Female dizziness, weakness and general weakness

In order to pursue a skinny figure, women nowadays take quite extreme measures to lose weight, such as not eating for a long time. However, this method is very harmful to the body. If it lasts for a long time, it will cause malnutrition and lead to anemia. At this time, most women will experience problems such as dizziness and fatigue. If this situation continues for a long time, it will cause considerable damage to the body.

Anemia refers to a common clinical symptom in which the volume of peripheral red blood cells in the human body decreases to below the lower limit of the normal range. Since the measurement of red blood cell volume is complicated, hemoglobin (Hb) concentration is often used instead in clinical practice. Chinese hematologists believe that in my country's sea level areas, adult males with Hb <120g/L, adult females (non-pregnant) with Hb <110g/L, and pregnant women with Hb <100g/L are considered anemic.

The diagnostic criteria established by WHO in 1972 consider anemia to be diagnosed when Hb is lower than the following levels in sea level areas: 110 g/L for children aged 6 months to < 6 years, 120 g/L for children aged 6 to 14 years, 130 g/L for adult males, 120 g/L for adult females, and 110 g/L for pregnant women. It should be noted that the normal hemoglobin value of residents who have lived in plateau areas for a long time is higher than that of residents at sea level; during pregnancy, hypoproteinemia, congestive heart failure, splenomegaly and macroglobulinemia, the plasma volume increases. At this time, even if the red blood cell volume is normal, the hemoglobin concentration decreases due to blood dilution, and it is easy to be misdiagnosed as anemia; when the circulating blood volume is reduced due to dehydration or acute massive blood loss, due to blood concentration, even if the red blood cell volume is low, anemia is easily missed due to the increase in hemoglobin concentration.

Disease classification and causes

Anemia has different classifications based on different clinical characteristics. For example: according to the speed of anemia progression, it can be divided into acute and chronic anemia; according to the red blood cell morphology, it can be divided into macrocytic anemia, normocytic anemia and microcytic hypochromic anemia; according to the hemoglobin concentration, it can be divided into mild, moderate, severe and very severe anemia; according to the proliferation of the bone marrow erythroid lineage, it can be divided into proliferative anemia (such as hemolytic anemia, iron deficiency anemia, megaloblastic anemia, etc.) and hypoproliferative anemia (such as aplastic anemia). Anemia is often classified clinically based on its pathogenesis and etiology:

1. Anemia due to decreased erythropoiesis

Abnormalities in hematopoietic cells, bone marrow hematopoietic microenvironment and hematopoietic raw materials affect erythropoiesis and may lead to erythropoietic anemia.

(1) Anemia caused by abnormal hematopoietic stem and progenitor cells

1) Aplastic anemia (AA) AA is a bone marrow hematopoietic failure disease associated with primary and secondary hematopoietic stem and progenitor cell damage. The pathogenesis of partial pancytopenia is related to the production of anti-bone marrow cell autoantibodies by B cells, which in turn destroy or inhibit bone marrow hematopoietic cells.

2) Pure red cell aplasia (PRCA) PRCA refers to damage to the erythroid hematopoietic stem progenitor cells in the bone marrow, which in turn causes anemia. Depending on the cause, the disease can be divided into two categories: congenital and acquired. Congenital PRCA is Diamond-Blackfan syndrome, which is caused by inheritance; acquired PRCA includes primary and secondary types. Some scholars have found that some primary PRCA patients have autologous EPO or immature erythrocyte antibodies in their serum. Secondary PRCA mainly includes drug-related type, infection-related type (bacteria and viruses, such as parvovirus B19, hepatitis virus, etc.), autoimmune disease-related type, lymphoproliferative disease-related type (such as thymoma, lymphoma, plasma cell disease and lymphocytic leukemia, etc.) and acute aplastic crisis.

3) Congenital dyserythropoietic anemia (CDA) CDA is a type of refractory anemia caused by a hereditary benign clonal abnormality of erythroid stem and progenitor cells, characterized by ineffective erythroid hematopoiesis and morphological abnormalities. According to the inheritance mode, the disease can be divided into autosomal recessive type and dominant type.

4) Malignant clonal diseases of the hematopoietic system In these diseases, qualitative abnormalities occur in hematopoietic stem and progenitor cells, including myelodysplastic syndrome and various hematopoietic tumor diseases such as leukemia. The former is due to pathological hematopoiesis, high proliferation and apoptosis of blood cells, resulting in in situ hemolysis; the latter is due to tumor proliferation, low apoptosis and poor differentiation, which also affects hematopoietic regulation, resulting in a decrease in normal mature red blood cells and anemia.

(2) Anemia caused by abnormal hematopoietic microenvironment The hematopoietic microenvironment includes bone marrow stroma, stromal cells and cytokines.

1) Anemia caused by damage to the bone marrow matrix and stromal cells, bone marrow necrosis, myelofibrosis, myelosclerosis, marble disease, bone marrow metastasis of various extramedullary tumors, and various infectious or non-infectious osteomyelitis can all affect blood cell production due to damage to the bone marrow matrix and stromal cells and abnormalities in the hematopoietic microenvironment.

2) Anemia caused by abnormal levels of hematopoietic regulatory factors Stem cell factor (SCF), interleukin (IL), granulocyte-monocyte colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), thrombopoietin (TPO), platelet growth factor (TGF), tumor necrosis factor (TNF) and interferon (IFN) all have positive and negative regulatory effects on hematopoiesis. EPO deficiency occurs in cases of renal insufficiency, liver disease, hypopituitarism or hypothyroidism; tumor diseases or certain viral infections can induce the body to produce more negative hematopoietic regulatory factors such as TNF, IFN, inflammatory factors, etc., which can lead to anemia of chronic disease (ACD).

3) Lymphocytic hyperfunction AA, autoimmune diseases, autoimmune hemolytic anemia.

4) Hyperapoptosis of hematopoietic cells in myelodysplastic syndrome (MDS) and AA.

(3) Anemia caused by insufficient hematopoietic raw materials or utilization disorders Hematopoietic raw materials refer to substances necessary for the proliferation, differentiation, and metabolism of hematopoietic cells, such as proteins, lipids, vitamins (folic acid, vitamin B12, etc.), trace elements (iron, copper, zinc, etc.), etc. Insufficient or impaired utilization of any hematopoietic raw material may lead to decreased red blood cell production.

1) Anemia caused by folic acid or vitamin B12 deficiency or utilization disorder Megaloblastic anemia can be caused by absolute or relative deficiency or utilization disorder of folic acid or vitamin B12 in the body due to various physiological or pathological factors.

2) Iron deficiency and iron utilization disorder anemia This is the most common anemia in clinical practice. Iron deficiency and iron utilization disorders affect hemoglobin synthesis, and this type of anemia is called hemoglobin synthesis abnormal anemia. In this type of anemia, the red blood cells become smaller and the central pale-stained area expands, which is a type of microcytic hypochromic anemia.

2. Anemia due to excessive red blood cell destruction

(1) Abnormalities of red blood cells themselves: abnormal membranes, abnormal enzymes, abnormal globin, and abnormal hemoglobin.

(2) Abnormal environment surrounding red blood cells: immune, vascular, and hemolytic anemia (HA).

3. Hemorrhagic anemia

Depending on the rate of blood loss, it can be divided into acute and chronic. Chronic hemorrhagic anemia is often accompanied by iron deficiency anemia. It can be divided into two categories: caused by coagulation diseases (such as idiopathic thrombocytopenic purpura, hemophilia and severe liver disease, etc.) and caused by non-coagulation diseases (such as trauma, tumor, tuberculosis, bronchiectasis, peptic ulcer, hemorrhoids and gynecological diseases, etc.).