【Mayo疾病大全】贫血

译者 明 ASAKURA

Definition

By Mayo Clinic staff 

Anemia is a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to your tissues. Having anemia may make you feel exhausted.

【定义&概述】  贫血是机体红细胞减少，不能对组织器官充分供氧的一种病理状态。此时常常会有精疲力竭的感觉。

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

    贫血有很多类型，每种都有不同的病因。贫血既可以是急性的也可以是慢性的，症状可能很轻也可能很重。

See your doctor if you suspect you have anemia, because anemia can be a sign of serious illnesses. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.

    怀疑自己贫血就要去看医生，因为贫血可能是某些严重疾病的征兆。贫血的治疗方法多种多样，从吃补剂到各种临床操作；合理的饮食也可以预防某些类型的贫血。

Symptoms

Signs and symptoms vary depending on the cause of your anemia, but may include:

【症状】  症状和体征因贫血类型而异，不过下面这些比较常见：

Fatigue

Pale skin

A fast or irregular heartbeat

Shortness of breath

Chest pain

Dizziness

Cognitive problems

Cold hands and feet

Headache

  ● 易疲劳
  ● 皮肤（和黏膜）苍白
  ● 心慌（心跳变快，或不规则）
  ● 胸闷气短、胸疼
  ● 头痛、头晕
  ● 认知障碍（比如注意力不集中、记忆力减退）
  ● 手脚冰冰凉

Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as anemia worsens.

    起初贫血轻微时，它可能会被忽视；但随着病情加重，症状和体征也会越来越明显。

When to see a doctor

§ 何时该去看医生？

Make an appointment with your doctor if you're feeling fatigued for unexplained reasons. Some anemias, such as iron deficiency anemia, are common. Fatigue has many causes besides anemia, so don't assume that if you're tired, you must be anemic.

    如果你总是莫名其妙地感到疲劳，就去找大夫看看——毕竟某些贫血比较常见，比如缺铁性贫血。当然，不要认为疲劳一定是贫血导致的。

Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. Low hemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you're told that you can't donate blood because of low hemoglobin, make an appointment with your doctor.

    一些人发现献血后血红蛋白(浓度)会降低——这意味着贫血。此时通过吃含铁丰富的食物或复合维生素可能就好了。然而，血红蛋白降低也可能警示着，你的身体正在失血（并可能由此导致缺铁）。如果献血时你因血红蛋白过低而被拒，去看医生吧。

Causes

Anemia occurs when your blood doesn't have enough red blood cells. This could result if:

【病因】  体内没有足够的红细胞时就会出现贫血。这可能是因为：

Your body doesn't make enough red blood cells

Bleeding causes you to lose red blood cells more quickly than they can be replaced

Your body destroys red blood cells

    1. 红细胞制造不足
    2. 失血（失血的速度大于造血的速度）
    3. 红细胞破坏过多

What red blood cells do

§ 红细胞是干嘛的？

Your body makes three types of blood cells — white blood cells to fight infection, platelets to help your blood clot and red blood cells to carry oxygen throughout your body. 

    人体有三种血细胞——白细胞负责抵御感染，血小板负责凝血，红细胞则负责给全身供氧。

Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body, and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled.

    红细胞内含有血红蛋白：这是一种富含铁元素的红色蛋白质，并赋予红细胞以红色。血红蛋白将氧气从肺部运往全身，并将二氧化碳从全身运回肺部以排出体外。

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

    包括红细胞在内的大多数血细胞都是在骨髓中制造的。骨髓是一种红色、海绵状的东东，居住在很多大骨头的腔隙（骨髓腔）里；它需要铁元素、维生素B12、叶酸等原料来制造血红蛋白和红细胞。

Causes of common types of anemia

Common types of anemia and their causes include:

【分类】  一些常见类型的贫血和它们的病因：

Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of the element iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells.

缺铁性贫血   由于铁缺乏引起的贫血。如前所述，骨髓需要铁元素才能制造血红蛋白，缺铁的话就无法为红细胞制造足够的血红蛋白了（就像还没有熟的水果）。

Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people may eat enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency anemia.

(营养性)巨幼细胞性贫血（维生素缺乏性贫血）  为了制造足量、健康的红细胞，除了铁以外，身体还需要叶酸和维生素B12等原料。如果饮食中缺乏这两种营养成分，或是身体无法吸收它们（比如，胃全切术后的患者无法在体内合成内因子，而内因子是吸收VitB12的关键物质），就会发生巨幼细胞性贫血。

Anemia of chronic disease. Certain chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can cause of anemia.

慢性病性贫血   一些慢性疾病，比如癌症、艾滋病、风湿性关节炎、克隆病、肾衰竭、某些慢性炎性疾病等等，会影响造血过程从而引起贫血。

Aplastic anemia. This very rare, life-threatening anemia is caused by a decrease in the bone marrow's ability to produce red blood cells. Causes of aplastic anemia include infections, drugs and autoimmune diseases.

再生障碍性贫血（再障）  这是一种由于骨髓造血能力降低导致的威胁生命的罕见贫血。可能的病因包括感染、自身免疫病、某些药物等等。

Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the blood-making process. Other cancers of the blood or bone marrow, such as multiple myeloma, myeloproliferative disorders and lymphoma, also can cause anemia.

骨髓疾病相关性贫血  白血病、骨髓发育不良等一些疾病会影响骨髓造血进而导致贫血。这些癌性疾病轻则“飘过”，重则彻底关闭造血进程——这可是致命的。
    其他一些血液肿瘤或骨髓肿瘤，比如多发性骨髓瘤、MPD（骨髓增生性疾病）、淋巴瘤等也会引起贫血。

Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Hemolytic anemias can be inherited or you can develop them later in life.

溶血性贫血  此时红细胞破坏速率增加，超过了骨髓造血的代偿能力。很多种血液病都会加速红细胞的破坏。溶血性贫血可能是遗传的，也可能是后天获得的。
（p.s. 正常的红细胞的寿命是120天左右，溶血性贫血时则<120天）
（surprisingly，造成溶血的原因有200余种之多）

Sickle cell anemia. This inherited and sometimes serious anemia is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.

镰状细胞性贫血  这是一种遗传性血红蛋白结构异常导致的贫血。此时红细胞变为镰刀形，并更容易被破坏，从而导致红细胞的慢性缺乏。镰状细胞性贫血的病情变化较大，有时会很严重。

Other anemias. There are several other, rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.

其它类型  比如地中海贫血、血红蛋白病等相对较为罕见的类型。

Risk factors

These factors place you at increased risk of anemia:

【危险因素】   下列因素会增加患贫血的风险：

A diet lacking in certain vitamins. Choosing a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of anemia.

  ● 饮食中缺乏某些营养  比如铁元素、维生素B12、叶酸等。

Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn's disease and celiac disease — puts you at risk of anemia. Surgical removal of or surgery to the parts of your small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.

  ● 小肠疾患。一些影响小肠对食物吸收的疾病（如克隆病）会增加患贫血的风险。回肠切除或回肠旁路术后会引起吸收障碍，进而营养缺乏，进而贫血。  

Menstruation. In general, women who haven't experienced menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. That's because menstruation causes the loss of red blood cells.

  ● 月经。育龄期（即从月经初潮至绝经期之间的时期）妇女会比绝经后的妇女和男童稚们更容易失血，从而更容易患缺铁性贫血。道理嘛，你懂的。  

Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a source of hemoglobin for your growing fetus.

  ● 妊娠。怀孕时，孕妇体内储存的铁不仅仅要支援此时多出来的血容量，更得为婴儿提供造血的原料。  

Chronic conditions. For example, if you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of what's called anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body's store of iron, leading to iron deficiency anemia.

  ● 一些慢性病理状态  癌症、肾衰竭、肝衰竭等病症会造成红细胞缺乏，进而引发慢性病性贫血。某些病灶（比如溃疡）的慢性失血会耗尽体内贮存的铁，进而导致缺铁性贫血。

Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk of the condition.

  ● 家族史  如果你有亲人患有遗传性的贫血，比如镰刀细胞性贫血，那么你患有这种贫血的风险也会比一般人高。

Other factors. A history of certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

  ● 其它。一些特定类型的感染、血液病、自身免疫病、毒物摄入、某些药物等等也会影响造血并导致贫血。

Complications

Left untreated, anemia can cause numerous complications, such as:

【并发症】   如果不进行治疗，贫血会导致多种并发症：

Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. You may be too exhausted to work or play.

  ● 严重的疲劳。当贫血严重到一定程度时，患者可能会疲劳得无法进行日常生活、工作和娱乐。

Heart problems. Anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure.

  ● 心脏疾病。贫血会导致心律失常——这是因为贫血时血液的供氧能力下降，作为代偿心脏不得不燃烧小宇宙，在单位时间内泵出更多的血，从而使心跳变快，或不规则。久而久之，甚至可能演变成心衰。

Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

  ● 死亡。某些遗传性的贫血，比如镰状细胞性贫血，会很严重并引起致命的并发症。快速大量失血导致的贫血也可以是致命的。

Preparing for your appointment

Make an appointment with your family doctor or a general practitioner if you have prolonged fatigue or other signs or symptoms that worry you. If you're diagnosed with a type of anemia that requires more complex treatment, such as aplastic anemia or anemia caused by other diseases, you may be referred to a doctor who specializes in blood disorders (hematologist).

【预约就诊】  如果总是感到疲劳，或有其它令你担心的症状，就去找家庭医生或全科医生看看。如果你被诊断出某些需要进一步治疗的贫血类型，就该去医院血液科门诊/病房了。

 Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect from your doctor.

What you can do

    因为就诊时间有限，而且有很多相关事情都需要考虑，你最好提早进行一些准备，包括：

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements that you're taking to show your doctor.

  ● 提前准备好检查时需要的限制。预约就诊时，问好你需要提前做的事情，比如限食。

  ● 写下所有你感觉到的症状，哪怕你觉得它无关紧要。

  ● 写下重要的个人信息，包括目前你所面临的主要压力，和近期的生活变化。

  ● 写下所有你在服用的药品、维生素、补品。

Write down questions to ask your doctor.

§ 写下你想问医生的问题

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your appointment. List your questions from most important to least important in case time runs out. For anemia, some basic questions to ask your doctor include:

    和家庭医生或全科医生交流的时间有限，预备一个问题清单会帮助你有效利用这段时间。把问题按照重要性排列，以免时间不够。关于贫血，一般你需要问：

What's the most likely cause of my symptoms?

Are there other possible causes for my symptoms?

What kinds of tests do I need?

Is my anemia likely temporary or chronic?

What treatments are available? What are the possible side effects of each?

What treatment do you recommend?

I have these other health conditions. How can I best manage them together?

Are there any dietary restrictions that I need to follow?

Are there foods I need to add to my diet? How often do I need to eat these foods?

Are there any brochures or other printed material that I can take with me? What websites do you recommend?

  ● 我（的贫血）最可能的病因是什么？还有其他可能性吗？
  ● 我还需要做哪些检查？
  ● 我的贫血会是暂时性的还是长期的？
  ● 治疗方案都有哪些？每种的副作用是什么？对我而言哪种是最好的？
  ● 我还有其他健康问题。如何兼顾？
  ● 有什么饮食上的限制或禁忌、或是需要额外补充的东东吗？对于后者，可以更详细地说明吗？（比如多长时间吃一次，每次吃多少，生吃还是炒了吃?）
  ● 有没有指南之类我可以带回家的东东？有推荐给我看的网站吗？

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

    有问题就问，不要犹豫。

What to expect from your doctor

§ 医生会问什么？

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

    医生会问你很多问题，提前准备好会帮你节省时间以留给重点。他/她可能会问：

When did you begin experiencing symptoms?

Have your symptoms been continuous or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

    ● 症状是何时出现的？
    ● 症状是持续的，还是偶尔的？
    ● 症状有多严重？
    ● 有没有什么可以减轻或加重症状？ 

Tests and diagnosis

To diagnose anemia, your doctor may recommend:

【检查&诊断】   为了对贫血进行鉴别诊断，医生可能会建议你做这些检查：

Physical exam. During a physical exam your doctor may listen to your heart and your breathing. Your doctor may also place his or her hands on your abdomen to feel the size of your liver and spleen.

查体（体格检查）  通过查体医生可以听你的心音、呼吸音；也可以对你的腹部进行触诊以辨认肝、脾的大小。

Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values vary from one medical practice to another, but are generally between 38.8 and 50 percent for men and 34.9 and 44.5 percent for women. Normal adult hemoglobin values are generally 13.5 to 17.5 grams per deciliter for men and 12 to 15.5 grams per deciliter for women.

全血细胞计数  顾名思义，这是一种用来测量血液样品中血细胞数量的方法。对于贫血，医生主要会关注这两个数据：Hct和Hb。（p.s. 原文是U.S.的标准数值，这里直接换成我国的了）
             Hct（血细胞比容）：成年男性正常范围0.42-0.50，成年女性正常范围0.37-0.48。
             Hb（血红蛋白浓度）：成年男性正常范围120-160g/L，成年女性正常范围110-150g/L。
    当然数值并不是绝对的，同样的样品在不同的测量方法、条件下得到的数值也不尽相同。

A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

红细胞形态学检查  一些红细胞在大小、形状、颜色等方面的异常会帮助医生确定诊断。比如，在缺铁性贫血时，红细胞会显得又小又苍白；而在巨幼细胞性贫血时，红细胞会变大且数量会减少。

Additional tests

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumors, or kidney failure. Your doctor may test for these and other conditions that may underlie the anemia.

 Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.

§ 额外的检查
    如果你被诊断为贫血，医生可能会让你进行一些额外的检查以寻找病因。比如，缺铁性贫血的病因可能是胃肠道溃疡的慢性失血、结肠息肉、结肠癌、肿瘤、肾衰竭等。
    有时，你可能需要去做腰穿（腰椎穿刺）以获得骨髓样品进行检查与鉴别诊断。

Treatments and drugs

Anemia treatment depends on the cause:

【治疗&药物】   贫血的治疗方法取决于病因：

Iron deficiency anemia. This form of anemia is treated with changes in your diet and iron supplements. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.

  ● 对于缺铁性贫血。治疗方法是在饮食中增加铁元素的摄入，以及服用铁剂。如果缺铁的根源是失血，就要找到失血部位进行止血——当然啦，月经除外。

Vitamin deficiency anemias. Folic acid deficiency anemia is treated with folic acid supplements. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.

  ● 对于巨幼细胞性贫血。缺叶酸的话就要服用叶酸补剂（有人把叶酸叫做维生素M）。而如果是无法吸收维生素B12，就需要直接注射进体内。

Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.

  ● 对于慢性病性贫血。并无特异性疗法，重点在于对原发病的治疗；而对症治疗则包括输血和注射人工促红细胞生成素。促红细胞生成素是一种由肾脏分泌的激素，会促进红细胞的制造，并缓解疲劳等症状。

Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells.

  ● 对于再生障碍性贫血。此时需要大大的（-_- !）输血。严重时患者可能需要骨髓移植，否则身体将无法制造健康的血细胞。

Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation.

  ● 对于骨髓疾病相关性贫血。治疗方法很多，从简单的药物到化疗到骨髓移植。

Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or immune suppressant medications can help suppress your immune system's attack on your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure.

  ● 对于溶血性贫血。控制溶血性贫血的方法包括避免服用可疑的药物、治疗相关感染、免疫抑制等。短期服用糖皮质激素或免疫抑制剂会抑制亢奋的免疫系统（此时免疫系统在攻击红细胞）。有时也需要输血、或血浆置换，后者是一种过滤血液的方法。

Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors may also recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.

  ● 对于镰状细胞性贫血。主要是对症治疗，包括吸氧、止疼药、口服液或输液以控制疼痛和并发症等（此句觉得翻的别扭，求指正~）。医生可能也会建议输血、补充叶酸、抗生素等。另外，有时骨髓移植会很有效。羟基脲是一种抗肿瘤药，也可以用来治疗镰状细胞性贫血。

Prevention

Choose a vitamin-rich diet

Many types of anemia can't be prevented. However, you can help avoid iron deficiency anemia and vitamin deficiency anemias by choosing a diet that includes a variety of vitamins and nutrients, including:

【预防】
§ 富含维生素的饮食。
     很多种贫血无法预防，但至少缺铁性贫血和巨幼细胞性贫血可以通过合理膳食来预防。 

Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables and dried fruit.

  ● 铁。含铁丰富的食物包括；肉类、大豆、小扁豆、加铁的谷类、深绿色叶的蔬菜、水果干等等。

Folate. This nutrient, and its synthetic form, folic acid, can be found in citrus fruits and juices, bananas, dark green leafy vegetables, legumes and fortified breads, cereals and pasta.

  ● 叶酸。含叶酸丰富的食物包括：柑桔类水果和果汁、香蕉、深绿色叶的蔬菜、豆类、以及加铁的面包、谷类、意大利面等等。

Vitamin B-12. This vitamin is found naturally in meat and dairy products. It's also added to some cereals and soy products, such as soy milk.

  ● 维生素B12。含VitB12丰富的食物包括：肉类、奶制品、一些谷物及大豆制品（比如豆浆）。

Vitamin C. Foods containing vitamin C, such as citrus fruits, melons and berries, help increase iron absorption.

  ● 维生素C。含VitC丰富的食物包括：柑桔类、瓜类、浆果类等水果。它们有助于铁的吸收。

Consider genetic counseling if you have a family history of anemia

If you have a family history of an inherited anemia, such as sickle cell anemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.

§ 如果有贫血家族史
    如果你有贫血家族史，请考虑基因学咨询——关于你患贫血的风险，以及传给下一代的可能性。

祝健康！