Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal. (Hypo- refers to less, and chromic means color.) A normal red blood cell will have an area of pallor in the center of it; it is biconcave disk shaped. In hypochromic cells, this area of central pallor is increased. This decrease in redness is due to a disproportionate reduction of red cell hemoglobin (the pigment that imparts the red color) in proportion to the volume of the cell. Red blood cells will also be small (microcytic), leading to substantial overlap with the category of microcytic anemia. The most common causes of this kind of anemia are iron deficiency and thalassemia.
Hypochromic anemia was historically known as chlorosis or green sickness for the distinct skin tinge sometimes present in patients, in addition to more general symptoms such as a lack of energy, shortness of breath, dyspepsia, headaches, a capricious or scanty appetite and amenorrhea.
- Now, the pox upon her green-sickness for me!
In 1554, German physician Johannes Lange described the condition as "peculiar to virgins". He prescribed that sufferers should "live with men and copulate. If they conceive, they will recover." The name "chlorosis" was coined in 1615 by Montpellier professor of medicine Jean Varandal from the word "Chloris" (Greek: χλωρις) meaning "greenish-yellow," "pale green," "pale," "pallid" or "fresh". Both Lange and Varande claimed Hippocrates as a reference.
In addition to "green sickness", the condition was known as morbus virgineus ("virgin's disease") or febris amatoria ("lover's fever"). Francis Grose' 1811 Dictionary of the Vulgar Tongue defined "green sickness" as: "The disease of maids occasioned by celibacy."
In 1681, English physician Thomas Sydenham classified chlorosis as a hysterical disease affecting not only adolescent girls but also "slender and weakly women that seem consumptive." He advocated iron as a treatment: "To the worn out or languid blood it gives a spur or fillip whereby the animal spirits which lay prostrate and sunken under their own weight are raised and excited".
Daniel Turner in 1714 preferred to term chlorosis "the Pale or White Sickness ... since in its worst State the Complexion is rarely or ever a true Green, tho' bordering on that Hue". He went on to describe it as "an ill Habit of Body, arising either from Obstructions, particularly of the menstrual Purgation, or from a Congestion of crude Humours in the Viscera, vitiating the Ferments of the Bowels, especially those of Concoction, and placing therein a depraved Appetite of Things directly preternatural, as Chalk, Cinders, Earth, Sand, &c". One of his case studies was that of an 11-year-old girl who was found, on investigation, to have been eating large quantities of coal.
Chlorosis is briefly mentioned in Casanova's Histoire de ma vie: "I do not know, but we have some physicians who say that chlorosis in girls is the result of that pleasure onanism indulged in to excess".
In 1841, the Bohemian doctor and pharmacist Albert Popper published a treatment for Chlorosis containing Vitriolum martis (sulfuric acid and iron) and Sal tartari (potassium carbonate) in Österreichische medicinische Wochenschrift which was republished and refined in the following years.
In 1845, the French writer Auguste Saint-Arroman gave a recipe for a treatment by medicinal chocolate that included iron filings in his De L'action du café, du thé et du chocolat sur la santé, et de leur influence sur l'intelligence et le moral de l'homme and in 1872, French physician Armand Trousseau also advocated treatment with iron, although he still classified chlorosis as a "nervous disease".
In 1887, physician Sir Andrew Clark of London Hospital proposed a physiological cause for chlorosis, tying its onset to the demands placed on the bodies of adolescent girls by growth and menarche. In 1891, Frank Wedekind's play Spring Awakening referenced the disease. In 1895, University of Edinburgh pathologist Ralph Stockman built upon experiments demonstrating that inorganic iron contributed to hemoglobin synthesis to show that chlorosis could be explained by a deficiency in iron brought on by loss of menstrual blood and an inadequate diet. Despite the work of Stockman and the effectiveness of iron in treating the symptoms of chlorosis, debate about its cause continued into the 1930s. A character in T. C. Boyle's The Road to Wellville suffers from chlorosis, and the narrator describes her green skin and black lips.
Hypochromic anemia may be caused by vitamin B6 deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by infections (e.g. hookworms) or other diseases, therapeutic drugs, and lead poisoning. One acquired form of anemia is also known as Faber's syndrome. It may also occur from severe stomach or intestinal bleeding caused by ulcers or medications such as aspirin or bleeding from hemorrhoids.
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Hypochromic-Mycrocitic anemia is a genetic auto-immune disorder. The causes are not known or how it is passed down from parent to child. Hypochromic anemia causes the blood cells to be unusually small and concave in the center which reduces the blood cells ability to carry the appropriate amount of iron throughout the body. Mycrocitic anemia is where the top layer of a blood cell is unusually thin and is responsible for carrying oxygen throughout the body. Iron and oxygen are necessary for the health and growth of the bones, muscles and soft tissue organs in the body.
Due to the lack of iron and oxygen in the blood stream can be the cause of other diseases and conditions that are often misdiagnosed, such as, arthritic conditions that result in chronic inflammation in the body that affect joints, muscles, and soft tissue organs. The treatment is on a case by case basis, however, many respond to a D3 vitamin supplement taken daily, vitamin B12, and iron sulfate under a doctor's supervision.
Symptoms experienced by the hereditary form can vary, including the pale, greenish hue, blood may have a vague, pearly-grey sheen or appear watery, weakness, general malaise, headaches or migraines, poor appetite, or an insatiable appetite. People who live with this condition can be under weight or over weight, and may experience a condition called pica. Some people have reported cravings for mineral salts, like what you would find in ice cream salt or soil among other things.
Hypochromic-Mycrocitic anemia can affect mental health like depression or sadness. However, once people get treated with the appropriate measures prescribed by their physician, symptoms can lessen and even improve. Many who suffer from this condition are generally turned down to donate blood due to iron deficiency.
- Microcytic anemia
- Iron deficiency anemia
- List of circulatory system conditions
- List of hematologic conditions
- Green children of Woolpit
- William Shakespeare (and possibly George Wilkins). Pericles Prince of Tyre, Act 4, Scene 6: A room in the brothel. First published 1609.
- 1811 Dictionary of the Vulgar Tongue by Francis Grose
- Turner, Daniel (1714). De Morbis Cutaneis: a treatise of diseases incident to the skin. London. pp. 90–91, 94.
- von Raimann, Johannes Nepomuk (17 July 1841). "Vitriolum Martis artefactum und Sal Tartari gegen Chlorosi". Österreichische medicinische Wochenschrift (Braumüller und Seidel, Vienna) 3 (29): 676–677.
- Schmidt, Carl Christian (1842). Jahrbücher der in- und ausländischen gesammten Medicin, Volume 35. Leipzig. p. 198.
- Dierbach, Johann Heinrich (1843). Die neuesten Entdeckungen in der Materia Medica: für praktische Aerzte geordnet, Volume 2. Heidelberg. pp. 1267–1268.
- "On the Mode of prescribing and preparing Pills composed of the Sulphate of Iron and Carbonate of Potass". The Medical Times: A Journal of English and Foreign Medicine, and Miscellany of Medical Affairs (J. Angerstein Carfrae, Essex Street, Strand, London) 13: 255. 28 March 1846.
- Anton, Karl Christian (1857). Vollständiges, pathologisch geordnetes Taschenbuch der bewährtesten Heilformeln fuer innere Krankheiten:Mit einer ausfuehrlichen Gaben- und Formenlehre, so wie mit therapeutischen Einleitungen und den noethigen Bemerkungen ueber die specielle Anwendung der Recepte. Leipzig. p. 209.
- Louis E. Grivetti, "From Aphrodisiac to Health Food: A Cultural History of Chocolate" Karger Gazette 6 no. 68.
- Guggenheim, KY (1995). "Chlorosis: the rise and disappearance of a nutritional disease" (pdf). The Journal of Nutrition 125 (7): 1822–5. PMID 7616296.
- Disease of Virgins; Green Sickness, Chlorosis and the Problems of Puberty by Helen King
- The appetite as a voice, by Joan Brumberg, pages. 164-165.
- Patek, Arthur J.; Heath, Clark W. (April 25, 1936). "Chlorosis" (PDF). Journal of the American Medical Association 106 (17): 1463–1466. doi:10.1001/jama.1936.02770170029010.
- Miale JB (1982). Laboratory Medicine: Hematology. (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6[page needed]
- Massey AC (1992). "Microcytic anemia. Differential diagnosis and management of iron deficiency anemia". The Medical Clinics of North America 76 (3): 549–66. PMID 1578956.