Blood disorders are a public health issue

Public health should focus not only on reducing the burden of common diseases but also address the needs of people with blood disorders , experts say in a supplement to December’s American Journal of Preventive Medicine.

Even relatively common blood disorders fly below the public health system’s radar with no established mechanisms for surveillance, supplement editors Scott D. Grosse, PhD, of the US Centers for Disease Control and Prevention (CDC); Andra H. James, MD, of Duke University; and Michele A. Lloyd-Puryear, MD, PhD, of the US National Institutes of Health, write in an introductory essay with Hani K. Atrash, MD, MPH, also of the CDC.

The authors contend that although most of the blood disorders discussed in the supplement are considered rare in the US and Western Europe—defined as affecting about 1 in 1,500 people—they should be ranked as a public health concern. “A public health framework is needed to address public health services and functions for all rare disorders, including blood disorders, regardless of the incidence or prevalence of a given disorder,” they say.

The most common blood disorder, venous thromboembolism (VTE), consists of deep vein thrombosis and Pulmonary embolism. It involves blood clots that occur in veins, usually in the legs, which can break up and move to the lungs and kill. VTE affects at least 1 million people in the US and is a major cause of death in adults, but “little is definitively known about the magnitude of [its] public health burden.”

Hereditary hemochromatosis is a genetic disorder present in about 1 million Americans but “the opportunity to detect iron overload at an early stage and intervene … to prevent the development of clinical disease … remains a challenge,” they add. And while at least 3 million Americans have sickle cell trait or are carriers of the sickle cell gene mutation, “the extent to which the carrier status poses health threats is not well established.”

Dozens of different diseases can involve the blood. Blood disorders can affect any of the three main components of blood -

Red blood cells, which carry oxygen to the body’s tissues
White blood cells, which fight infections
Platelets, which help blood to clot
Blood disorders can also affect the liquid portion of blood, called plasma
.

The supplement, comprised of 13 research papers and five workshop/meeting summaries, is authored by top medical educators and public health professionals. Its publication was supported by the CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

Two papers focus on sickle cell trait screening policy in college athletes and military recruits, while seven address hemophilia and bleeding disorders, the most common of which are hemophilia A and B, and the hemoglobinopathies- sickle cell disease and thalassemia.

Treatments and prognosis for blood diseases vary, depending on the blood condition and its severity.

Blood Disorders Affecting Red Blood Cells

Blood disorders that affect red blood cells include -

Anemia  -  People with anemia have a low number of red blood cells. Mild anemia often causes no symptoms. More severe anemia can cause fatigue, pale skin, and shortness of breath with exertion.

Iron-deficiency anemia -  Iron is necessary for the body to make red blood cells. Low iron intake and loss of blood due to menstruation are the most common causes of iron-deficiency anemia. Treatment includes iron pills, or rarely blood transfusion.

Anemia of chronic disease -  People with chronic kidney disease or other chronic diseases tend to develop anemia. Anemia of chronic disease does not usually require treatment. Injections of a synthetic hormone (Epogen, Procrit) to stimulate the production of blood cells or blood transfusions may be necessary in some people with this form of anemia.

Pernicious anemia (B12 deficiency) -  An autoimmune condition that prevents the body from absorbing enough B12 in the diet. Besides anemia, nerve damage (neuropathy) can eventually result. High doses of B12 prevent long-term problems.

Aplastic anemia -  In people with aplastic anemia, the bone marrow does not produce enough blood cells, including red blood cells. A viral infection, drug side effect, or an autoimmune condition can cause aplastic anemia. Blood transfusions, and even a bone marrow transplant, may be required to treat aplastic anemia.

Autoimmune hemolytic anemia -  In people with this condition, an overactive immune system destroys the body’s own red blood cells, causing anemia. Medicines that suppress the immune system, such as prednisone, may be required to stop the process.

Thalassemia -  This is a genetic form of anemia that mostly affects people of Mediterranean heritage. Most people have no symptoms and require no treatment. Others may need regular blood transfusions to relieve anemia symptoms.

Sickle cell anemia -  A genetic condition that affects mostly African-Americans. Periodically, red blood cells change shape, and block blood flow. Severe pain and organ damage can occur.

Polycythemia vera  -  The body produces too many blood cells, from an unknown cause. The excess red blood cells usually create no problems, but cause blood clots in some people.

Malaria -  A mosquito’s bite transmits a parasite into a person’s blood, where it infects red blood cells. Periodically, the red blood cells rupture, causing fever, chills, and organ damage. This blood infection is most common in Africa; malaria was eradicated from the U.S. in the 1940s.

Grosse and his colleagues propose a public health framework to address such often-overlooked conditions. The framework is similar to the 10 essential public health services but focuses on rare disorders rather than common exposures or common health problems. The framework calls for public health officials to -

  Assess the prevalence/incidence of specific rare disorders;
  Monitor the health status and health-related quality of life of people with rare disorders and their families;
  Quantify the impacts of rare disorders on disability, mortality, and healthcare system use, particularly hospital-based care;
  Conduct research to identify preventable causes of health problems among people with rare disorders, including barriers to the consistent use of effective prophylaxis and treatment;
  Establish systems for early and continuous screening where appropriate;
  Educate and empower people with rare disorders along with their family members and primary care providers;
  Ensure access to cost-effective and affordable screening, diagnostic, primary care, and specialty health services;
  Evaluate the effectiveness, accessibility, and quality of health services for people with rare disorders and
  Inform program and policy decision makers about cost-effective strategies to improve health outcomes for people with rare outcomes.

“Blood disorders have a vital importance to public health and vice versa,” the authors conclude. “Whether relatively common or relatively rare, people with blood disorders have health challenges specific to their conditions that require knowledgeable healthcare providers, access to screening and diagnostic testing, and information to help them manage their conditions.”

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Beverly Lytton
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858-534-9340
Elsevier Health Sciences

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