Moreno Chulilla Jose Antonio, Romero Colás Maria Soledad, Gutiérrez Martín Martín
Department of Hematology, University Hospital Lozano Blesa, University of Zaragoza, C/San Juan Bosco 15, Zaragoza 50009, Spain.
World J Gastroenterol. 2009 Oct 7;15(37):4627-37. doi: 10.3748/wjg.15.4627.
Most anemia is related to the digestive system by dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anemia, its morphological classification (microcytic, macrocytic and normocytic) and pathogenic classification (regenerative and hypo regenerative), and integration of these classifications. Interpretation of laboratory tests is included, from the simplest (blood count, routine biochemistry) to the more specific (iron metabolism, vitamin B12, folic acid, reticulocytes, erythropoietin, bone marrow examination and Schilling test). In the text and various algorithms, we propose a hierarchical and logical way to reach a diagnosis as quickly as possible, by properly managing the medical interview, physical examination, appropriate laboratory tests, bone marrow examination, and other complementary tests. The prevalence is emphasized in all sections so that the gastroenterologist can direct the diagnosis to the most common diseases, although the tables also include rare diseases. Digestive diseases potentially causing anemia have been studied in preference, but other causes of anemia have been included in the text and tables. Primitive hematological diseases that cause anemia are only listed, but are not discussed in depth. The last section is dedicated to simplifying all items discussed above, using practical rules to guide diagnosis and medical care with the greatest economy of resources and time.
大多数贫血与消化系统相关，病因包括饮食缺乏、吸收不良或慢性出血。我们回顾了世界卫生组织对贫血的定义、其形态学分类（小细胞性、大细胞性和正细胞性）和病因学分类（再生性和低再生性），以及这些分类的整合。还包括实验室检查的解读，从最简单的（血细胞计数、常规生化检查）到更具特异性的（铁代谢、维生素B12、叶酸、网织红细胞、促红细胞生成素、骨髓检查和希林试验）。在正文和各种算法中，我们提出了一种分层且合乎逻辑的方法，通过妥善管理医学问诊、体格检查、适当的实验室检查、骨髓检查及其他辅助检查，尽快做出诊断。各章节均强调了患病率，以便胃肠病学家能将诊断指向最常见的疾病，尽管表格中也包含罕见疾病。我们优先研究了可能导致贫血的消化系统疾病，但正文中和表格里也纳入了其他贫血病因。仅列出了导致贫血的原发性血液系统疾病，但未深入讨论。最后一部分致力于简化上述所有内容，运用实用规则以最节省资源和时间的方式指导诊断和医疗护理。
