• Screening by hematocrit
  Cost effective for the following high risk group:
  a. Premature infants
  b. Infants born of multiple pregnancy or iron-deficient women
  c. Individuals in low socioeconomic circumstances
  

• Iron supplements in foods
  a. In baby formula and cereal products
  b. As supplement for pregnant and heavily menstruation women

• Consumption of the following food:
  a. Red meats and organ meats (especially liver)
  b. Leafy, green vegetables that high in B vitamins for those at high risk and previously diagnosed with anemia

• Genetic counseling for familial predisposition
• Avoiding heavy metals toxicity; Arsenic & copper
• Avoiding organic toxins; snake venoms
• preventing excessive mechanical stress Intravascularly or during extracorporeal circulation
• Treating and preventing the chronic diseases
• Watching for drug induced hemolysis
• Screening for bleeding disorders by (PT, APTT, T, BT)

Risk Factors For Anemia

• Poor Nutrition
• Smoking, reduce absorption
• Excess alcohol Consumption
• Use of anticoagulant drugs
• Any disorder reduce absorb.
• Thyroid disease; Myxedema
• Bulimia or Anorexia nervosa
• Diabetes mellitus
• Family History; pernicious and some other Anemias
• Previous stomach surgery
• Genetic factors

In order to assess the risk factors in anemic patients we should ask about the following histories:
Dietary History, Drug history, Occupational & Environmental history Ethnic origin History, family history, travel history, bleeding History, gastrointestinal history, genitourinary history, pregnancy history, Surgical history, and history of other diseases.

Treatment

• Should be directed to the causal factors
• Iron, B12, Folate
• Treatment of the underline disease
• Eliminating any toxic
• Blood Transfusion
• Exchange Transfusions
• Bone marrow Trans.
• Symptomatic & supportive

The most important point in the treatment strategies is that should be directed to the causal factor and towards the underline disease. If the anemia due to dietary deficiency, Iron, B12, folic acid or Vitamin C is the treatment and according to the deficient element. If there is symptomatic acute or chronic blood loss, Packed cell transfusion is the treatment of choice.

Bone marrow transfusion is recommended for those with Aplastic Anemia. In renal disease Recombinant erthropoietin is the treatment of choice. In spherocytosis Splenectomey is recommended. In G-6-P dehydrogenase deficiency, avoidance of drugs known to precipitate hemolysis is the most important step in treatment. In sickle cell Anemia the treatment should be directed towards preventing the crises and crisis management. Hydration, analgesics, oxygen, and hydroxyurea. Blood transfusion is only recommended when sequestration crises causing acute chest syndrome, and strokes. It is also approved in aplastic anemia . Other symptomatic and supportive treatment might be endorsed as well.

The Outcome & Prognosis of untreated Anemia:

• The outcome of the underling disease:
  "anemia is not a disease but rather a symptom of another disorder".

• Decrease oxygen supply to most organs
• Frontal bossing, Deafness, and Retinopathy
• Peripheral neuropathy, Dementia, and Ataxia
• Failure to thrive, physical and mental retardation
• Susceptibility to infectious diseases
• Ultimately congestive Heart failure, Stroke & death