Anemia in the tropics is a common medical condition resulting from various nutritional deficiencies, infections, parasites, and inherited disorders. Its prevalence and causes differ significantly from developed countries and are often multifactorial.
Overall, iron deficiency is the most common cause of anemia worldwide. Similar to deficiencies of folic acid and vitamin B12, it results from diets rich in carbohydrates, but poor in meats, proteins, and vegetables. Most patients with AIDS in developing countries are anemic, with more severe cases seen in those coinfected with tuberculosis. Malaria causes hemolysis and hypersplenism and should always be considered in anemic patients. Hookworm infection is another common cause of anemia, particularly in children and pregnant women. Other parasitic illnesses causing anemia include visceral leishmaniasis (kala-azar) and African trypanosomiasis (sleeping sickness). Hemoglobinopathies, including sickle cell anemia and thalassemia, are common in Africa, the Middle East, the Americas, and South Asia. Severe hemolytic anemia can occur in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Management and Disposition
Treatment depends on the suspected cause(s). Iron and folate supplementation can lead to a rapid and dramatic increase in red cell counts in patients with nutritional deficiencies. A low threshold for malaria diagnosis and treatment is important. Empiric treatment for hookworm is advisable. Red blood cell transfusion is rarely needed in stable patients, even those with extremely low counts.
Anemia. Conjunctival pallor in a Haitian woman with complaints of weakness and a hemoglobin (Hgb) of 2.2. (Photo contributor: Andreas Fischer, RN.)
Administration of the antimalarial agent primaquine to patients with G6PD deficiency can lead to fatal hemolysis.
Thrombocytopenia in conjunction with anemia is highly suggestive of malaria in endemic areas.
Anemia in pregnancy should be screened for and aggressively treated as this improves both maternal and fetal outcomes.
Anemia. Pale tongue in a severely anemic Haitian woman. Pale mucous membranes, palms, and soles are often good indicators of anemia, particularly in dark-skinned individuals. (Photo contributor: Andreas Fischer, RN.)
Anemia in AIDS. Gums of Ugandan patient with end-stage AIDS and Hgb of 3.0. (Photo contributor: Seth W. Wright, MD.)