Tropical Anemia

315 Pages·2007·1.76 MB·English

T A
ROPICAL NEMIA

T A
ROPICAL NEMIA

VIROJ WIWANITKIT

Nova Science Publishers, Inc.
New York
Copyright © 2007 by Nova Science Publishers, Inc.

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Library of Congress Cataloging-in-Publication Data
Viroj Wiwanitkit.
Tropical anemia / Viroj Wiwanitkit.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60692-822-6
1. Anemia. 2. Tropical medicine. I. Title.
[DNLM: 1. Anemia--classification. 2. Anemia--etiology.
3. Hematologic Tests. 4. Tropical Medicine--methods. WH 155
V819t 2006]
RC641.V57 2006
616.1'52--dc22
2005034979

Published by Nova Science Publishers, Inc. New York
Contents
Preface vii
Chapter 1 Introduction to Tropical Anemia 1
Chapter 2 Malarial Anemia 19
Chapter 3 Non-Malarial Protozoa Induced Anemia 33
Chapter 4 Hookworm Anemia and other Intestinal Helminth-Induced Anemia 47
Chapter 5 Anemia in Bacterial Infections 61
Chapter 6 Anemia in Fungal Infections 77
Chapter 7 Anemia in Viral Diseases 89
Chapter 8 Advances in Thalassemia 105
Chapter 9 Tropical Hemoglobinopathy 123
Chapter 10 Glucose-6-Phosophate Dehydrogenase Deficiency in Tropical Countries 137
Chapter 11 Nutritional Anemia in Tropical Countries 149
Chapter 12 Iron Deficiency in the Tropics 163
Chapter 13 Tropical Sprue and Anemia 177
Chapter 14 Anemia and Tropical Toxin 185
Chapter 15 Occupational Induced Anemia in the Tropics 197
Chapter 16 Anemia in the Pregnant in Tropical Countries 209
Chapter 17 Anemia in Infancy and Childhood in Tropical Countries 225
Chapter 18 Anemia in the Elderly in the Tropical Countries 241
Chapter 19 Emerging and Reemerging Anemic Diseases in the Tropics 257
Chapter 20 Quality System of Hematology Laboratory in Tropical Countries 271
Index 283

Preface

Anemia is a common health problem all over the world. The term “tropical anemia”
means anemic disorders, predominant in the tropical regions of the world. The purpose of this
book is to summarize and present the topics specifically relating to anemia in the forms that
are unique in tropical countries. Due to globalization in the present day, a change in the
epidemiology of diseases from one site to others all around the world can be expected. The
summative on the common anemic problems in the tropical countries can be and should be
performed. This book can make them at least realize and become familiarized with the
problems. The details of this book focus on anemia in the aspects relating to tropical
medicine. This book will cover specifically the clinical aspect, the scientific laboratory
aspect, and the public health aspects as well as the social sciences relating to anemia in
important tropical diseases. The common tropical diseases, including inherited disorders and
infectious diseases, which relate to anemia will be summarized, presented and discussed.
Mainly the book will present summative data from molecular to population scales, as well as
additional meta-analysis for important topics. In addition, the diagnostic guidelines and
clinical practice guidelines of the mentioned conditions will be presented. This work can be a
useful reference for practitioners who are not familiar with the unique problems of the
developing world and who might face those problems due to the possible migration of
diseases. The academic level of this book is aimed at a wide range from the medical student,
resident, general practitioner, specialist in hematology and tropical medicine to researchers in
medical sciences. It can also be useful for medical personnel in allied health sciences.

Viroj Wiwanitkit, M.D.

Chapter 1

Introduction to Tropical Anemia

Some Basic Knowledge on Anemia

In laboratory medicine, anemia (uh-NEE-mee-uh) means the condition in which the level
of hemoglobin is lower than the lower normal limit (-2 standard deviation: - 2 S.D.) [1 – 2].
In some cases, it can be easily referred to as a deficiency of red blood cells. However,
sometimes the word “anemia” is used as a term for the condition called “pale”. Indeed, “pale”
is not equal to “anemia” but “pale” is an important manifestation of anemia. Recently, Kent
et al. performed a study to assess the correlation of the bulbar conjunctival blood column
(BCBC) with anemia [3]. In this study, observations of the palpebral conjunctival hue (PCH)
and BCBC by two observers masked to the patient's diagnosis and laboratory test results were
assessed [3]. The PCH and BCBC were correlated by slit-lamp examination with serum
hemoglobin values, and different threshold levels for anemia were defined as hemoglobin
<10, <11, and <12 mg/dl [3]. According to this study, the sensitivity of the BCBC and PCH
for anemia was 83%-94% and 38%, respectively, regardless of the definition of anemia, but
the specificity of BCBC improved with increasing hemoglobin threshold levels for anemia
[3]. Kent et al. concluded that the BCBC is significantly associated with anemia, with higher
sensitivity and only slightly less specificity than PCH [3].
According to the definition of anemia, it is necessary to perform a laboratory
investigation to document an anemic case. The hematological investigation that is necessary
for detection of anemia is hemoglobin determination or hemoglobinometry.
Naturally, hemoglobin is a red blood cell pigment, consisting of globin and heme. This
red blood cell pigment’s main function is to carry oxygen from the lung to the tissue. At
present, there are many methods for hemoglobin determination. Those methods for
hemoglobinometry can be grouped into 5 main classes depending on the basic technique as
colorimetric methods, gasometric methods, specific gravity methods, chemical methods and
mathematical model methods (Table 1.1). Of those several methods, cyanmethemoglobin
method, a colorimetric method, is the standard reference method [1]. The principle of this
method is that when blood is mixed with a solution containing potassium ferricyanide and
potassium cyanide (Drabkin's solution), the potassium ferricyanide oxidizes iron to form
methemoglobin. The potassium cyanide then combines with methemoglobin to form