Performance 1. Neurological manifestations Headache, dizziness, depression, insomnia, dreaminess, tinnitus, blurred vision, memory loss, and lack of concentration are common symptoms of anemia. The mechanism may be caused by anemia-induced brain tissue hypoxia, blood volume deficiency due to blood loss or lower blood pressure; it may also be caused by hemolysis-induced hyperbilirubinemia or hyperfree hemoglobinemia. Numbness of extremities can be caused by peripheral neuritis complicated by anemia, especially seen in vitamin B12 deficiency megaloblastic anemia. 2. Skin and mucous membranes Pallor is the main manifestation of skin and mucous membranes in anemia, and the mechanism is mainly through neurohumoral regulation causing redistribution of effective blood volume. To ensure the blood supply to important organs, the blood supply to relatively minor organs is reduced. The roughness of the skin, lack of luster and even the formation of ulcers are related to the reduced blood supply and insufficient nutrition to the skin and mucous membranes. Hemolytic anemia can cause yellow staining of the skin and mucous membranes. 3. Respiratory system In mild anemia, due to the body’s compensatory and adaptive ability, the number of breaths may not increase when calm, but after activity, the body is in a state of low oxygen and high carbon dioxide, which stimulates the respiratory center and causes deeper and faster breathing. In case of severe anemia, shortness of breath or even telescopic breathing may occur in a calm state. 4. Circulatory system In acute hemorrhagic anemia, the main response is to low blood volume, such as peripheral vasoconstriction. In non-hemorrhagic anemia, because the blood volume is not low, the main manifestation is the heart’s response to tissue hypoxia, such as palpitations and accelerated heart rate, especially obvious after activity. Long-term anemia, with overloaded heart and insufficient blood supply, can lead to anemic heart disease. 5. Digestive system Anemia affects the function or structure of the digestive system, causing a decrease in digestive gland secretion or even glandular atrophy, resulting in reduced digestive function, indigestion, abdominal distention, loss of appetite, and changes in the regularity and character of stools. Patients may have swallowing foreign body sensation (iron deficiency anemia), heterophilia (hookworm disease), tongue inflammation, tongue atrophy, beef tongue, mirror tongue (megaloblastic anemia), etc. 6. Urological system Renal anemia has clinical manifestations of primary renal disease before and at the same time as anemia. Collagen disease can affect both the hematopoietic system and the kidneys. Extravascular hemolysis appears as bilirubinuria and hyperuriculogenuria, intravascular hemolysis appears as free hemoglobin and ferric hemoglobinuria, and in severe cases, free hemoglobin may even block the renal tubules, causing oliguria, anuria, and acute, renal failure. The anemia caused by thrombotic thrombocytopenic purpura/hemolytic uremic syndrome is mostly accompanied by renal insufficiency. 7. Endocrine system Hemorrhage in childbirth can lead to ischemic necrosis of the pituitary gland and the occurrence of Sheen syndrome. Long-term anemia affects the function of thyroid, gonads, adrenal glands and pancreas, and changes the secretion of erythropoietin and gastrointestinal hormones. 8. Reproductive system Long-term anemia causes ischemia and necrosis of testicular spermatogenic cells, which in turn affects the secretion of testosterone and weakens male characteristics. In women, besides affecting the secretion of female hormones, it may also cause excessive menstruation due to the combination of coagulation factors and platelet quantity or quality abnormalities. 9. Immune system All patients with anemia secondary to immune system diseases have clinical manifestations of the primary immune system disease. Anemia itself can also cause changes in the immune system, such as erythrocyte reduction has reduced the regulatory role of erythrocytes in the process of defending against pathogenic microbial infections, and the reduction of C3 on the erythrocyte membrane can affect the non-specific immune function of the body. 10.Hematological system includes changes in both peripheral blood and hematopoietic organs. The changes in peripheral blood are mainly in blood cell volume, morphology and biochemical composition, and in some cases may be combined with abnormalities in plasma or serum composition. Changes in hematocrit, hemoglobin, hematocrit, and reticulocyte count may be combined with abnormal white blood cell or platelet counts. The morphological changes include large, small, and orthocytic anemia, as well as anomalous red blood cells, white blood cells, and platelets. The abnormalities of the biochemical components of red blood cells are twofold: first, more 2,3-diphosphoglycerate (2,3-DPG) is synthesized in red blood cells, which reduces the affinity of hemoglobin for oxygen, shifting the oxygen dissociation curve to the right and allowing more oxygen to the tissues; second, alterations that vary depending on the type of anemia, such as abnormalities of red blood cell membranes, enzymes, hemoglobin, and certain anemias complicated by changes in leukocyte and platelet mass. Changes in plasma or serum components are mostly seen in plasma cell disease anemia, hemolytic anemia, combined diffuse intravascular coagulation anemia, liver disease anemia and renal anemia. The changes in the hematopoietic organs are mainly in the bone marrow, and the morphological proportions of the granulocyte, red, mononuclear, megakaryocyte, and lymphocyte lineages in the bone marrow may vary widely among different types of anemia. Anemia caused by tumors of the hematopoietic system may be combined with enlarged liver, spleen and lymph nodes; hemolytic anemia may be combined with enlarged liver or spleen; myelofibrosis and hypersplenism are mostly combined with splenomegaly. Causes 1. Chronic disease anemia is one of the causes of tumor-induced anemia, especially in non-progressive tumor patients, and is mostly manifested as mild to moderate orthocytic anemia. The mechanism is mainly related to the reduced function of hematopoietic progenitor cells and low response to erythropoietin. The occurrence of hemolytic anemia in patients with hemolytic anemia is related to the following factors: â‘ Shortened erythrocyte lifespan Most patients with combined anemic tumors have mildly shortened erythrocyte lifespan, which is related to the hyperfunction of the mononuclear macrophage system. During the flow of red blood cells through the spleen and liver, their cell membranes are constantly phagocytosed by mononuclear macrophages, resulting in premature destruction of red blood cells. â‘¡Microangiopathic hemolytic anemia advanced tumors can be combined with diffuse intravascular coagulation, and certain gastric and lung cancers can produce mucin, causing fibrin deposition in small blood vessels, leading to the occurrence of a mechanism similar to DIC, which causes the destruction of red blood cells in small blood vessels. (iii) Autoimmune hemolytic anemia is seen in patients with ovarian cancer, malignant lymphoma and lymphocytic leukemia, producing anti-self red blood cell antibodies. In patients with ovarian cancer combined with hemolysis, the antibodies produced are basically warm antibodies. The anemia can be cured by removing the ovarian tumor. 3.Pure red blood cell aplastic anemia thymoma patients are often combined with acquired pure red blood cell aplastic anemia (PRCA), which accounts for about 7% to 50% of PRCA as reported in the literature. The close relationship between thymoma and PRCA is demonstrated by: (i) removal of thymoma, which can cure PRCA in half of the patients. The presence of anti-erythrocyte antibodies and erythropoiesis-inhibiting factor, which is IgG type, in the serum of patients. Treatment of PRCA with immunosuppressive agents and anti-lymphocyte serum is effective. (iii) Patients often have other abnormalities, such as hyper (or hypo) globulinemia, positive antiglobulin test and antinuclear antibodies or combined myasthenia gravis. Recent studies have demonstrated that in some PRCA patients, T8 suppressor cells function abnormally, which may be related to the pathogenesis. 4. 16% of patients with secondary iron granulocytic anemia are secondary to neoplastic diseases. Prostate cancer and myeloproliferative diseases, leukemia, and myeloma are the most common. The mechanism of how the tumor interferes with iron utilization by erythrocytes is unknown and may be related to abnormal heme synthesis or the presence of abnormal red lineage hematopoietic progenitor cells in tumor patients. 5.Infiltration of tumor in bone marrow Bone marrow metastasis of malignant tumor can cause myelopathic anemia. The common tumors prone to bone marrow metastasis are stomach, lung, prostate, breast and kidney cancer. Patients with myelopathic anemia are often combined with bone marrow fibrosis, which makes it difficult to obtain ideal specimens by bone marrow aspiration, and bone marrow biopsy can be used for pathological examination. 6.Megaloblastic anemia is occasionally seen in combination with megaloblastic anemia in tumor patients. Folic acid deficiency is more common in patients, due to poor nasal and insufficient intake, rapid tumor growth, excessive consumption of folic acid, digestive disorders and reduced absorption. Vitamin B12 deficiency is rare. 7.Iron deficiency Gastrointestinal tumor and uterine cancer are often combined with bleeding, resulting in iron deficiency anemia. 8.Treatment-related anemia Bone marrow function suppression caused by chemotherapy and radiotherapy is quite common in clinical practice. Some of these chemotherapeutic agents such as: Tysol, Tysodex, carboplatin or cisplatin, cyclophosphamide in combination with carboplatin or cisplatin; Noviben, CPT11 in combination with cisplatin, etc. In addition radiotherapy of extensive vertebral body is highly prone to irreversible pernicious anemia. Treatment 1.Remove the cause 2.Supplement the hematopoietic material 3.Anticoagulation, reduce platelet consumption and prevent thrombosis, 4.Stimulate the production of blood cells (testosterone and EPO use) 5.Blood transfusion 6.Antihemolytic treatment 7.Symptomatic support treatment 8.Chinese herbal medicine treatment.