Anemia: A Global Health Challenge with Multifactorial Implications
Main Article Content
Abstract
Anemia is the most prevalent hematologic disorder worldwide, affecting over one billion individuals. It is characterized by a reduction in hemoglobin levels, leading to tissue hypoxia and systemic complications. The condition is classified based on onset, pathophysiology, and mean corpuscular volume, with the latter being the most widely used parameter in clinical practice.
Iron deficiency remains the primary cause of anemia, followed by anemia of inflammation, particularly in high-risk populations such as children, pregnant women, and the elderly. In children, iron deficiency anemia is highly prevalent and has been linked to neurocognitive developmental delays. Among women, menstrual blood loss and pregnancy significantly contribute to iron depletion, affecting overall health and maternal-fetal outcomes. In the elderly, anemia often results from multifactorial causes, including chronic inflammation, nutritional deficiencies, and underlying diseases, leading to impaired cognitive and physical function.
Recent advances in anemia research have highlighted the role of inflammatory pathways, hepcidin regulation, and novel therapeutic strategies, such as targeted iron supplementation and erythropoiesis-stimulating agents. Addressing anemia requires a multidisciplinary approach, integrating early diagnosis, nutritional interventions, and individualized treatment strategies to mitigate complications and improve patients’ quality of life.
Article Details
How to Cite
SILVA, Jiviane Beatriz Cunha Barretto da et al.
Anemia: A Global Health Challenge with Multifactorial Implications.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6397>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6397.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Machado ÍE, Malta DC, Bacal NS, Rosenfeld LGM. Prevalência de anemia em adultos e idosos brasileiros. Revista Brasileira De Epidemiologia. 2019;22(suppl 2). doi:10.1590/1980-54972019000 8.supl.2
2. De Santis GC. Anemia. Medicina (Ribeirão Preto). 2019;52(3):239-251. doi:10.11606/issn.2176-7262.v52i3p239-251
3. Santos MEATD, Roque JS, Martins ANT, et al. Anemia: definição, epidemiologia, fisiopatologia, classificação e tratamento. Brazilian Journal of Health Review. 2024;7(1):4197-4209. doi:10.3411 9/bjhrv7n1-341
4. Safiri S, Kolahi AA, Noori M, et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology. 2021;14(1). doi:10.1186/s13045-021-01202-2
5. Raleigh MF, Yano AS, Shaffer NE. Anemia in Infants and Children: Evaluation and Treatment. Am Fam Physician. 2024 Dec;110(6):612-620. PMID: 39700365.
6. Gallagher PG. Anemia in the pediatric patient. Blood. 2022;140(6):571-593. doi:10.1182/blood.2 020006479.
7. Almeida M, Siqueira D, Barros A, et al. Diagnóstico diferencial de anemia ferropriva. Hematology Transfusion and Cell Therapy. 2023; 45:S945. doi:10.1016/j.htct.2023.09.1698
8. Benson CS, Shah A, Stanworth SJ, et al. The effect of iron deficiency and anaemia on women’s health. Anaesthesia. 2021;76(S4):84-95. doi:10.1111/a nae.15405
9. Tang GH, Sholzberg M. Iron deficiency anemia among women: An issue of health equity. Blood Reviews. 2023;64:101159. doi:10.1016/j.blr e.2023.101159
10. De Bettencourt Moreira Da Silva ICGF. Anemia em idosos: Published September 20, 2022. https://repositorio.ulisboa.pt/handle/10451/57946
11. Da Silva JBCB, Vieira GM. Perfil epidemiológico da anemia em ambulatório de hematologia da rede privada de saúde. Revista De Medicina. 2021;100(1):20-27. doi:10.11606/issn.1679-9836.v100i1p20-27
12. Wang M. Iron deficiency and other types of anemia in infants and children. AAFP. Published February 15, 2016. https://www.aafp.org/pubs/afp/issues/2016/0215/p270.html
13. Novaes TG, Gomes AT, Da Silveira KC, et al. Prevalência e fatores associados à anemia em crianças de creches: uma análise hierarquizada. Revista Paulista De Pediatria. 2017;35(3):281-288. doi:10.1590/1984-0462/;2017;35;3;00008
14. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. 2019;1450(1):15-31. doi:10.1111/nyas.14092
15. Purnami GM, Praba KD, Fauziah IL, Dewi MM, Judistiani RTD, Setiabudiawan B. Anemia Prevalence, Characteristics, and Hematological Profile among Stunted Children Under 2 Years Old in Bandung Regency, Indonesia. Journal of Child Science. 2023;13(01):e75-e84. doi:10.1055/s-0043-1769483
16. Gallagher PG. Anemia in the pediatric patient. Blood. 2022;140(6):571-593.
doi:https://doi.org/10.1182/blood.2020006479
17. Sankaran, V., Weiss, M. Anemia: progress in molecular mechanisms and therapies. Nat Med 21, 221–230 (2015). https://doi.org/10.1038/nm.3814
18. Bezerra AGN, Leal VS, De Lira PIC, et al. Anemia e fatores associados em mulheres de idade reprodutiva de um município do Nordeste brasileiro. Revista Brasileira De Epidemiologia. 2018;21(0). doi:10.1590/1980-549720180001
19. Milman N. Ferro na gravidez – Como garantimos um estado de ferro Milman N. Iron in pregnancy – How do we secure an appropriate iron status in the mother and child? Annals of Nutrition and Metabolism. 2011;59(1):50-54. doi:10.1159/00 0332129
20. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131(5):505-514. doi:10.1182/blood-2017-07-746446
21. Cotter J, Baldaia C, Ferreira M, Macedo G, Pedroto I. Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review. World Journal of Gastroenterology. 2020;26(45):7242-7257. doi:10.3748/wjg.v26.i45.7242
22. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018;9(1):143-150. Published 2018 Feb 1. doi:10.14336/AD.2017.0306
23. Ribeiro H, Rodrigues I, Napoleão L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: Adjusting prescription to patient features. Biomed Pharmacother. 2022;150:112958. doi:10.1016/j.biopha.2022.112958
24. Friedrisch JR, Cançado RD. Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia. Rev Bras Hematol Hemoter. 2015;37(6):400-405. doi:10.1016/j.bjhh.2015.08.012
25. Przybyszewska J, Żekanowska E, Kędziora Kornatowska K, Boinska J, Cichon R, Porzych K. Serum prohepcidin and other iron metabolism parameters in elderly patients with anemia of chronic disease and with iron deficiency anemia. Polskie Archiwum Medycyny Wewnętrznej. 2013;123(3):105-111. doi:10.20452/pamw.1623
26. De Souza Farias Filho AM, Hirai KE, Sekioka NML, Batista NT. A relação dos mecanismos fisiopatológicos entre a anemia e a doença renal crônica. Revista Brasileira De Analises Clinicas/ RBAC. 2022;54(4). doi:10.21877/2448-3877.20220 2157
27. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. 2019;1450(1):15-31. doi:10.1111/nyas.14092
28. Bruserud Ø, Vo AK, Rekvam H. Hematopoiesis, Inflammation and Aging—The biological background and clinical impact of anemia and increased C-Reactive protein levels on elderly individuals. Journal of Clinical Medicine. 2022;11(3):706. doi:10.3390/jcm11030706
29. Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017;26(1):1-9. doi:10.1159/000452104
30. Ismaiel A, Srouji NA. Anemia of Chronic Disease: Epidemiology and Pathophysiological Mechanisms – literature review. Global Journal of Medical Therapeutics. 2020;2(4). doi:10.46982/gj mt.2020.109
31. Hashmi MF, Aeddula NR, Shaikh H, Rout P. Anemia of Chronic Kidney Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 23, 2024.
32. Bonaccorsi AC. Andropausa: insuficiência androgênica parcial do homem idoso. Uma revisão. Arquivos Brasileiros De Endocrinologia & Metabologia. 2001;45(2):123-133. doi:10.1590/s0004-27302001000200003
33. Roy CN, Snyder PJ, Stephens-Shields AJ, et al. Association of testosterone levels with anemia in older men. JAMA Internal Medicine. 2017;177 (4):480. doi:10.1001/jamainternmed.2016.9540
34. Bachman E, Travison TG, Basaria S, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014;69(6):725-735. doi:10.1093/gerona/glt154
35. Magalhães SMM, Lorand-Metze I. Síndromes mielodisplásicas: protocolo de exclusão. Revista Brasileira De Hematologia E Hemoterapia. 2004; 26(4). doi:10.1590/s1516-84842004000400006
2. De Santis GC. Anemia. Medicina (Ribeirão Preto). 2019;52(3):239-251. doi:10.11606/issn.2176-7262.v52i3p239-251
3. Santos MEATD, Roque JS, Martins ANT, et al. Anemia: definição, epidemiologia, fisiopatologia, classificação e tratamento. Brazilian Journal of Health Review. 2024;7(1):4197-4209. doi:10.3411 9/bjhrv7n1-341
4. Safiri S, Kolahi AA, Noori M, et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology. 2021;14(1). doi:10.1186/s13045-021-01202-2
5. Raleigh MF, Yano AS, Shaffer NE. Anemia in Infants and Children: Evaluation and Treatment. Am Fam Physician. 2024 Dec;110(6):612-620. PMID: 39700365.
6. Gallagher PG. Anemia in the pediatric patient. Blood. 2022;140(6):571-593. doi:10.1182/blood.2 020006479.
7. Almeida M, Siqueira D, Barros A, et al. Diagnóstico diferencial de anemia ferropriva. Hematology Transfusion and Cell Therapy. 2023; 45:S945. doi:10.1016/j.htct.2023.09.1698
8. Benson CS, Shah A, Stanworth SJ, et al. The effect of iron deficiency and anaemia on women’s health. Anaesthesia. 2021;76(S4):84-95. doi:10.1111/a nae.15405
9. Tang GH, Sholzberg M. Iron deficiency anemia among women: An issue of health equity. Blood Reviews. 2023;64:101159. doi:10.1016/j.blr e.2023.101159
10. De Bettencourt Moreira Da Silva ICGF. Anemia em idosos: Published September 20, 2022. https://repositorio.ulisboa.pt/handle/10451/57946
11. Da Silva JBCB, Vieira GM. Perfil epidemiológico da anemia em ambulatório de hematologia da rede privada de saúde. Revista De Medicina. 2021;100(1):20-27. doi:10.11606/issn.1679-9836.v100i1p20-27
12. Wang M. Iron deficiency and other types of anemia in infants and children. AAFP. Published February 15, 2016. https://www.aafp.org/pubs/afp/issues/2016/0215/p270.html
13. Novaes TG, Gomes AT, Da Silveira KC, et al. Prevalência e fatores associados à anemia em crianças de creches: uma análise hierarquizada. Revista Paulista De Pediatria. 2017;35(3):281-288. doi:10.1590/1984-0462/;2017;35;3;00008
14. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. 2019;1450(1):15-31. doi:10.1111/nyas.14092
15. Purnami GM, Praba KD, Fauziah IL, Dewi MM, Judistiani RTD, Setiabudiawan B. Anemia Prevalence, Characteristics, and Hematological Profile among Stunted Children Under 2 Years Old in Bandung Regency, Indonesia. Journal of Child Science. 2023;13(01):e75-e84. doi:10.1055/s-0043-1769483
16. Gallagher PG. Anemia in the pediatric patient. Blood. 2022;140(6):571-593.
doi:https://doi.org/10.1182/blood.2020006479
17. Sankaran, V., Weiss, M. Anemia: progress in molecular mechanisms and therapies. Nat Med 21, 221–230 (2015). https://doi.org/10.1038/nm.3814
18. Bezerra AGN, Leal VS, De Lira PIC, et al. Anemia e fatores associados em mulheres de idade reprodutiva de um município do Nordeste brasileiro. Revista Brasileira De Epidemiologia. 2018;21(0). doi:10.1590/1980-549720180001
19. Milman N. Ferro na gravidez – Como garantimos um estado de ferro Milman N. Iron in pregnancy – How do we secure an appropriate iron status in the mother and child? Annals of Nutrition and Metabolism. 2011;59(1):50-54. doi:10.1159/00 0332129
20. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131(5):505-514. doi:10.1182/blood-2017-07-746446
21. Cotter J, Baldaia C, Ferreira M, Macedo G, Pedroto I. Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review. World Journal of Gastroenterology. 2020;26(45):7242-7257. doi:10.3748/wjg.v26.i45.7242
22. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018;9(1):143-150. Published 2018 Feb 1. doi:10.14336/AD.2017.0306
23. Ribeiro H, Rodrigues I, Napoleão L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: Adjusting prescription to patient features. Biomed Pharmacother. 2022;150:112958. doi:10.1016/j.biopha.2022.112958
24. Friedrisch JR, Cançado RD. Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia. Rev Bras Hematol Hemoter. 2015;37(6):400-405. doi:10.1016/j.bjhh.2015.08.012
25. Przybyszewska J, Żekanowska E, Kędziora Kornatowska K, Boinska J, Cichon R, Porzych K. Serum prohepcidin and other iron metabolism parameters in elderly patients with anemia of chronic disease and with iron deficiency anemia. Polskie Archiwum Medycyny Wewnętrznej. 2013;123(3):105-111. doi:10.20452/pamw.1623
26. De Souza Farias Filho AM, Hirai KE, Sekioka NML, Batista NT. A relação dos mecanismos fisiopatológicos entre a anemia e a doença renal crônica. Revista Brasileira De Analises Clinicas/ RBAC. 2022;54(4). doi:10.21877/2448-3877.20220 2157
27. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. 2019;1450(1):15-31. doi:10.1111/nyas.14092
28. Bruserud Ø, Vo AK, Rekvam H. Hematopoiesis, Inflammation and Aging—The biological background and clinical impact of anemia and increased C-Reactive protein levels on elderly individuals. Journal of Clinical Medicine. 2022;11(3):706. doi:10.3390/jcm11030706
29. Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017;26(1):1-9. doi:10.1159/000452104
30. Ismaiel A, Srouji NA. Anemia of Chronic Disease: Epidemiology and Pathophysiological Mechanisms – literature review. Global Journal of Medical Therapeutics. 2020;2(4). doi:10.46982/gj mt.2020.109
31. Hashmi MF, Aeddula NR, Shaikh H, Rout P. Anemia of Chronic Kidney Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 23, 2024.
32. Bonaccorsi AC. Andropausa: insuficiência androgênica parcial do homem idoso. Uma revisão. Arquivos Brasileiros De Endocrinologia & Metabologia. 2001;45(2):123-133. doi:10.1590/s0004-27302001000200003
33. Roy CN, Snyder PJ, Stephens-Shields AJ, et al. Association of testosterone levels with anemia in older men. JAMA Internal Medicine. 2017;177 (4):480. doi:10.1001/jamainternmed.2016.9540
34. Bachman E, Travison TG, Basaria S, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014;69(6):725-735. doi:10.1093/gerona/glt154
35. Magalhães SMM, Lorand-Metze I. Síndromes mielodisplásicas: protocolo de exclusão. Revista Brasileira De Hematologia E Hemoterapia. 2004; 26(4). doi:10.1590/s1516-84842004000400006