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by: A. Lorenzo Lucino Jr, 4th Year Medical Intern (MD & Ph.D program)


Male Adolescents and Adults


A significant percentage of adolescents in the developing world are anemic, causing considerable health consequences for this age group. Among adolescents, prevalence rates of anemia are closer for males and females in some parts of the world. The prevalence of anemia is disproportionately high in developing countries, due to poverty, inadequate diet, certain diseases, pregnancy and lactation, and poor access to health services. Young people are particularly susceptible because of their rapid growth and associated high iron requirements (1). Anemia is a critical health concern because it affects growth and energy levels. Anemia is typically defined as a hemoglobin level of less than 13.0 g/ dL in males and 12.0g d/dL in females (3). It is also important to note that indications for anemic cases are either dietary deficiency or an underlying pathologic process or disease. It is important to note also that iron deficiency anemia is the most prevalent among women of childbearing age and is more common in developing countries (3).
Adolescence is an opportune time for interventions to address anemia. In addition to growth needs, girls need to improve iron status before pregnancy. In pregnancy, it is associated with premature births, low birth weight, and perinatal and maternal mortality. Girls often enter their active reproductive years in late adolescence with poor iron status. Because pregnancy requires more iron for increased blood production, an iron deficit can result in negative reproductive consequences(1). Considering the high demands of hemoglobin levels in females, it is understandable that a hemoglobin level of 12.0 g/dL would be considered anemic in appropriation of the physiologic responsibilities of the female sex (2)
Boys and girls both need iron for growth during adolescence, and girls have a continuing need to replace iron lost during menstruation. Body growth slows down late in adolescence, at which point the iron status of boys appears to improve, which indicates the anatomical strengthening of the body at maturation. As the male body matures, the body is not pervious to injury and can take damage and heal faster. Adult men, therefore, typically have larger iron stores than women (1) and thus correlates why males don’t become anemic until their hemoglobin levels hit 13.0 g/Dl. This is one of the reasons why adult males won’t realize that they are loosing hemoglobin due to substantial stores of such.

The average hemoglobin levels in adolescent males were 10.69g/dL. For adult  males age 50-59 years of age, had the lowest level of hemoglobin levels of 10.43g/dL. The highest levels of hemoglobin was found in the 18-19 year old males with a value of 11.6g/dL(Graph 1). One also notices that a related factor of such differences is the older groups had a higher variance in medical conditions that contributed to the disparity in hemoglobin levels as compared to the adolescent groups. Adolescents suffered 6 specific kinds of medical conditions while the older adult population suffered over 18 kinds of medical ailments (Graph 1).

In this study a total of 145 males were considered to be anemic and the underlying cause of it included trauma, hypertension, gastrointestinal problems, more than 1 causes, cellulitis, surgery, cancer, hepatitis, chronic obstructive pulmonary disease, coronary artery disease, seizure, alcohol-related diseases, diabetes mellitus, urinary disorders, malaria, snake bite, drugs and even other causes. The most common cause of anemia in adult men is trauma, which was a substantial 39% of all anemia cases in adult men.
In adolescent males (age 12-15) trauma was the most common cause. There were also other factors such as surgery, gastrointestinal problems, drugs, or more than once cause of illness that led to anemia, which were substantially less as compared to the underlying pathologies seen in adult males(Graph 2).

In adult males (18-59) the majority of anemic cases also fell into the category of trauma. The second most common group of males was gastrointestinal and other causes of illness. The source of bleeding can come from peptic ulcers, colon cancer, hemorrhoids, fissures, infection, and inflammatory bowel disease, disease of the intestines or polyps in the colon (Graph 3). Naturally, these underlying pathologies effectively disturb the homeostasis of hemoglobin levels and can explain the overwhelmingly large anemia cases in adult males as compared to adolescent males. Gastrointestinal bleeding can also come from excessive use of aspirin, an NSAID, and is one of the major causes of acute tubular necrosis as well as in cases of liver toxicity, pancreatic toxicity and ulcerations in the duodenum if taken for chronicity (4). It is important to note that many men may not be aware they are bleeding enough to affect their iron levels (2) considering the population we are studying in a third world nation individuals may not be medically aware of the importance of continued medical checkups due to financial limitations or other reasons (3).

The other groups had clinical conditions of chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, surgery, hepatitis, malaria, snake bite, urinary problems, alcohol abuse and cancer (Graph 3).

For this study, the values to analyze were only limited to hemoglobin levels. We are not able to conclude whether the conditions are associated with the patients ailments for the other disorders. In order to fully understand which type of anemia is present other reference laboratory values are needed for the evaluation of anemia(3). The values including blood hemoglobin are serum iron, serum ferritin, mean corpuscular volume, red blood cell width, and total iron binding capacity and reticulocyte count (1, 2). This would help one to understand the type of anemia present being microcytic, normocytic or macrocytic. This would greatly help one to identify the underlying clinical condition in correlation with anemia presentation.



Works Cited:


Senderowitz. “Young People and Anemia”. Youthnet Publications: 1998

Harris, Lynn. Iron Deficiency Anemia in Men. 2004.
<http://www.associatedcontent.com/article/359733/iron_deficiency_anemia_in_men.html?cat=70>

Karnath, Bernard M. Anemia In The Adult Patient. Review of Clinical Signs. 2004.
< http://www.turnerwhite.com/memberfile.php?PubCode=hp_oct04_anemia.pdf>

Daily Aspirin Therapy: Understand the benefits and risks. 2010.
< http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073>



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This medical research report , which was one of 8 required reports during my Internal Medicine Rotation, was reviewed by the Heads of Internal Medicine. They were rather interested in the reports of anemia cases in third world countries. The reason for their interest was because the fact that anemia prevalent in adolescents is usually nutritional -based, a common in poorer countries, which is alien to many American hospital systems.

In my report, and defense, 85% of the questions they asked me was about the consumption rates of the children in India, and in that region of the world. With 5-6 questions regarding enzyme deficiencies.

It was rather interesting how they were interested on the nutritional factor. Quite interesting. I  did not expect such a heightened interest in the nutritional factors.

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