href="/wiki/Allied_health_professions" title="Allied health professions">Allied health</a></li> <li><a href="/wiki/Molecular_oncology" title="Molecular oncology">Molecular oncology</a></li> <li><a href="/wiki/Nanomedicine" title="Nanomedicine">Nanomedicine</a></li> <li><a href="/wiki/Personalized_medicine" title="Personalized medicine">Personalized medicine</a></li> <li><a href="/wiki/Public_health" title="Public health">Public health</a></li> <li><a href="/wiki/Rural_health" title="Rural health">Rural health</a></li> <li><a href="/wiki/Therapy" title="Therapy">Therapy</a></li> <li><a href="/wiki/Traditional_medicine" title="Traditional medicine">Traditional medicine</a></li> <li><a href="/wiki/Veterinary_medicine" title="Veterinary medicine">Veterinary medicine</a></li> <li><a href="/wiki/Physician" title="Physician">Physician</a> <ul><li><a href="/wiki/Chief_physician" title="Chief physician">Chief physician</a></li></ul></li> <li><a href="/wiki/History_of_medicine" title="History of medicine">History of medicine</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /> <a href="/wiki/Category:Medicine" title="Category:Medicine">Category</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/18px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/24px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /> <a href="https://commons.wikimedia.org/wiki/Medicine" class="extiw" title="commons:Medicine">Commons</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/16px-People_icon.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/24px-People_icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/32px-People_icon.svg.png 2x" data-file-width="100" data-file-height="100" /> <a href="/wiki/Wikipedia:WikiProject_Medicine" title="Wikipedia:WikiProject Medicine">Wikiproject</a></li> <li><a href="/wiki/File:Symbol_portal_class.svg" class="mw-file-description" title="Portal"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/16px-Symbol_portal_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/23px-Symbol_portal_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/31px-Symbol_portal_class.svg.png 2x" data-file-width="180" data-file-height="185" /></a> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Portal</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/10px-Global_thinking.svg.png" decoding="async" width="10" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/15px-Global_thinking.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/21px-Global_thinking.svg.png 2x" data-file-width="130" data-file-height="200" /> <a href="/wiki/Outline_of_medicine" title="Outline of medicine">Outline</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" 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