Serena is a 45-year-old woman. She is married with two kids. She has been under a lot of stress lately. She says it is hard for her to be happy these days, and she has trouble sleeping at night.Could she be depressed?
What is Depression?
Depression(Depressive disorder) is a mood disorder that causes feelings of sadness or emptiness. It can affect the way you sleep, eat, feel about yourself, and think about things.
While most of us may normally feel down for a few days, a person who is depressed may persistently feel sad for a long time. For many, depressive disorder happens in recurrent cycles. Depression is a significant cause of disability among adults in the United States. It impacts individuals and their families, children, and work environments. Depressive disorder can also lead to impairment at work, school, and relationships, but it can be treated as long as one seeks medical help.
Depression Symptoms
If you have the following symptoms every day for at least two weeks, talk to your family doctor, you could be dealing with depression:
Depression can present differently according to age groups and can be hard to identify.
Children with depression can be anxious and cranky, pretend to be sick often, refuse to go to school, or cling to a parent.
Older children and teenagers with depressive disorder may get into trouble at school, get easily frustrated, or have low self-esteem. They may also deal with anxiety, eating disorders, attention-deficit hyperactivity, or substance use disorder.
Older adults with depressive disorder commonly experience less apparent symptoms. They may report a lack of emotions but refrain from mentioning they are depressed.
Types of Depression
Major depression: The depressive symptoms will typically interfere with one’s ability to work, sleep, study, or eat for most of the time, for at least 2 weeks.
Bipolar Disorder:(Manic-depressive Disorder): Bipolar disorders involve episodes of major depressive disorder and abnormally elevated mood called mania or hypomania (which is less severe than mania).
Postpartum Depression: A type of depressive disorder seen in a mother or father after the birth of their baby.
Seasonal Affective Disorder: A major depression that occurs in seasons with low sunlight.
Persistent depressive disorder (Dysthymia). In this type of depression, you can have less severe symptoms of depressive disorder that last much longer, typically for at least 2 years.
Who is at Risk for Depression?
Depression affects about 3.8% of the United States population, but everyone is at risk. You are more susceptible to depressive disorder if you have a strong family history of depression and/or negative life experiences and trauma, especially in childhood, or if you lack social support. You could also be at a higher risk if you have chronic medical conditions or lower socioeconomic status. If you use drugs or other substances, you could have depression as well. Hormonal problems surrounding menstruation and childbirth can also place you at a higher risk of depression.
How Will Your Doctor Diagnose and Treat Depression?
Your doctor will ask questions about your mood, behavior, and how often you experience feelings of depression. You will be asked how you feel and if you are having suicidal thoughts. They may also ask if you have access to firearms. You will need to provide your medical history of mania/hypomania, anxiety, substance use disorder, and psychosis. Your doctor will also review the medicines you are taking and can ask about other substances you use.
Depending on your need, your doctor will develop an individualized plan to treat your depressive disorder with therapy, medicine, or a combination of both. You and your doctor will work together to identify a plan that works best for you. For some people, depression improves over weeks to months, and your doctor can stop treatment according to your needs. For others, long-term and continuous treatment is necessary to help manage symptoms of depression, especially for recurrent depression. Maintaining social support such as friends, coworkers, or family and regular physical activity can help avoid future depression. Your primary care physician can often treat depression. However, sometimes, a referral to a psychiatrist can be more effective in exploring more advanced therapy options.
1. Medication
There are many types of antidepressants on the market. Your doctor will help you choose the best one for you. If you have problems with sleeping, you will be prescribed medications that will allow you to have healthy sleeping habits. Sometimes if you have a poor appetite, you may be prescribed medications that increase it. Do note that the medications may take several weeks before they begin working.
Your doctor will decide the type of antidepressant medication based on your severity of depression and your symptoms. It is essential to know the side effects of the drug. Side effects are common in the first few weeks but improve over time. Notify your doctor before stopping any medication because of side effects. Your doctor can help you with a medication plan to treat your depressive disorder safely.
2. Psychotherapy
Psychotherapy is best described as ’talktherapy and has proven effective for depressive disorder. The most evidence-based therapy for depressive disorder is called cognitive behavioral therapy. This process involves evaluating and changing your thoughts and behaviors and improving your coping ability. Psychotherapy does help and can often be as effective as medication for mild to moderate depressive disorder and in lowering the risk of future relapses. However, medication and therapy combinations have been proven to be most effective for moderate to severe depression.
Coping Strategies
It may take one to two months (for medication) or longer (for therapy) before you start feeling better. If you do not feel better after two months of treatment, talk to your doctor and adjust your treatment plan.
Once you begin treatment, you should gradually feel better. This will eventually improve your mood. It will also help if you keep trying new things or put yourself in situations where you enjoy yourself.
Here are some things you can do to lower your risk for depressive disorder or to prevent relapses:
Eat regular, healthy meals.
Try to get some physical activity. Even a brisk evening or morning walk can boost your mood.
Maintain a regular bedtime and wake-up time.
Connect with people and talk to trusted friends and family about how you feel.
Avoid using alcohol, nicotine, or drugs.
Set realistic goals for yourself.
Do not isolate yourself. There is no shame in letting others help you.
Expect your mood to improve gradually since you might not see immediate results.
Continue to educate yourself about the depressive disorder.
Consider postponing important stressful decisions in life, such as getting married or changing jobs, if you think you can not handle them until you feel better.
How to Help a Loved One Who Is Depressed?
Talk to them. Help them seek a primary care physician or mental health professional.
Offer support, understanding, and encouragement frequently.
Invite them for walks or other outdoor activities. Make them feel they are essential to your life.
Help set them reminders to take prescribed medications.
Make sure they have transportation and access to doctors and therapy sessions.
What Do You Do if You Have Suicidal Thoughts?
Depression is the most common cause of suicide. Do not be afraid to ask for help. If you feel you may harm yourself or need help, call 911 or the local suicide hotline or go to the emergency department immediately.
Questions For Your Doctor
How do I know if I am depressed or just sad?
Do I need medicine to treat my depressive disorder?
What are the side effects of the medications I was prescribed?
Will it interfere with my other medications?
What should I do if I have side effects?
How long does it take for the medication to work?
Do alternative therapies help with depression?
Should I see a psychiatrist?
Can I take antidepressants if I am pregnant or planning to become pregnant?
What should I do if any treatments do not make me feel better?
Mike is a 45-year-old man recently diagnosed with diabetes. He was prescribed metformin and insulin by his primary care provider. He is concerned that the insulin will lower his blood sugar. What advice do you have for him?
What is Diabetes?
Diabetes mellitus is a chronic disease where your body has high glucose levels. The defect either lies in the pancreas (your insulin factory), or your body cannot use insulin efficiently. We understand that a new diagnosis of diabetes can be scary but don’t let it stop you and your family from living a healthy life.
Diabetes Symptoms
The symptoms of diabetes are caused by rising blood sugar levels in your bloodstream. Your blood sugar may be high during a random check-up. Most people experience excessive thirst, fatigue, frequent infections, or unintentional weight loss. You might experience signs of poor circulation, including tingling or numbness in the hands and feet, wounds that do not heal, or blurred vision. Many people with type 2 diabetes show no symptoms, but your doctor can help detect diabetes during an annual checkup or while testing for other medical problems.
What Are The Common Types of Diabetes?
Insulin is a hormone our body needs to get glucose from the bloodstream into the body’s cells.
Type 1 diabetes: Your body does not produce insulin.
Type 2 diabetes: Your body doesn’t use insulin properly.
Gestational diabetes: It is detected during pregnancy during a routine blood sugar test or oral glucose tolerance test performed between the 24th and 28th weeks of gestation.
How To Test For Diabetes
1. Random blood sugar test
This involves checking blood samples at random times. If the blood sugar level is 200 milligrams per deciliter (mg/dL) or more, you may have diabetes.
2. Fasting blood sugar test
A blood sample will be taken after overnight fasting. A fasting blood sugar level of less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If the fasting blood sugar is 126 mg/dL or higher on two separate tests, you have diabetes.
3. HbA1c
This blood test shows average blood sugar levels over the past two to three months. An HbA1C between 5.7% and 6.4% means that you have prediabetes, while below 5.7% is considered normal. If you have HbA1c of 6.5% or higher on two separate tests, you have diabetes.
Treatment of Diabetes
Many people control their blood sugar levels with lifestyle changes, including weight loss, healthy eating, and exercise. However, some may need medication or insulin to maintain their blood sugar levels. Balanced nutrition, daily physical activity, avoiding smoking, frequent blood sugar monitoring, and regular monitoring of HbA1c are cornerstones of treatment for both type 1 and type 2 diabetes mellitus.
Things to know about treating diabetes:
Insulin is always required to treat type 1 diabetes. Please note: Oral medications do not work for type 1 diabetes.
Your doctor will create individualized treatment plans based on your medical conditions and needs. In type 2 diabetes, oral medications are prescribed if diet and exercise do not improve blood sugar control after a few months. Some diabetes medications work best with heart failure, some need to be avoided in kidney disease, while others are costly or not covered by your insurance. For example, if you have stage 4 or more chronic kidney disease, your doctor may stop prescribing your metformin.
You might also require insulin to treat type 2 diabetes if diet, exercise, and oral medications do not improve blood glucose control. Tell your doctor if your HbA1c levels are unmet to check and see if you need insulin.
High blood sugar levels can place you at risk for heart disease, stroke, kidney failure, vision and nerve problems, skin ulcers, and infections.. Lowering blood sugar levels to achieve the desired hemoglobin A1c (HbA1c) is vital to reduce the risk of these serious complications.
How to Measure Blood Sugar at Home?
You will need a glucometer to measure your blood sugar levels at home. The blood glucose meter is like a powerful little home laboratory that can fit in your pocket. All you need to do is add a tiny drop of blood, and the meter will show your blood glucose level on a display screen.
How often you check your blood glucose level depends on your diabetes type, control, and whether you are taking insulin or not. Blood sugar levels are expected to range between 90- 120 mg/dl when fasting and less than 140mg/dl after a meal (postprandial) when your diabetes is under control. We recommend checking your blood sugar at least twice daily and maintaining a logbook of your blood sugar levels. Consistently logging your blood sugar levels in a diary can help inform your medication regimen for your primary care provider or endocrinologist.
Steps of Checking Blood Sugar at Home Blood
Wash your hands with soap and water.
Please do not wash your hands with alcohol as it dries the skin.
Get the lancet ready. Always use a fresh lancet.
Always place a new test strip into the meter. Make sure the code on the strip matches the code on the meter.
Prick your fingertip with the lancet in the protective lancing device. Do not prick the same finger every time you measure your blood sugar.
Squeeze from the finger’s base. Carefully place a drop of blood onto the test strip.
The test results will appear on the screen of the glucometer.
If you have Type 1 diabetes or uncontrolled type 2 diabetes, you might benefit from continuous glucose monitors (CGMs) that check your blood glucose regularly. CGMs report your blood glucose levels in real-time, alert you when your glucose hits a high or a low limit and can track your glucose levels. The CGMs can also help you track your blood sugar levels in compatible smartphones.
What is HbA1C? Why is A1C tracking important?
HbA1c is a blood test thatshows average blood sugar levels over the past two to three months. Hb A1c can diagnose diabetes or monitor how well your diabetes treatment plan works. Your primary care provider can take it as a guide to formulate a game plan to manage your diabetes.
It is best to get Hb A1c tested at least twice every year. If you’re not meeting your goals or changing treatments, you may need an Hb A1C test more often.
The American Diabetes Association suggests a target A1C of 7% for nonpregnant adults. Elderly patients with various medical conditions can have a higher target of less than 8%.
HbA1C Goal for Older Adults
The health benefits of lowering HbA1c levels to below 7 % in older people are uncertain. Please note that lowering HbA1c may increase your risk for hypoglycemia. When we age, our kidneys become less efficient, which causes insulin (or other drugs) to accumulate in the body. Older people also often take multiple medicines, some of which may interact with diabetes medication and contribute to hypoglycemia. Hypoglycemia (severely low blood sugar) can result in confusion, coma, falls, hospitalizations, and even death. Elderly patients with various medical conditions can have a higher target of less than 8%.
Since it depends on the individual and external, it is never the same target for every individual. Talk to your doctor regarding maintaining your A1c in a healthy range with lifestyle changes and medications.
What is Hypoglycemia? Why is it Dangerous?
Hypoglycemia is a condition where blood glucose levels in the body are low. You will have symptoms of hypoglycemia when your blood glucose is less than 70 mg/dL. If you are at home, you need to act NOW. Hypoglycemia is a life-threatening emergency.
Signs of Hypoglycemia
Feeling shaky
Sweating, chills, and clamminess
Irritability or impatience
Confusion
Feeling lightheaded or dizzy
Feeling sleepy
Feeling weak or having no energy
Blurred/impaired vision
Headaches
Coordination problems, clumsiness
Seizures or loss of consciousness
Rapid pounding of the heart or irregular heartbeat
How to Confirm & Treat Hypoglycemia?
The only way to ensure you are experiencing low blood glucose is to check your blood glucose levels. If you are experiencing symptoms of low blood sugar and cannot check your blood glucose for any reason, treat hypoglycemia instead. You can do this by taking glucose tablets, drinking juice, or eating food that can raise your blood sugar level. Your doctor might prescribe glucagon, which can be given as an injection by a family member if you are unresponsive at home. If you have frequent hypoglycemia attacks, seek medical attention. If you take a medication that can cause hypoglycemia, your doctor might be able to adjust your medication dose.
How to Prevent Low Blood Glucose?
The best way to prevent hypoglycemia is to monitor your blood glucose levels closely. When you see blood glucose levels dropping, you can treat it before it gets too low.
We recommend maintaining a logbook of your blood glucose recordings. Blood glucose levels can be checked before and after meals, before and after exercises, early in the morning, and before bed. If you have a new insulin routine, change in medications, or a new work schedule, check your blood glucose more frequently. Talk to your doctor if you see low blood glucose levels.
When is an Insulin Pump? Is an Insulin Pump Right for You?
Insulin pumps are additional devices attached to your body that are programmed to mimic your body’s normal release of insulin. The pump can deliver insulin continuously or as a surge (bolus) close to mealtimes. This delivery method can control the rise in blood sugar after a meal. Using a pump doesn’t mean you no longer have to check your blood sugar. It can take some time to get used to the pump.
Talk to your provider if an insulin pump is best for you.Check with your insurance provider if your doctor determines that an insulin pump is a good option for you. Most insurance providers cover insulin pumps, but sometimes they may not be covered and can be expensive.
Questions For Your Doctor
How many pills do I take?
How often should I take my insulin?
Do I need to decrease my insulin dose when feeling ill or fasting?
What if I forget to take my diabetes pills and remember later? Can I still have them?
What should be the goal for my blood sugar levels?
What are the side effects of the diabetes medications I am taking?
Will the diabetes medications interact with other medicines I am taking?
Am I a candidate for continuous glucose monitoring?
Do I need an insulin pump?
Where can I buy insulin at a lower price if I have no insurance?
Pneumonia is a lung infection that causes the air sacs in one or both lungs to become inflamed, causing difficulty in breathing.
Pneumonia can be life-threatening, especially in young children, older adults, and those with weakened immune systems or chronic illnesses.
The signs of pneumonia can be subtle and differ from those of adults, making it difficult for parents to recognize it.
The treatment of pneumonia depends on its cause, and antibiotics are one option, but viral pneumonia does not require antibiotics.
While most healthy adults with mild pneumonia recover within 1 to 3 weeks, older adults, very young children, and those with chronic health conditions may have a prolonged duration of illness.
What is Pneumonia?
Pneumonia is an infection that inflames the air sacs in your lungs, making it hard for you to breathe. These air sacs can fill with fluid or pus, causing symptoms like coughing, fever, chills, and difficulty breathing. Pneumonia can be caused by bacteria, viruses, or fungi. In some cases, it follows a cold or the flu, but it can also develop on its own. [1]
Types of Pneumonia
Pneumonia can be classified based on where or how you get it. Community-acquired pneumonia (CAP) happens outside healthcare settings and is often caused by bacteria like Streptococcus pneumoniae that you can get from the community. Hospital-acquired pneumonia (HAP) develops 48 hours or more after hospital admission, while ventilator-associated pneumonia (VAP), a type of HAP, occurs after being on a ventilator. [2] Healthcare-associated pneumonia (HCAP) affects those recently in healthcare facilities like nursing homes or dialysis centers. Atypical pneumonia, caused by organisms like Mycoplasma pneumoniae, tends to have milder symptoms, while aspiration pneumonia occurs when you inhale food liquids or vomit into your lungs. [3, 4]
Causes and Risk Factors of Pneumonia
1. Bacterial Infection
Bacteria like Streptococcus pneumoniae and Haemophilus influenzae are common causes of pneumonia. These infections typically occur when bacteria in the upper respiratory tract invade the lungs. [5]
2. Viral Pneumonia
Viruses such as influenza, respiratory syncytial virus (RSV), or COVID-19 can lead to pneumonia. Viral pneumonia is common in children and older adults and may weaken your immune system, increasing susceptibility to bacterial pneumonia. [5]
3. Fungal Pneumonia
Certain fungi, especially in people with weakened immune systems, can cause pneumonia. For example, Histoplasma and Coccidioides fungi are linked to pneumonia in specific geographic regions. [6]
4. Age
The very young (infants and toddlers) and the elderly (over 65) are more susceptible to pneumonia because their immune systems are either still developing or have become weaker over time. [7]
5. Chronic Lung Diseases
Chronic obstructive pulmonary disease (COPD), asthma, and chronic bronchitis increase the risk. These diseases reduce lung function, making it harder to clear infections from the lungs. [8]
6. Smoking
Smoking damages your airways and weakens the lungs’ ability to clear out germs. Both current and former smokers have a higher chance of developing pneumonia. [9]
7. Aspiration
Inhaling food, liquids, or vomit into your lungs can lead to aspiration pneumonia. This is more common in people with swallowing difficulties or impaired reflexes, such as those who have had a stroke. [10]
8. Immunosuppression
If your immune system is weakened due to diseases like HIV/AIDS, cancer, or certain medications (like chemotherapy or immunosuppressants), you’re more vulnerable to infections, including pneumonia. [11]
9. Environmental Exposures
Exposure to pollutants, secondhand smoke, or hazardous chemicals at work can raise your risk. Poor living conditions, such as overcrowded spaces and lack of ventilation, also increase the likelihood of infection. [12]
Symptoms of Pneumonia
Pneumonia comes with several symptoms that can get worse if not treated early. Here are the main signs to look out for, explained simply:
1. Cough
A persistent cough is often one of the first signs of pneumonia. It may bring up thick mucus or phlegm, which can be clear, yellow, green, or even tinged with blood. This is your body’s way of trying to clear the infection from your lungs. [13]
2. Fever
Pneumonia frequently causes a high fever, sometimes exceeding 101°F (38.5°C). This may be accompanied by chills, sweating, and feeling unwell as your body fights off the infection. [14]
3. Shortness of Breath
You might feel like you can’t catch your breath, even when resting. This can worsen with physical activity as your lungs struggle to supply enough oxygen due to inflammation and fluid buildup. [13]
4. Chest Pain
Many people experience sharp or stabbing pain in their chest, especially when coughing or taking deep breaths. This is due to the inflamed tissues in and around your lungs. [14]
5. Fatigue
Pneumonia often makes you extremely tired and weak, even after simple activities. This happens because your body uses most of its energy to fight off the infection, leaving you drained. [14]
6. Confusion
Older adults with pneumonia might feel confused or notice changes in their thinking, which can be an early sign of the illness. [14] Pneumonia in younger children may not always show the classic signs seen in adults. Instead, your child might vomit, have a fever, cough, or seem unusually tired and restless. Watch closely for specific signs of breathing problems, such as a bluish tone to their skin and lips, grunting noises while breathing, or the muscles between their ribs squeezing in with each breath. Rapid breathing and flaring nostrils with each breath are also key signs indicating your baby is struggling to breathe and may need immediate medical attention. [15]
Diagnosis of Pneumonia
Accurately diagnosing pneumonia is essential for effective treatment. Various tests help determine the presence, severity, and cause of the infection. Here are the key diagnostic methods used by healthcare professionals.
1. Pulse Oximetry
This simple, non-invasive test uses a small device clipped onto your finger to measure the oxygen levels in your blood. Pneumonia can lower oxygen levels, and this test helps assess how well your lungs are functioning. [16]
2. Blood Test
Blood tests can show if you have an infection by checking for elevated white blood cell counts or markers of inflammation. A blood culture may also be done to identify the specific bacteria causing the pneumonia, especially in severe cases. [16]
3. Sputum Test
If you cough up mucus, your doctor may ask for a sample. A lab test can analyze this sample to identify the specific germ causing the infection, which helps guide treatment decisions. [16]
4. Point-of-Care Tests
They are rapid and convenient diagnostic tools to identify the cause of pneumonia quickly. Rapid antigen tests detect viruses like influenza and RSV.. Rapid Polymerase chain reaction (PCR) tests find bacterial and viral infections in mucus or sputum samples. Lateral flow tests quickly detect infections like Streptococcus pneumoniae. [17]
5. Chest X-ray
A chest X-ray is often the first imaging test to confirm pneumonia. It helps identify the location and extent of the infection in your lungs. However, it might not reveal the cause, whether bacterial, viral, or fungal. [16]
6. Computed Tomography (CT) Scan of The Chest
In cases where the diagnosis is unclear, a CT scan provides detailed images of your lungs, offering a more precise view than a regular X-ray. It can show the extent of pneumonia and any complications, such as lung abscesses or pleural disorders. This is sometimes needed to rule out other lung conditions. [16]
7. Bronchoscopy
If pneumonia doesn’t improve with initial treatment or your doctor suspects an unusual cause, they may perform a bronchoscopy. This procedure uses a thin, flexible tube with a camera to look inside your lungs and collect samples from the inside of your lungs to determine the cause of your pneumonia. [18]
8. Pleural Fluid Analysis
If fluid builds up around your lungs, it is called pleural effusion. Your doctor might take this sample with a needle with the help of a procedure called thoracentesis. Analyzing this fluid can help identify the infection and its cause. [19]
Treatment of Pneumonia
Treating pneumonia involves a combination of medications, supportive care, and, in severe cases, medical procedures. The approach depends on the cause and severity of the infection. Here are the key treatment methods used to manage pneumonia effectively.
1. Antibiotics and Antivirals
If your pneumonia is caused by bacteria, your doctor will prescribe antibiotics. These medications help kill the bacteria and speed up recovery. It’s important to take the entire course of antibiotics to eliminate all bacteria, even if you start feeling better. And if a virus is the cause of your pneumonia, you may need antiviral medications. These drugs can help manage symptoms and shorten the duration of the illness. [20]
2. Oxygen Therapy
If your oxygen levels are low, you may receive oxygen through nasal prongs, a facemask, or a special high-flow device. This helps deliver more oxygen to your lungs and can provide almost pure oxygen if needed. If you need more oxygen or are having trouble breathing, you may be given non-invasive ventilation to help your body receive it. This type of device uses a mask that can push the air into the congested lungs. If these methods don’t work, a tube connected to a machine might be inserted directly into your lungs to help supply the oxygen. During this time, your doctors will carefully manage the air pressure and volume to protect your lungs from further damage. [21]
3. Rest and Fluids
Getting plenty of rest and staying hydrated is essential for recovery. Drinking fluids helps thin mucus, making it easier to expel, and rest allows your body to use energy for healing. It’s important to avoid any strenuous activities until you’re fully recovered. [14]
4. Chest Tube Drainage
In severe cases of pneumonia, complications like pleural effusion or empyema can occur, where fluid or pus collects around the lungs. Chest tube drainage involves inserting a thin tube through the chest wall into the pleural space to drain this buildup. This procedure helps reduce pressure on the lungs, making breathing easier and lowering the risk of further infection. The chest tube placement is often guided by imaging techniques such as ultrasound or X-rays to ensure precision and effectiveness. [22]
5. Video-Assisted Thoracoscopic Surgery (VATS)
When chest tube drainage is insufficient to manage complications, video-assisted thoracoscopic surgery (VATS) may be needed. This minimally invasive procedure involves small incisions through which a surgeon inserts a camera and specialized instruments to remove infected fluid, thickened pus, or damaged tissue from the pleural space. [23]
Complications of Pneumonia
Pneumonia can lead to serious complications, especially if left untreated or if the immune system is weakened. These complications may require additional treatments and medical interventions. Here are some common complications associated with pneumonia.
1. Pleural Effusion
Fluid can build up between the layers of tissue surrounding your lungs, making it harder to breathe. If the fluid gets infected (called empyema), it might need to be drained with a tube or surgery. [24]
2. Lung Abscess
This is a pocket of pus formed inside the lung. This can cause severe illness, high fever, and a bad-smelling cough. It is usually treated with antibiotics or, in rare cases, drained with a needle. [24]
3. Blood Infection
The bacteria causing pneumonia can enter your bloodstream, spreading the infection to other parts of your body. This is a serious condition that may lead to sepsis, requiring immediate treatment in a hospital. [24]
4. Respiratory Failure
Severe pneumonia can make it very difficult for your lungs to get enough oxygen into your blood. You may need oxygen therapy or even a ventilator to help you breathe. [24]
5. Heart Problems
Pneumonia can stress your heart, sometimes causing irregular heartbeats or worsening existing heart conditions. In rare cases, it might lead to a heart attack. [25]
6. Chronic Breathing Issues
Some people may experience long-term breathing problems after severe pneumonia or develop conditions like bronchiectasis, where the airways become damaged and inflamed. [25]
7. Kidney or Liver Damage
Severe infections or low oxygen levels can sometimes harm your kidneys or liver, especially if you already have underlying health issues affecting these organs. [26]
Recovery from Pneumonia
Recovery from pneumonia can take time and varies depending on your age, overall health, and the severity of the illness. Most healthy adults with mild pneumonia recover within 1 to 3 weeks. Older adults, very young children, and those with chronic health conditions are at greater risk of complications, which can prolong recovery or lead to more severe outcomes. Regular follow-ups may be needed to monitor your progress and ensure your lungs heal properly. [27]
Prevention of Pneumonia
Preventing pneumonia involves taking steps to protect your lungs and overall health. Vaccinations are key, especially for children, older adults, and those with chronic conditions. Children need vaccines for Haemophilus influenzae (Hib) and Streptococcus pneumoniae. For adults, especially those over 65 or with health issues, pneumococcal and flu vaccines are recommended to help prevent pneumonia. Good hygiene also plays a huge role. You should wash your hands frequently, cover your mouth when coughing or sneezing, and avoid close contact with sick individuals. If you smoke, quitting can improve your lung health and lower your chances of getting pneumonia. Maintaining a healthy lifestyle with regular exercise, a balanced diet, and enough sleep can boost your immune system, helping your body fight infections more effectively. [28]
Aspiration Prevention
Prevention of aspiration is of utmost importance in people with neurological conditions or who are elderly to prevent pneumonia. Preventing aspiration involves simple yet effective steps to ensure food, liquids, or other substances do not enter your airway or lungs. Always sit upright at a 90-degree angle while eating or drinking, and stay in that position for at least 30 minutes after meals. [29]
Eat slowly, thoroughly chew food, and avoid talking or laughing. If you have swallowing difficulties, work with a speech therapist and use techniques like thickening liquids or pureeing food as needed. [30] For those who are bedridden, keeping the head of the bed elevated can help reduce the risk. Good oral hygiene is essential to prevent harmful mouth bacteria from aspirating into the lungs. Managing conditions like reflux and avoiding unnecessary sedatives can also lower aspiration risks. [30]
Questions To Ask Your Doctor
How can I lower my risk of developing pneumonia?
Is the pneumonia I have contagious, and if so, for how long?
Are there specific activities or foods I should avoid while recovering?
What things might slow down my recovery?
How will pneumonia affect my everyday activities?
What should I do about resting or going to the gym?
Conflict of Interest
PK and GA are research assistants at eHealthyInfo and receive compensation for their work. No other conflicts of interest declared.
Chan SS, Kotecha MK, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child. Journal of the American College of Radiology [Internet]. 2020 May [cited 2024 Oct 5];17(5):S215–25. Available from: https://www.jacr.org/article/S1546-1440(20)30121-6/fulltext
Atypical Pneumonia: Definition, Causes, and Imaging Features Nicholas P. Dueck, Samantha Epstein, Tomás Franquet, Christopher C. Moore, and Juliana Bueno RadioGraphics 2021 41:3, 720-741. Available from: https://doi.org/10.1148/rg.2021200131
Jennifer Febbo, Jonathan Revels, Loren Ketai, Viral Pneumonias, Infectious Disease Clinics of North America, Volume 38, Issue 1, 2024, Pages 163-182, ISSN 0891-5520, ISBN 9780443293801. Available from: https://doi.org/10.1016/j.idc.2023.12.009.
Tecson F;Louria DB. Infectious pneumonias: a review. The Journal of family practice [Internet]. 2024 [cited 2024 Oct 5];4(2). Available from: https://pubmed.ncbi.nlm.nih.gov/320285/
Almirall J, Serra-Prat M, Bolíbar I, Balasso V. Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration. 2017;94(3):299–311. Available from: https://pubmed.ncbi.nlm.nih.gov/28738364/
Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease: Table 1. Thorax. 2015 Jul 28;70(10):984–9. Available from:https://thorax.bmj.com/content/70/10/984
Reichel F, Reichel F, Reichel F, Reichel F, Reichel F, Reichel F, et al. Epidemiology and risk factors of community-acquired pneumonia in patients with different causes of immunosuppression. Infection. 2024 Jun 27; Available from: https://pubmed.ncbi.nlm.nih.gov/38935248
Lu C, Yang W, Liu Z, Liao H, Li Q, Liu Q. Effect of preconceptional, prenatal and postnatal exposure to home environmental factors on childhood pneumonia: A key role in early life exposure. Environmental Research. 2022 Nov;214:114098.Available from: https://pubmed.ncbi.nlm.nih.gov/35981613
Htun TP, Sun Y, Chua HL, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Scientific Reports [Internet]. 2019 May 20;9(1):1–10.Available from: https://pubmed.ncbi.nlm.nih.gov/31110214
Hill AT, Gold PM, El Solh AA, Metlay JP, Ireland B, Irwin RS, et al. Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza. Chest. 2019 Jan;155(1):155–67.Available from: https://pubmed.ncbi.nlm.nih.gov/30296418
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the american thoracic society and infectious diseases society of america. American Journal of Respiratory and Critical Care Medicine [Internet]. 2019 Oct 1;200(7):e45–67. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812437/
Gentilotti E, De Nardo P, Cremonini E, Górska A, Mazzaferri F, Canziani LM, et al. Diagnostic accuracy of point-of-care tests in acute community-acquired lower respiratory tract infections. A systematic review and meta-analysis. Clinical Microbiology and Infection. 2021 Oct; Available from: https://pubmed.ncbi.nlm.nih.gov/34601148/
Tang F, Zhu F, Wang Y, Xiankui Zha, Lyu L, Ma D. Role of bronchoscopy in the management of patients with suspected or suffering from ventilator-associated pneumonia: A meta-analysis. Heliyon. 2024 Jun 1;10(12):e32751–1.Available from: https://pubmed.ncbi.nlm.nih.gov/39183884
Zhu L, Hao Y, Li W, Shi B, Dong H, Gao P. Significance of pleural effusion detected by metagenomic next-generation sequencing in the diagnosis of aspiration pneumonia. Frontiers in Cellular and Infection Microbiology. 2022 Dec 20;12.Available from: https://pubmed.ncbi.nlm.nih.gov/36605125
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the american thoracic society and infectious diseases society of america. American Journal of Respiratory and Critical Care Medicine [Internet]. 2019 Oct 1;200(7):e45–67. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812437/
Fitzgerald DB, Polverino E, Waterer GW. Expert Review on Nonsurgical Management of Parapneumonic Effusion: Advances, Controversies, and New Directions. Seminars in Respiratory and Critical Care Medicine. 2023 Jul 10;44(04):468–76.Available from: https://pubmed.ncbi.nlm.nih.gov/37429296
Middendorp van, Franssen S, Sanne Gillissen, Maessen JG, Karel, Vissers YLJ, et al. Uniportal video-assisted thoracoscopy is a safe approach in patients with empyema requiring surgery. Journal of thoracic disease. 2020 Apr 1;12(4):1460–6.Available from: https://pubmed.ncbi.nlm.nih.gov/32395283
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases. 2011 Oct 1;53(7):e25–76. Available from: https://pubmed.ncbi.nlm.nih.gov/21880587
Violi F, Cangemi R, Falcone M, Taliani G, Pieralli F, Vannucchi V, et al. Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia. Clinical Infectious Diseases [Internet]. 2017 Jun 1 [cited 2020 Oct 10];64(11):1486–93. Available from: https://pubmed.ncbi.nlm.nih.gov/28205683
de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. The Lancet. 2020 Sep;396(10253):786–98. Available from: https://pubmed.ncbi.nlm.nih.gov/32919518/
Perticone ME, Manti A, Luna CM. Prevention of Aspiration: Oral Care, Antibiotics, Others. Seminars in Respiratory and Critical Care Medicine [Internet]. 2024 Nov 29 [cited 2025 Jan 4];45(06):709–16. Available from: https://pubmed.ncbi.nlm.nih.gov/39612936
Ortega O, Guidotti L, Yoshimatsu Y, Sitges C, Martos J, Miró J, et al. “SWALLOWING AND ASPIRATION: HOW TO EVALUATE AND TREAT SWALLOWING DISORDERS ASSOCIATED WITH ASPIRATION PNEUMONIA IN OLDER PERSONS.” Seminars in Respiratory and Critical Care Medicine. 2024 Oct 21;Available from: https://pubmed.ncbi.nlm.nih.gov/39433063
Acute leukemia is a blood cancer that starts in your bone marrow, where a large number of white blood cells are produced that don’t work and crowd out healthy cells.
Symptoms of acute leukemia appear quickly and may include extreme tiredness, frequent infections, easy bruising or bleeding, bone or joint pain, pale skin, and swollen lymph nodes.
Younger patients with acute myeloid leukemia have a better chance of long-term survival, though the risk of relapse is high.
A bone marrow biopsy helps diagnose leukemia by collecting a small sample to check for cancerous cells, assess disease severity, and guide treatment plans.
A stem cell transplant replaces damaged bone marrow with healthy stem cells to help restore normal blood cell production in leukemia patients, especially those with high-risk or relapsed disease.
What is Acute Leukemia?
Acute leukemia is a type of cancer that starts in your bone marrow, where your blood cells are made. In leukemia, your body quickly produces too many immature white blood cells, which don’t work properly. These abnormal cells can be either myeloid or lymphoid, leading to two main types of leukemia: acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). These cells can alter your immunity, making it harder for your body to fight infections, carry oxygen, or stop bleeding. [1]
Types of Acute Leukemia
Two main types of leukemia:
1. ALL
This type mainly affects lymphoid cells, a kind of white blood cell. ALL is more common in children but can also happen in adults. [2]
2. AML
This type begins in another group of blood cells, including red blood cells, platelets, and certain white blood cells. AML is more common in adults. [3]
Causes and Risk Factors of Acute Leukemia
The exact cause of acute leukemia isn’t always clear, but several factors can increase your risk:
1. Genetic Factors
Genes can play a significant role in the risk of developing acute leukemia. Some inherited conditions, like Down syndrome, Li-Fraumeni syndrome, and neurofibromatosis, make it more likely to get this type of cancer. [4]
2. Radiation Exposure
Exposure to high levels of ionizing radiation, like from nuclear accidents or radiation therapy for other cancers, is strongly linked to the development of acute leukemia. [5]
3. Chemical Exposure
Long-term exposure to certain chemicals, such as benzene, which is found in industrial settings, can be a risk factor. [6]
4. Previous Cancer Treatment
Medications used in chemotherapy like melphalan, cyclophosphamide etoposide, and mitoxantrone may increase your risk of developing acute leukemia. Some of them are known to cause leukemia depending on the amount of these chemotherapy agents used and with a latency period of 5 to 7 years. [7]
5. Infections
Infections and immune system factors might contribute to the development of acute leukemia, especially in children. Some studies suggest that infections during early childhood could trigger the disease in children who are genetically more likely to develop it. [8]
Symptoms of Acute Leukemia
Acute leukemia can cause a variety of symptoms that develop quickly, often within days or weeks. Common symptoms include:
1. Fatigue and Weakness
You may feel extremely tired and weak because your bone marrow isn’t making enough red blood cells (anemia). [9]
2. Fever
You might experience persistent or recurring fevers due to leukemia or because your immune system is weakened. [10]
3. Bruising and Bleeding
It’s easier to bruise, have frequent nosebleeds or bleeding gums, or notice small red spots on your skin (petechiae) due to a low platelet count (thrombocytopenia). [10]
4. Bone and Joint Pain
As the bone marrow expands, you might feel pain in your bones or joints, especially in children. [10]
5. Pale Skin and Recurrent Infections
Your skin may look paler than usual because of anemia (a low red blood cell count), and with a low white blood cell count (leukopenia), you’re more likely to get infections.
6. Swollen Lymph Nodes, Liver, or Spleen
You could have painless lumps in your neck, armpit, or groin. You might also notice swollen lymph nodes, an enlarged liver, or an enlarged spleen. [11]
7. Weight Loss and Loss of Appetite
You could lose weight and have a reduced appetite due to the body’s increased energy needs and the disease’s impact on your digestive system.
8. Night Sweats
Though more common in chronic leukemia, night sweats can also happen in acute leukemia. [12]
Diagnosis of Acute Leukemia
If leukemia is suspected, several tests may be done depending on your symptoms and health services at your local facility.
1. Blood Tests
A complete blood count (CBC) and peripheral blood smear (PBS) are necessary tests to check for leukemia. A CBC looks at the levels of your white blood cells, red blood cells, and platelets. If you have leukemia, your white blood cell count may be too high or too low, and you might have anemia or a low platelet count. The PBS will look at your blood cells under a microscope to check for blasts (immature white blood cells) or other abnormal cells. [13]
2. Bone Marrow Aspirate and Biopsy
A bone marrow aspirate and biopsy can confirm leukemia and determine its type. In this procedure, your doctor takes a small sample of liquid bone marrow (aspirate) and a tiny piece of bone (biopsy), usually from your hip bone. These samples are examined under a microscope to check for blasts (immature white blood cells) and other abnormal cells. The test helps determine how well your bone marrow works and whether leukemia cells exist. While the procedure may cause some discomfort, it is quick and done with local anesthesia to help reduce pain. [13]
3. Flow Cytometry
Flow cytometry is a test that helps to examine your blood or bone marrow cells to identify the type of leukemia you may have. It uses a special machine that sends a stream of cells through lasers. These lasers detect specific markers on the surface of the cells, which helps doctors see whether the cells are normal or cancerous. The quick test involves drawing a small amount of blood or taking a bone marrow sample, depending on your situation. [14]
4. Lumbar Puncture
This test checks for leukemia cells in the fluid around your brain and spinal cord, especially if there’s a concern that the disease has spread to your central nervous system. [13]
5. Imaging Studies
Imaging studies help to check if leukemia has spread to different parts of your body. While leukemia mainly affects your blood and bone marrow, imaging can detect complications like infections, enlarged organs, or leukemia spreading to the brain, chest, or bones. A chest X-ray is often used to check for swollen lymph nodes or lung infections. A Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) provides detailed images of your organs, helping to see if leukemia has affected your liver, spleen, or brain. Sometimes, a Positron Emission Tomography (PET) scan can detect active cancer cells. While imaging isn’t used to diagnose leukemia, it helps doctors assess your overall health and plan the best treatment. [15]
6. Genetic Tests or Karyotyping
Genetic tests help doctors understand changes in leukemia cells that affect diagnosis, treatment, and prognosis. Karyotyping is a type of genetic test that checks for missing or extra chromosome parts. At the same time, Fluorescence In Situ Hybridization (FISH) highlights specific genetic changes that may not be visible in karyotyping. Next-Generation Sequencing (NGS) goes even deeper, detecting small gene mutations that influence how leukemia grows and which treatments may work best. [16]
Treatment of Acute Leukemia
Phase of treatment: The treatment of acute leukemia, including both AML and ALL, usually happens in several stages:
Induction Therapy
In this first phase, the goal is to reduce the number of leukemia cells in your body to an undetectable level and help your body start producing normal blood cells again. [17]
Consolidation Therapy
After you reach remission (when the cancer isn’t detectable), consolidation therapy works to eliminate any remaining leukemia cells to prevent the cancer from coming back. In AML, this might involve high-dose chemotherapy or a stem cell transplant if you’re at high risk. In ALL, you’ll likely go through more chemotherapy, and you might also receive treatment to protect your brain and spinal cord from leukemia. [18]
Maintenance Therapy
Maintenance therapy is often used in ALL to keep the leukemia in remission. This phase involves taking lower doses of chemotherapy over a long period, usually 2-3 years. [18]
CNS-Directed Therapy
If you have ALL, it’s important to protect your brain and spinal cord because leukemia can spread there. During your treatment, you might receive chemotherapy directly into the fluid around your spinal cord or undergo radiation therapy to the brain to prevent this. [19] Treatment options: Treatment often involves a combination of therapies
1. Chemotherapy
Chemotherapy is the primary treatment for leukemia, using powerful drugs to destroy cancer cells in your blood and bone marrow. These drugs can be given as pills, injections, or through an IV. The treatment is usually given in cycles to allow your body time to recover. While chemotherapy effectively kills leukemia cells, it can also affect healthy cells, leading to side effects like fatigue, nausea, hair loss, and a weakened immune system. In some cases, doctors combine different chemotherapy drugs or use them alongside other treatments like targeted therapy or a stem cell transplant to improve results. Chemotherapy that might be used is daunorubicin. Cytarabine, and vincristine. [20]
2. Targeted Therapy
Targeted therapy is a treatment for leukemia that uses special drugs to attack cancer cells while causing less harm to normal cells. Unlike chemotherapy, which affects all rapidly growing cells, targeted therapy focuses on specific proteins or genes that help leukemia cells grow. These drugs can block signals that allow cancer to spread, cut off its blood supply, or help the immune system destroy cancer cells. Common types include FLT3 inhibitors like midostaurin and gilteritinib, IDH1/2 inhibitors like ivosidenib and enasidenib, and BCL-2 inhibitors like venetoclax. Targeted therapy is often used alone or combined with chemotherapy to improve treatment outcomes. [21]
3. Radiation Therapy
Radiation therapy uses high-energy rays to kill or stop leukemia cells from growing. While leukemia mainly affects the blood and bone marrow, radiation may be used in specific cases, such as when leukemia has spread to the brain, spinal cord, or lymph nodes. It can also be part of treatment before a stem cell transplant to help destroy remaining cancer cells. The procedure is painless and typically given in short sessions over several days. Depending on the area treated, common side effects include fatigue, skin irritation, and nausea. Radiation is often combined with other treatments like chemotherapy for better results. [22]
4. Stem Cell Transplant
Stem cell transplant replaces damaged bone marrow with healthy stem cells. It is usually done after high-dose chemotherapy or radiation, which destroys both cancerous and healthy cells in the bone marrow. The new stem cells, either from a donor (allogeneic transplant) or the patient’s own body(autologous transplant), help rebuild healthy blood cells. This procedure can improve the chances of remission, especially in aggressive or relapsed leukemia. However, it carries risks like infections, graft-versus-host disease (if donor cells attack the body), and a lengthy recovery period. Stem cell transplants are often used when other treatments are not enough to cure leukemia. [23]
Complications of Acute Leukemia
Acute leukemia can lead to various complications, both from the disease itself and its treatment.
1. Blood-Related Complications
Tumor Lysis Syndrome: This happens when cancer cells break down quickly, releasing substances into the blood that can cause high levels of uric acid, potassium, and phosphate and low calcium levels. [24]
Hyperleukocytosis and Leukostasis: High white blood cell counts can clog blood vessels, leading to breathing problems and neurological symptoms. [25]
Thrombohemorrhagic Syndromes: Particularly in acute promyelocytic leukemia (APL), you may experience severe bleeding or clotting due to issues like disseminated intravascular coagulation (DIC). [26]
2. Infectious Complications
Infectious complications are common due to low white blood cell counts and weakened immunity. Neutropenic fever can occur when your body has too few infection-fighting cells, putting you at high risk for serious infections that require immediate antibiotic treatment. Opportunistic infections, including fungal, viral, and bacterial infections, can also develop due to prolonged immunosuppression from leukemia or its treatments. [27]
3. Neurologic Complications
Leukemia can affect your nervous system, leading to serious complications. Leukemic meningitis occurs when leukemia cells spread to the brain and spinal cord, causing symptoms like headaches, nausea, vision changes, and confusion, similar to meningitis. Chemotherapy-induced neurotoxicity happens when certain chemotherapy drugs, like cytarabine, affect the brain and nervous system. This can lead to cerebellar toxicity, which causes problems with coordination and balance, or encephalopathy, which results in confusion and altered mental function. [28]
4. Heart-Related Complications
Some chemotherapy drugs, especially anthracyclines like doxorubicin, can weaken the heart muscle over time, leading to cardiomyopathy or heart failure. Radiation therapy to the chest may also damage the heart and blood vessels, increasing the risk of coronary artery disease or irregular heart rhythms (arrhythmias). [29]
5. Digestive System Complications
Chemotherapy and radiation can damage the lining of your digestive tract, causing nausea, vomiting, diarrhea, or constipation. Some treatments may also lead to mucositis, which causes painful sores in the mouth and throat, making it difficult to eat and swallow. Some chemotherapy drugs can inflame the liver and pancreas, especially in children. Additionally, chemotherapy can affect your liver, leading to liver toxicity or abnormal liver function. Weakened immunity increases the risk of gut infections, which can cause severe diarrhea, dehydration, and even sepsis. [30]
Prognosis of Acute Leukemia
The outlook for acute leukemia depends on factors like your age, genetic makeup, and response to treatment.
AML: If you’re under 60, chemotherapy can lead to remission in about 70-80% of cases, but there’s still a high chance of relapse. Long-term survival improves with additional treatments like high-dose chemotherapy or a stem cell transplant, especially for high-risk patients. For those over 60, remission rates drop to about 50%, and relapse is very common within three years. Unfortunately, only 5-8% of older adults survive beyond five years due to other health conditions and genetic factors. [19]
ALL: The prognosis is much better for children, with about 90% surviving at least five years. Adolescents and young adults also have a good outlook, with around 60% surviving five years or more. However, for adults, the survival rate drops to 20-40%, and for those over 40, it’s even lower, with only about 20% surviving beyond five years. Early diagnosis and aggressive treatment play a key role in improving outcomes. [19]
Questions To Ask Your Doctor
How will having acute leukemia change my daily life and activities?
What are the chances that the leukemia will come back after treatment?
How often will I need to have check-ups and monitoring after my treatment for acute leukemia?
Are there any specific foods I should eat or avoid while I have acute leukemia?
How can I stay physically healthy and fit during and after my treatment for acute leukemia?
Conflict of Interest
PK is a research assistant at eHealthyInfo and receives compensation for her work.
Gbenjo JTC, McCrary GLM, Wilson SE. Leukemia: What Primary Care Physicians Need to Know. American Family Physician [Internet]. 2023 Apr 1;107(4):397–405. Available from: https://pubmed.ncbi.nlm.nih.gov/37054416/
Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. American Family Physician [Internet]. 2014 May 1;89(9):731–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24784336/
Brown PA, Shah B, Advani A, Aoun P, Boyer MW, Burke PW, et al. Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2021 Sep;19(9):1079–109. Available from: https://pubmed.ncbi.nlm.nih.gov/34551384/
Kosik P, Skorvaga M, Igor Belyaev. Preleukemic Fusion Genes Induced via Ionizing Radiation. International Journal of Molecular Sciences [Internet]. 2023 Apr 1 [cited 2024 Feb 18];24(7):6580–0. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095576/
Vivarelli S, Sevim C, Giambò F, Fenga C. Integrated Computational Analysis Reveals Early Genetic and Epigenetic AML Susceptibility Biomarkers in Benzene-Exposed Workers. International journal of molecular sciences [Internet]. 2025;26(3):1138. Available from: https://pubmed.ncbi.nlm.nih.gov/39940906/
Lomov NA, Viushkov VS, Rubtsov MA. Mechanisms of Secondary Leukemia Development Caused by Treatment with DNA Topoisomerase Inhibitors. Biochemistry Biokhimiia [Internet]. 2023 Jul;88(7):892–911. Available from: https://pubmed.ncbi.nlm.nih.gov/37751862/
Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ. Clinical presentation of childhood leukaemia: a systematic review and meta-analysis. Archives of Disease in Childhood. 2016 Sep 19;101(10):894–901. Available from: https://pubmed.ncbi.nlm.nih.gov/27647842/
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W. Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. British Journal of General Practice. 2016 Feb 25;66(644):e182–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26917658/
Biswas S, Chakrabarti S, Chakraborty J, Paul PC, Konar A, Das S. Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features. Asian Pacific journal of cancer prevention : APJCP [Internet]. 2009;10(5):903–6. Available from: https://pubmed.ncbi.nlm.nih.gov/20104987/
Howell DA, Warburton F, Ramirez AJ, Roman E, Smith AG, Forbes LJL. Risk factors and time to symptomatic presentation in leukaemia, lymphoma and myeloma. British Journal of Cancer. 2015 Sep;113(7):1114–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4651121/
de Haas V, Ismaila N, Advani A, Arber DA, Dabney RS, Patel-Donnelly D, et al. Initial Diagnostic Work-Up of Acute Leukemia: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists and American Society of Hematology Guideline. Journal of Clinical Oncology [Internet]. 2019 Jan 20;37(3):239–53. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338392/
Ally F, Chen X. Acute Myeloid Leukemia: Diagnosis and Evaluation by Flow Cytometry. Cancers. 2024 Nov 17;16(22):3855–5. Available from: https://pubmed.ncbi.nlm.nih.gov/39594810/
Pollyea DA, Altman JK, Assi R, Bixby D, Fathi AT, Foran JM, et al. Acute Myeloid Leukemia, Version 3.2023, NCCN Clinical Practice Guidelines in Oncology. 2023 May 1;21(5):503–13. Available from: https://pubmed.ncbi.nlm.nih.gov/37156478/
Harris MH, Czuchlewski DR, Arber DA, Czader M. Genetic Testing in the Diagnosis and Biology of Acute Leukemia. American Journal of Clinical Pathology. 2019 Jul 2;152(3):322–46.Available from: https://pubmed.ncbi.nlm.nih.gov/31367767/
Lechner. Treatment of acute leukemia. Annals of oncology : official journal of the European Society for Medical Oncology [Internet]. 2024 [cited 2024 Sep 4];10 Suppl 6. Available from: https://pubmed.ncbi.nlm.nih.gov/10676552/
Pratz KW, Cherry M, Altman JK, Cooper BW, Podoltsev NA, Jose Carlos Cruz, et al. Gilteritinib in Combination With Induction and Consolidation Chemotherapy and as Maintenance Therapy: A Phase IB Study in Patients With Newly Diagnosed AML. Journal of Clinical Oncology. 2023 Sep 10;41(26):4236–46. Available from: https://pubmed.ncbi.nlm.nih.gov/37379495/
Burnett A, Wetzler M, Löwenberg B. Therapeutic Advances in Acute Myeloid Leukemia. Journal of Clinical Oncology. 2011 Feb 10;29(5):487–94. Available from: https://pubmed.ncbi.nlm.nih.gov/21220605/
Jaramillo S, Schlenk RF. Update on current treatments for adult acute myeloid leukemia: to treat acute myeloid leukemia intensively or non-intensively? That is the question. Haematologica. 2023 Feb 1;108(2):342–52. Available from: https://pubmed.ncbi.nlm.nih.gov/36722404/
Kantarjian HM, Kadia TM, DiNardo CD, Welch MA, Ravandi F. Acute myeloid leukemia: Treatment and research outlook for 2021 and the MD Anderson approach. Cancer. 2021 Mar 18;127(8):1186–207. Available from: https://pubmed.ncbi.nlm.nih.gov/33734442/
Bodet-Milin C, Kraeber-Bodéré F, Eugène T, Guérard F, Gaschet J, Bailly C, et al. Radioimmunotherapy for Treatment of Acute Leukemia. Seminars in Nuclear Medicine [Internet]. 2016 Mar 1 [cited 2021 Dec 16];46(2):135–46. Available from: https://pubmed.ncbi.nlm.nih.gov/26897718/
Stubbins RJ, Francis A, Kuchenbauer F, Sanford D. Management of Acute Myeloid Leukemia: A Review for General Practitioners in Oncology. Current Oncology [Internet]. 2022 Aug 30;29(9):6245–59. Available from: https://pubmed.ncbi.nlm.nih.gov/36135060/
Xue Y, Chen J, Gao S, Zhai X, Wang N, Gao J, et al. Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia. Scientific Reports. 2021 May 6;11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33958615/
Giammarco S, Chiusolo P, Piccirillo N, Di Giovanni A, Metafuni E, Laurenti L, et al. Hyperleukocytosis and leukostasis: management of a medical emergency. Expert Review of Hematology. 2016 Dec 26;10(2):147–54. Available from: https://pubmed.ncbi.nlm.nih.gov/27967252/
Paterno G, Palmieri R, Cristiano Tesei, Nunzi A, Ranucci G, Mallegni F, et al. The ISTH DIC-score predicts early mortality in patients with non-promyelocitic acute myeloid leukemia. Thrombosis Research. 2024 Feb 16;236:30–6. Available from: https://pubmed.ncbi.nlm.nih.gov/38387301/
Zając-Spychała O, Skalska-Sadowska J, Wachowiak J, Szmydki-Baran A, Hutnik Ł, Matysiak M, et al. Infections in children with acute myeloid leukemia: increased mortality in relapsed/refractory patients. Leukemia & Lymphoma. 2019 May 28;60(12):3028–35. Available from: https://pubmed.ncbi.nlm.nih.gov/31132917/
Baloda R, Sharma S, Anand R, Mandal P, Parakh N, Katti B, et al. Neurologic Complications in Patients With Lymphoreticular Malignancy: A Descriptive Cohort Study. Journal of Pediatric Hematology/Oncology. 2023 Jul 24;45(7):e885–91. Available from: https://pubmed.ncbi.nlm.nih.gov/37526372/
Assuncao BMBL, Handschumacher MD, Brunner AM, Yucel E, Bartko PE, Cheng KH, et al. Acute Leukemia is Associated with Cardiac Alterations before Chemotherapy. Journal of the American Society of Echocardiography. 2017 Nov;30(11):1111–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28927558/
Rocka A, Woźniak M, Lejman M, Zawitkowska J. Severe complications in the induction phase of therapy in a pediatric patient with T-cell acute lymphoblastic leukemia: A case report. Medicine. 2023 Sep 8;102(36):e34965. Available from: https://pubmed.ncbi.nlm.nih.gov/37682188/
Hepatocellular carcinoma accounts for 75–85% of liver cancers and is a leading cause of cancer-related deaths.
The most important risk factor for hepatocellular carcinoma is chronic liver disease, particularly hepatitis B or C infection, and non-alcoholic fatty liver disease.
About 30% of the cases of hepatocellular carcinoma are due to the consumption of a heavy amount of alcohol.
A liver transplant is not the only treatment option for hepatocellular cancer, and it is an option only for a few people.
Omega-3 fatty acids, specifically alpha-linolenic acid, have been shown to stop the growth of HCC cells, suggesting a potential role in suppressing the progression of HCC.
What is Hepatocellular Carcinoma?
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy of the liver and a significant cause of cancer-related mortality worldwide. It accounts for approximately 75-85% of all liver cancers. It is estimated that there will be over one million cases by 2025. [1]
The disease is most common in East Asia and sub-Saharan Africa due to widespread hepatitis B infection. In Western countries, its rates are rising because of the increasing prevalence of metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). [1]
Risk Factors of Hepatocellular Carcinoma
Several well-established risk factors contribute to the development of HCC, including:
1. Chronic Hepatitis B Virus (HBV) Infection
The hepatitis B virus (HBV) is a significant cause of HCC globally. Chronic HBV infection leads to persistent liver inflammation, fibrosis, and eventual cirrhosis, creating a high-risk environment for carcinogenesis. HBV is particularly oncogenic due to its ability to integrate into the host genome. East Asia and sub-Saharan Africa report a disproportionately higher HCC incidence, and those are the regions with a higher prevalence of HBV. [2]
2. Chronic Hepatitis C Virus (HCV) Infection
Hepatitis C virus (HCV)-associated cirrhosis also accounts for a significant proportion of HCC cases in Western countries and Japan. Of patients infected with the hepatitis C virus, about 80% progress to chronic hepatitis, with almost 20% developing cirrhosis. With chronic inflammation and fibrosis, HCV induces long-term liver damage and hepatocellular carcinoma. [3]
3. Alcohol-Related Liver Disease
Chronic heavy alcohol consumption is a well-established risk factor for HCC, with 30% of the cases attributed to it. Alcohol causes liver damage through mechanisms such as oxidative stress, inflammation, DNA damage, and direct hepatotoxicity. This leads to cirrhosis, ultimately increasing the risk of hepatocellular carcinoma. [4]
4. Fatty Liver Disease
NAFLD, especially its severe form, non-alcoholic steatohepatitis (NASH), is an emerging risk factor for HCC. Around 60% of patients over 50 with diabetes or obesity are believed to have NASH with advanced fibrosis. Linked to metabolic syndrome, obesity, and type 2 diabetes, NAFLD and NASH contribute to progressive liver inflammation, fibrosis, and cancer development. With NAFLD becoming more common, particularly in developed countries, it is expected to become a leading cause of HCC. [5]
5. Aflatoxin Exposure
Aflatoxin is a carcinogenic toxin produced by Aspergillus species in improperly stored grains and is a significant risk factor in regions with poor food storage practices. Aflatoxin induces mutations in the TP53 tumor suppressor gene, accelerating the pathogenesis of HCC. [6]
6. Male Gender
HCC is found to be more common in men than in females; it occurs about two to four times more often in men. [1]
7. Disease Conditions
Disorders like hereditary hemochromatosis, Wilson’s disease, α-1 antitrypsin disease, glycogen storage disease, and porphyrias predispose to chronic liver damage and subsequent HCC. [7]
Pathophysiology of Hepatocellular Carcinoma
HCC develops when liver cells become damaged over time and start growing abnormally. Long-term liver injury from conditions like hepatitis B or C, fatty liver disease, or excessive alcohol use can lead to ongoing inflammation and scarring. As the liver tries to repair itself, some cells may grow uncontrollably, leading to cancer. Even chronic inflammation, genetic changes in the cells like the mutation of genes that suppress cancer, and the buildup of harmful substances in the liver contribute to this process. Over time, these cancerous cells form a tumor that can spread to other parts of the liver or beyond. [8–9]
Clinical Features of Hepatocellular Carcinoma
HCC often presents with a wide range of clinical features, depending on the disease stage and underlying liver conditions. In its early stages, HCC is frequently asymptomatic. As the disease progresses, more specific symptoms and signs may develop.
1. Unexplained Weight Loss
Many people with HCC lose weight without trying. This happens because the cancer affects the body’s metabolism, making it harder to absorb nutrients. As the disease progresses, weight loss becomes more noticeable due to reduced appetite and muscle wasting. [10]
2. Loss of Appetite and Feeling Full Quickly
Even after eating a small amount, you may feel full or uninterested in food. This is because liver cancer can affect digestion and slow down the movement of food in the stomach. Over time, this lack of appetite leads to weakness and malnutrition. [10]
3. Abdominal Pain or Discomfort
Pain in the upper right side of the abdomen is common and may start as mild discomfort before worsening. The growing tumor pressures surrounding organs and nerves lead to a persistent dull or sharp pain. Sometimes, the pain may radiate to the back or right shoulder. [10]
4. Swelling in the Abdomen (Ascites)
The liver helps regulate fluid balance in the body. When it is damaged by cancer, fluid builds up in the belly, causing noticeable swelling and tightness. This condition, is called ascites, can make it difficult to breathe or move comfortably. It is often a sign that the cancer is affecting liver function significantly. [11]
5. Yellowing of the Skin and Eyes (Jaundice)
The liver processes bilirubin, a substance that gives bile its yellow color. When liver function declines due to cancer, bilirubin accumulates in the blood, causing the skin and eyes to turn yellow. Jaundice is often accompanied by dark-colored urine and pale stools, which indicate poor bile flow. [11]
6. Fatigue and Weakness
Many people with HCC feel extremely tired, even after resting. This happens because the liver filters toxins, produces proteins, and stores energy. When the liver is damaged, the body struggles to function properly, leading to persistent fatigue and reduced stamina. [12]
7. Easy Bruising or Bleeding
The liver produces clotting factors that help stop bleeding. When HCC affects liver function, blood does not clot as well, leading to frequent bruising, nosebleeds, and bleeding gums. Even minor injuries may result in excessive bleeding. [11]
8. Lump or Mass in the Upper Right Abdomen
As the tumor grows, it may form a hard lump under the ribs on the right side. Some people may feel this mass when lying down or pressing on the area. The presence of a lump often indicates that the tumor has become large. [12]
9. Fever and General Feeling of Being Unwell
Some people with HCC experience recurring fevers, chills, and a general sense of discomfort. This happens because the body recognizes the cancer as abnormal and responds with inflammation. The immune system’s reaction can cause flu-like symptoms, adding to overall weakness. [12]
Diagnosis of Hepatocellular Carcinoma
HCC is diagnosed through clinical evaluation, imaging modalities, laboratory tests, and sometimes by histological confirmation.
Clinical and Laboratory Assessment
Liver Function Tests: Liver function tests play an important role in both the diagnosis and management of HCC. Key liver function tests include the measurement of serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, albumin, and prothrombin time. [13]
Biomarkers: Elevated alpha-fetoprotein (AFP) levels are commonly used for initial screening, but its sensitivity and specificity are low. Other markers include des-gamma-carboxy prothrombin (DCP), and these biomarkers are combined with imaging for both surveillance and diagnosis. [13]
Imaging
Ultrasonography (USG): USG is a commonly used imaging tool for diagnosing HCC. It is non-invasive, widely available, and helps detect liver tumors early, especially in high-risk individuals. Sound waves create images of the liver during the scan, allowing doctors to identify abnormal growths or suspicious lesions. Doppler ultrasound can also assess blood flow within the liver and detect changes in blood vessels associated with HCC. In patients with cirrhosis or chronic liver disease, regular USG screenings help monitor liver health and catch cancer in its early stages. If a suspicious lesion is found, further tests like contrast-enhanced ultrasound, CT scans, or MRI may be needed to confirm the diagnosis. [14]
Computed Tomography (CT) Scan of the Abdomen: CT scan is the primary imaging modality for diagnosing HCC. A CT scan is an advanced imaging test that provides detailed cross-sectional images of the liver, helping to detect HCC. It is often performed with contrast dye, which enhances the visibility of liver tumors. [15]
Magnetic Resonance Imaging (MRI): MRI is a highly sensitive test for diagnosing HCC, especially in detecting smaller tumors and distinguishing them from benign liver lesions. MRI uses powerful magnets and radio waves to create detailed liver images. Additionally, MRI provides better soft tissue contrast, helping clearly identify tumor characteristics. It is particularly useful in patients with liver cirrhosis or when CT findings are inconclusive. [16]
Liver Biopsy
A liver biopsy involves taking a small tissue sample from the liver to examine under a microscope. It is usually performed when imaging tests like ultrasound, CT, or MRI do not diagnose clearly. The procedure uses a thin needle inserted through the skin, guided by imaging to target the suspicious area. A pathologist then examines the sample to check for cancerous cells. While a biopsy is the most definitive way to confirm HCC, it is not always necessary if imaging findings are characteristic. However, it carries small risks, such as bleeding or infection, and is usually reserved for cases where the diagnosis remains uncertain. [13]
Management of Hepatocellular Carcinoma
The treatment options for managing HCC are tailored to the patient’s liver function and stage of the disease.
Surgical Therapies
Resection: Surgical resection is a treatment option for liver cancer when the tumor is confined to the liver and there is good liver function without significant cirrhosis. The procedure involves removing the cancerous part of the liver while preserving as much healthy tissue as possible. It is typically performed in patients with well-preserved liver function and no signs of widespread disease. Surgery offers the best chance for long-term survival, but it is not suitable for all patients, especially those with severe liver damage. After resection, regular follow-up is needed to monitor for recurrence, as HCC can return even after successful surgery. [17]
Liver Transplantation: Liver transplantation is a treatment option for HCC in patients who meet specific criteria that help determine eligibility based on tumor size and number. This procedure involves replacing the diseased liver with a healthy donor liver, treating both the cancer and underlying liver disease, such as cirrhosis. It offers the best chance for long-term survival and a lower risk of cancer recurrence compared to resection. However, organ availability is limited, and patients may need to wait on a transplant list. After transplantation, lifelong immunosuppressive medications are required to prevent organ rejection. [18]
Locoregional Therapies
Ablation: Ablation is a minimally invasive treatment for HCC mainly used for small tumors in patients who are not candidates for surgery or transplantation. The most common methods include radiofrequency and microwave ablation, which use heat to destroy cancer cells. Ablation is effective for tumors smaller than 3 cm and can help control cancer growth, especially in patients with liver disease. The procedure is done through a needle inserted into the tumor under imaging guidance, such as ultrasound or CT scan. [19]
Transarterial Chemoembolization (TACE): TACE is a targeted treatment for HCC that helps slow tumor growth in patients not candidates for surgery or liver transplantation. The procedure involves injecting chemotherapy drugs directly into the blood vessels that supply the tumor, followed by blocking these vessels with tiny particles to cut off the tumor’s blood supply. This dual action helps deliver high-dose chemotherapy to the cancer while starving it of oxygen and nutrients. TACE is commonly used for intermediate-stage HCC or to shrink tumors before surgery or transplantation. It is performed through a catheter inserted into the artery and guided to the liver using imaging techniques. Side effects of TACE may include post-procedure pain, fever, and temporary liver function changes, but the procedure can be repeated if necessary to control tumor progression. [20]
Transarterial Radioembolization (TARE): TARE is a targeted treatment for HCC that delivers tiny radioactive beads directly into the tumor’s blood supply. Unlike TACE, which uses chemotherapy and blocks blood flow, TARE uses radiation to destroy cancer cells while allowing some blood flow to continue. This can benefit patients with larger tumors or portal vein involvement, where TACE may be less effective. The procedure involves injecting radioactive microspheres into the liver artery, which emit radiation over time, leading to gradual tumor shrinkage with fewer side effects compared to TACE. While TACE is preferred for intermediate-stage HCC, TARE is often considered for more advanced cases or when patients cannot tolerate repeated TACE sessions. [21]
External Beam Radiation Therapy (EBRT): EBRT is a non-invasive treatment for HCC that uses high-energy X-rays to target and destroy cancer cells. It is especially useful for patients who are not candidates for surgery, liver transplantation, or other local treatments like TACE or ablation. EBRT is delivered from outside the body, focusing radiation precisely on the tumor while minimizing damage to healthy liver tissue. Advanced techniques like stereotactic body radiotherapy allow for high-dose radiation in fewer sessions, improving effectiveness while reducing side effects. EBRT is often considered for patients with large tumors, vascular invasion, or those with pain due to tumor growth. It can also be used in combination with other therapies to improve outcomes. [22]
Systemic Therapies
Systemic therapies for HCC include targeted therapy and immunotherapy, which are used when surgery or local treatments aren’t an option. Targeted drugs like sorafenib and lenvatinib block cancer growth and blood vessel formation, while second-line options like regorafenib and cabozantinib help slow progression. Immunotherapy, such as atezolizumab with bevacizumab or nivolumab, boosts the immune system to fight cancer. These treatments can improve survival but may cause side effects like fatigue, high blood pressure, or immune-related reactions. The choice depends on liver function, tumor stage, and overall health. [23]
Omega-3 Fatty Acids and Hepatocellular Carcinoma
Omega-3 fatty acids, found in foods like fish, flaxseeds, and walnuts, have been studied for their potential role in managing HCC. These healthy fats possess anti-inflammatory properties, which may help reduce liver inflammation, a key contributor to liver damage and HCC development. Studies have shown that omega-3 fatty acids, specifically alpha-linolenic acid (ALA), have been shown to stop the growth of HCC cells through some sort of signalling pathway, suggesting a potential role for ALA in suppressing HCC progression. However, more research is needed to understand their role in HCC management. [24]
Questions To Ask Your Doctor
What lifestyle changes or dietary adjustments should I make during treatment?
What if I don’t want a liver transplant?
Are there any clinical trials available for liver cancer?
Are there any natural methods available for treatment?
What are the possible side effects of the recommended treatments, and how can they be managed?
Wong GLH. Risk prediction of hepatitis B virus-related hepatocellular carcinoma in the era of antiviral therapy. World Journal of Gastroenterology. 2013;19(39):6515. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3801362/
Bucci L, Garuti F, Camelli V, Lenzi B, Farinati F, Giannini EG, et al. Comparison between alcohol- and hepatitis C virus-related hepatocellular carcinoma: clinical presentation, treatment and outcome. Alimentary Pharmacology & Therapeutics. 2015 Dec 14;43(3):385–99. Available from: https://pubmed.ncbi.nlm.nih.gov/26662476/
Ganne-Carrié N, Nahon P. Hepatocellular carcinoma in the setting of alcohol-related liver disease. Journal of Hepatology. 2019 Feb;70(2):284–93. Available from: https://pubmed.ncbi.nlm.nih.gov/30658729
Cai P, Zheng H, She J, Feng N, Zou H, Gu J, et al. Molecular Mechanism of Aflatoxin-Induced Hepatocellular Carcinoma Derived from a Bioinformatics Analysis. Toxins [Internet]. 2020 Mar 23 [cited 2021 Nov 4];12(3):203. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150856/
Jophlin L, Singal AK, Ramón Bataller, Wong RJ, Sauer BG, Terrault NA, et al. ACG Clinical Guideline: Alcohol-Associated Liver Disease. The American Journal of Gastroenterology. 2023 Sep 1;119(1):30–54. Available from: https://pubmed.ncbi.nlm.nih.gov/38174913
Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nature Reviews Disease Primers [Internet]. 2021 Jan 21;7(1):1–28. Available from: https://www.nature.com/articles/s41572-020-00240-3
Khemlina G, Ikeda S, Kurzrock R. The biology of Hepatocellular carcinoma: implications for genomic and immune therapies. Molecular Cancer. 2017 Aug 30;16(1). Available from: https://pubmed.ncbi.nlm.nih.gov/28854942
Di Bisceglie AM. Epidemiology and Clinical Presentation of Hepatocellular Carcinoma. Journal of Vascular and Interventional Radiology. 2002 Sep;13(9):S169–71. Available from: https://pubmed.ncbi.nlm.nih.gov/12354833
Bucci L, Garuti F, Camelli V, Lenzi B, Farinati F, Giannini EG, et al. Comparison between alcohol- and hepatitis C virus-related hepatocellular carcinoma: clinical presentation, treatment and outcome. Alimentary Pharmacology & Therapeutics. 2015 Dec 14;43(3):385–99. Available from: https://pubmed.ncbi.nlm.nih.gov/26662476/
Benson AB, D’Angelica MI, Abbott DE, Anaya DA, Anders R, Are C, et al. Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2021 May;19(5):541–65. Available from: https://pubmed.ncbi.nlm.nih.gov/34030131
Liava C, Emmanouil Sinakos, Elissavet Papadopoulou, Lamprini Giannakopoulou, Stamatia Potsi, Anestis Moumtzouoglou, et al. Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview. 2022 Aug 28 [cited 2023 Jun 25];28(32):4540–56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476877/
Nadarevic T, Giljaca V, Colli A, Fraquelli M, Casazza G, Miletic D, et al. Computed tomography for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. The Cochrane Database of Systematic Reviews [Internet]. 2021 Oct 6;10:CD013362. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8493329/
Nadarevic T, Colli A, Giljaca V, Fraquelli M, Casazza G, Manzotti C, et al. Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database of Systematic Reviews. 2022 May 6;2022(5). Available from: https://pubmed.ncbi.nlm.nih.gov/35521901
Neha Jakhete, Majeed NA, Maluf D, Shetty K. The Role of Liver Transplantation in Hepatocellular Carcinoma. Clinics in Liver Disease [Internet]. 2024 Oct 30 [cited 2025 Mar 1];29(1):73–85. Available from: https://pubmed.ncbi.nlm.nih.gov/39608959
Niemeyer DJ, Simo KA, Iannitti DA, McKillop IH. Ablation therapy for hepatocellular carcinoma: past, present and future perspectives. Hepatic Oncology. 2014 Jan;1(1):67–79. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6114009/
Thornton LM, Abi-Jaoudeh N, Lim HJ, Malagari K, Spieler BO, Kudo M, et al. Combination and Optimal Sequencing of Systemic and Locoregional Therapies in Hepatocellular Carcinoma: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. Journal of vascular and interventional radiology : JVIR [Internet]. 2024 Jun;35(6):818–24. Available from: https://pubmed.ncbi.nlm.nih.gov/38789204
Berardi G, Guglielmo N, Alessandro Cucchetti, Usai S, Colasanti M, Meniconi RL, et al. Transarterial Radioembolization Can Downstage Intermediate and Advanced Hepatocellular Carcinoma to Liver Transplantation. Transplantation [Internet]. 2024 Sep 17 [cited 2025 Mar 1];109(1):e54–63. Available from: https://pubmed.ncbi.nlm.nih.gov/39285520
Dudzinski SO, Newman NB, McIntyre J, Engineer R, Sanford NN, Wo JY, et al. Emerging evidence-based role for external-beam radiation therapy in hepatocellular carcinoma. The Lancet Gastroenterology & hepatology [Internet]. 2025 Feb 1 [cited 2025 Mar 1]; Available from: https://pubmed.ncbi.nlm.nih.gov/39993402
Lei J, Yang S, Chen B, Zhang L, Yan T, Yang G, et al. Efficacy and Safety of Tyrosine Kinase Inhibitors Alone or Combination with Programmed Death-1 Inhibitors in Treating of Hepatitis C-Related Hepatocellular Carcinoma. Journal of Hepatocellular Carcinoma [Internet]. 2023 Mar 1 [cited 2024 Nov 26];Volume 10:357–67. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9987323/
Feng S, Xie X, Chen C, Zuo S, Zhao X, Li H. Alpha-linolenic acid inhibits hepatocellular carcinoma cell growth through Farnesoid X receptor/β-catenin signaling pathway. Nutrition & Metabolism [Internet]. 2022 Aug 23 [cited 2025 Mar 1];19(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35999582
Gestational diabetes mellitus (GDM) develops when the body cannot produce enough insulin to meet the extra demands of pregnancy, leading to higher blood glucose levels.
Women who are overweight or suffer from Polycystic Ovary Syndrome are at higher risk of developing GDM.
Many women with gestational diabetes don’t always experience symptoms. Every woman should be tested with the glucose challenge test between 24-28 weeks of pregnancy.
If your baby grows too large or if your blood glucose levels are not well-controlled, a cesarean section may be needed.
Women who have had gestational diabetes during pregnancy are at a higher risk of developing type 2 diabetes later on.
What is Gestational Diabetes?
Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy. It can develop at any time during pregnancy but is more common in the second or third trimester. This happens because your body can’t produce enough insulin, the hormone that controls blood glucose levels, to meet the increased needs of pregnancy. Gestational diabetes can cause issues for both you and your baby during and after pregnancy. [1–2]
Causes of Gestational Diabetes Mellitus
During pregnancy, the body naturally becomes more insulin-resistant to ensure the growing baby gets enough glucose. This resistance is mainly caused by hormones from the placenta, which block the action of insulin. Usually, the pancreas tries to compensate by making more insulin to keep blood glucose levels normal. However, in some women, the pancreas is not able to compensate enough, and as a result, they persistently have high blood glucose levels, leading to gestational diabetes. So, women with gestational diabetes have both higher insulin resistance and not enough insulin produced by the pancreas. [3-4]
Who is at Risk of Developing Gestational Diabetes Mellitus?
Gestational diabetes mellitus (GDM) is influenced by several important risk factors. Below are some of the main risk factors associated with GDM:
1. Obesity or overweight
Obesity is a significant risk factor for GDM, as excess fat causes insulin resistance. A pre-pregnancy body mass index (BMI) of 30 kg/m² or higher significantly increases the risk of GDM, especially if you’re not physically active. [5]
2. Advanced Maternal Age
If you are 30 years or older, you’re susceptible to high blood glucose levels during pregnancy. With age, the sensitivity of insulin decreases, and the function of the pancreas also gets affected, because of which older women are more likely to get GDM. [6]
3. Family History of Diabetes
A family history of diabetes further increases the risk of GDM due to genetic factors that affect insulin production and secretion. About 30% of women with GDM have been found to have at least one parent with type II diabetes. [7]
4. Previous History of GDM
If you had gestational diabetes in a past pregnancy, there’s a higher chance it will happen again. This means your body may have difficulty managing glucose levels during pregnancy. [8]
5. Previously Given Birth To a Large Baby
If you had a baby weighing more than 9 pounds (4 kg) before, there is an increased risk of gestational diabetes in future pregnancies. [9]
6. Ethnic Background
Ethnic groups, like South Asian, Black Caribbean, and Middle Eastern women, have a higher prevalence of GDM. This has been associated with various factors like genetics, body composition, and gestational weight gain, which differ among different ethnic groups. [10]
Symptoms of Gestational Diabetes
Gestational diabetes often doesn’t cause noticeable symptoms. Some of the symptoms you might notice are:
1. Frequent Urination
You may find yourself going to the bathroom more often. While frequent urination is common in pregnancy, it can be worse if your blood glucose is too high because your kidneys are trying to flush out the extra glucose. [11]
2. Unusual Thirst
You might feel thirsty more often than usual, even if you drink enough water. This happens because high blood glucose levels make your body lose more fluids. [11]
3. Fatigue
Whether it’s high blood glucose, insulin resistance, dehydration, problems producing energy, changes in the way blood flows, or hormonal imbalances, the way an individual feels flat-out tired is one of the common signs of diabetes. [12]
4. Blurred vision
If you have GDM, you might notice your vision getting slightly blurry. This happens because high blood glucose levels can shift the fluid balance in your eyes, temporarily changing their shape and making it harder to focus. [13]
Diagnosis of Gestational Diabetes Mellitus
Gestational diabetes is usually diagnosed using a glucose screening test:
1. Glucose Challenge Test
The GCT is a simple routine test to check if you have GDM. This test is usually done between 24 to 28 weeks of pregnancy. In this test, you will drink a sweet liquid with 50 grams of glucose and wait one hour before a blood test. You don’t need to fast before the test. If your blood glucose is below 140 mg/dL, it’s normal. If it’s 140 mg/dL or higher, you may need another test called the glucose tolerance test for confirmation. Since gestational diabetes has no apparent symptoms, this test helps find it early to keep you and your baby healthy. [14]
2. Oral Glucose Tolerance Test
This test confirms gestational diabetes if your GCT shows abnormal results. You will need to fast overnight before the test. First, a fasting blood sample is taken. Then, you will drink a sweet liquid with 75 or 100 grams of glucose, and your blood will be tested every hour for up to three hours. If your blood glucose is higher than normal at multiple time points, it means you have gestational diabetes. The test is usually done between 24 to 28 weeks of pregnancy if your GCT results are high, but if you have a higher risk of gestational diabetes, your doctor may recommend doing it earlier in pregnancy and possibly repeating it later if needed. [15]
Treatment of Gestational Diabetes Mellitus
The goal of treatment for GDM is to keep your blood glucose levels within the target range without affecting the baby and you.
Lifestyle changes
Healthy Eating: With the right food choices, portion control, and meal timing, you can maintain your blood glucose levels within the desired range. You should go for a balanced diet with whole grains, vegetables, fruits, lean proteins, and healthy fats while avoiding sugary foods and drinks. If you’re not eating enough or if your blood glucose levels are too high, your body may produce ketones. Ketones in your urine or blood indicate that your body is using fat for energy instead of glucose, which can harm both your and your baby’s health. So, you need to eat the right food and in the right amount. [16]
Regular Exercise: Physical activity can help reduce insulin resistance and control blood glucose levels. However, exercise should always begin with a consultation with your doctor, as you may have other conditions that limit exercise during pregnancy. Your doctor may suggest gentle exercises like walking, swimming, or yoga to keep you active. [16]
Glucose Monitoring: Regular glucose monitoring is an important part of managing It helps keep your blood glucose levels stable and reduces risks for you and your baby. Your doctor will ask you to check your blood glucose multiple times daily using a glucometer, a small device that measures glucose levels from a finger-prick blood sample. Typically, you will test before meals and one or two hours after eating. Recording your blood gulose readings helps doctors adjust your diet, exercise, or medications. [17–18]
Medications: If diet and exercise aren’t enough, you might need insulin injections or oral medications to help control your blood glucose.
Insulin: If your pancreas cannot produce as much insulin as is required to keep your blood glucose under control. You might need to take it as an injection. It is given as an injection under the skin, usually before meals or bedtime, depending on blood glucose levels. Your doctor will decide the dose and type of insulin based on your glucose readings. And learning how to inject insulin properly and monitor blood glucose levels is equally important in treatment. Regarding safety, insulin is safe during pregnancy and does not harm your baby. [19]
Oral medications: Sometimes, doctors may prescribe oral medications instead of insulin to control gestational diabetes. The two most common medications are metformin and glyburide. Metformin helps lower blood glucose by improving insulin sensitivity and reducing glucose production in the liver. Glyburide stimulates the pancreas to release more insulin. Metformin is preferred among these two due to its better safety profile and effectiveness, similar to insulin. While both are effective, insulin is preferred as these oral medications cross the placenta in small amounts, needing monitoring for their effects on both the mother and baby. [20]
Complications of Gestational Diabetes
GDM can cause various problems for you and your baby.
Complications in the Mother: If blood glucose levels are not well controlled, it increases the risk of high blood pressure, pre-eclampsia (a serious pregnancy condition with high blood pressure and organ damage), and infections like urinary tract or vaginal infections. There is also a higher likelihood of needing a cesarean section due to excessive fetal growth, which can make vaginal delivery more difficult. Also, women with GDM are at a higher risk of developing type 2 diabetes later in life, even after the pregnancy ends. [21]
Complications in Babies: The most common issue of GDM in babies is excessive growth, as high blood glucose levels cause the baby to store extra fat. This can cause difficult delivery, shoulder dystocia (when the baby’s shoulder gets stuck during delivery), and the need for a C-section. Babies born to mothers with GDM are also at higher risk for low blood glucose shortly after birth, as their bodies produce extra insulin to cope with the high glucose levels in the womb. Other potential risks include respiratory problems, jaundice, and an increased chance of developing obesity or type 2 diabetes later in life. [21]
Choosing the Right Delivery Method for Women with Gestational Diabetes
The choice of delivery method for women with GDM depends on various factors, including blood glucose control, baby size, and overall pregnancy health. If your blood glucose levels are well managed, a vaginal delivery may be possible. However, suppose the baby is large due to excessive glucose in the bloodstream. In that case, a cesarean section may be recommended to reduce the risk of complications like shoulder dystocia or difficult delivery. Women with poorly controlled blood glucose or other complications may also require a C-section. Additionally, factors like high blood pressure, pre-eclampsia, and the baby’s well-being may influence the decision. Close monitoring of blood glucose levels and regular prenatal visits help determine the safest delivery method for both the mother and baby. [22]
1. Antihistamines
Since it is one of the most common symptoms of auto dermatitis, antihistamines are often recommended. They work by blocking histamine, a substance released by your immune system during an allergic reaction, which can cause itching. These can be helpful, especially at night, as they may also have a sedative effect to help with sleep when itching is severe. [17]
2. Phototherapy
Phototherapy (or light therapy) involves exposing the skin to controlled amounts of ultraviolet (UV) light under medical supervision. This treatment can help reduce inflammation and improve symptoms, particularly in severe cases of atopic dermatitis that don’t respond to topical treatments. It’s commonly used in cases where the condition is widespread and persistent. [18]
3. Antibiotics
Antibiotics are not needed for dermatitis, but with the cracks in the skin because of atopic dermatitis, there is a very high chance of infection. Atopic dermatitis is commonly associated with infections caused by Staphylococcus aureus. Managing these infections can help prevent the condition from worsening. [19]
4. Lifestyle Changes
Making lifestyle adjustments is crucial in managing atopic dermatitis. This includes avoiding known triggers like harsh soaps, certain fabrics (such as wool), and hot water. Using gentle, fragrance-free skin care products and wearing soft, breathable clothes can also help minimize irritation. Additionally, managing stress through relaxation techniques like meditation or yoga can prevent flare-ups since stress is a known trigger. [20]
Risk of Developing Diabetes after Gestational Diabetes
Women who have had GDM are at a higher risk of developing type 2 diabetes later in life. Even though blood glucose levels usually return to normal after pregnancy, the risk remains elevated. Studies show that women with GDM are about 7 times more likely to develop type 2 diabetes compared to those who didn’t have GDM. The risk is higher if they have poor blood glucose control during pregnancy, are overweight, or have a family history of diabetes. It’s important for women who have had GDM to continue monitoring their blood glucose levels and maintain a healthy lifestyle to reduce the risk of developing type 2 diabetes in the future. [23]
Postpartum Glucose Monitoring for Women with Gestational Diabetes: Timing and Importance
The American Diabetes Association recommends having a glucose test (usually a 2-hour OGTT) at 4 to 12 weeks postpartum to assess if diabetes persists. Follow-up tests should be done at least every 1 to 3 years to monitor for any changes in glucose metabolism. The idea is to check your blood glucose even after the pregnancy and even if your blood glucose levels return to normal because of the increased risk. [24–25]
Gestational Diabetes and Polycystic Ovarian Syndrome
If you have polycystic ovarian syndrome (PCOS), you’re more likely to develop GDM than someone without it because of the similarity they share. Women with PCOS like GDM have insulin resistance, where the body has difficulty using insulin properly, increasing blood glucose levels. This insulin resistance can make it more difficult for women with PCOS to control their blood glucose during pregnancy, leading to a higher risk of GDM. Because of this higher risk, women with PCOS need to be watched closely for GDM during pregnancy. [26]
Questions to Ask Your Doctor
Is it possible to manage gestational diabetes without medication?
How long will I need to continue taking medication for gestational diabetes?
What should I do if I forget to take my insulin shot?
What should I do if my blood glucose is too high or too low?
Could gestational diabetes of this pregnancy affect my future children in any way?
References
American Diabetes Association. Standards of Medical Care in Diabetes–2008. Diabetes Care. 2007 Dec 28;31(Supplement 1):S12–54.Available from: https://pubmed.ncbi.nlm.nih.gov/18165335/
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care [Internet]. 2010 Dec 30;33(Supplement_1):S62–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/
Baz B, Riveline JP, Gautier JF. ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects. European Journal of Endocrinology. 2016 Feb;174(2):R43–51. https://pubmed.ncbi.nlm.nih.gov/26431552/
Usman TO, Goma Chhetri, Yeh H, H. Henry Dong. Beta-Cell Compensation and Gestational Diabetes. Journal of Biological Chemistry. 2023 Dec 1;299(12):105405–5. Available from: https://pubmed.ncbi.nlm.nih.gov/38229396/
Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, et al. Diabetes and Pregnancy. Canadian Journal of Diabetes. 2013 Apr;37:S168–83. Available from: https://pubmed.ncbi.nlm.nih.gov/24070943/
Thornton JM, Shah NM, Lillycrop KA, Cui W, Johnson MR, Singh N. Multigenerational diabetes mellitus. Frontiers in Endocrinology [Internet]. 2023 [cited 2024 Mar 19];14:1245899. Available from: https://pubmed.ncbi.nlm.nih.gov/38288471/
Zhang Y, Xiao CM, Zhang Y, Chen Q, Zhang XQ, Li XF, et al. Factors Associated with Gestational Diabetes Mellitus: A Meta-Analysis. Journal of Diabetes Research [Internet]. 2021 May 10 [cited 2022 Jan 3];2021:e6692695. Available from: https://www.hindawi.com/journals/jdr/2021/6692695/
Rottenstreich M, Rotem R, Reichman O, Farkash R, Rottenstreich A, Samueloff A, et al. Previous non-diabetic pregnancy with a macrosomic infant – Is it a risk factor for subsequent gestational diabetes mellitus? Diabetes Research and Clinical Practice. 2020 Oct;168:108364.Available from: https://pubmed.ncbi.nlm.nih.gov/32791161
Yuen L, Wong V, Jincy Immanuel, Hague WM, Cheung NW, Teede H, et al. Ethnic Differences in Characteristics of Women Diagnosed with Early Gestational Diabetes: Findings from the TOBOGM Study. The Journal of Clinical Endocrinology & Metabolism. 2024 Dec 6; Available from: https://pubmed.ncbi.nlm.nih.gov/39657254
Sobrevia L, Valero P, Grismaldo A, Villalobos-Labra R, Pardo F, Subiabre M, et al. Mitochondrial dysfunction in the fetoplacental unit in gestational diabetes mellitus. Biochimica et Biophysica Acta (BBA) – Molecular Basis of Disease [Internet]. 2020 Dec 1 [cited 2020 Nov 28];1866(12):165948. Available from: https://pubmed.ncbi.nlm.nih.gov/32866635/
Pota ÇE, Doğan ME, Bülbül GA, Sanhal CY, Pota A. Optical Coherence Tomography Angiography Evaluation of Retinochoroidal Microvascular Circulation Differences in Pregnant Women with Pregestational and Gestational Diabetes Mellitus. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association [Internet]. 2024 Jun 6 [cited 2024 Jun 11]; Available from: https://pubmed.ncbi.nlm.nih.gov/38843821
Sacks DB, Arnold MA, Bakris GL, Bruns DE, Horvath AR, Åke Lernmark, et al. Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023 Jul 20;46(10):1740–6. Available from: https://pubmed.ncbi.nlm.nih.gov/37471272
Oskovi-Kaplan ZA, Ozgu-Erdinc AS. Management of Gestational Diabetes Mellitus. Advances in Experimental Medicine and Biology [Internet]. 2021;1307:257–72. Available from: https://pubmed.ncbi.nlm.nih.gov/32548833
American Diabetes Association. Gestational Diabetes Mellitus. Diabetes Care. 2003 Dec 23;27(Supplement 1):S88–90. Available from: https://pubmed.ncbi.nlm.nih.gov/14693936/
Valent AM, Barbour LA. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics and Gynecology. 2024 Jun 13; Available from: https://pubmed.ncbi.nlm.nih.gov/38870526
Bergel R, Hadar E, Toledano Y, Hod M. Pharmacological Management of Gestational Diabetes Mellitus. Current Diabetes Reports. 2016 Oct 17;16(11). Available from: https://pubmed.ncbi.nlm.nih.gov/27752931/
Oros Ruiz M, Perejón López D, Serna Arnaiz C, Siscart Viladegut J, Àngel Baldó J, Sol J. Maternal and foetal complications of pregestational and gestational diabetes: a descriptive, retrospective cohort study. Scientific Reports [Internet]. 2024 Apr 19 [cited 2024 May 12];14(1):9017. Available from: https://www.nature.com/articles/s41598-024-59465-x
Will JS, Crellin H. Gestational Diabetes Mellitus: Update on Screening, Diagnosis, and Management. American Family Physician [Internet]. 2023 Sep 1;108(3):249–58. Available from: https://pubmed.ncbi.nlm.nih.gov/37725457
Lo JC, Yang J, Gunderson EP, Hararah MK, Gonzalez JR, Ferrara A. Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women with Polycystic Ovary Syndrome. Journal of Diabetes Research. 2017;2017:1–5. Available from: https://pubmed.ncbi.nlm.nih.gov/29423416/
Sacks DB, Arnold MA, Bakris GL, Bruns DE, Horvath AR, Åke Lernmark, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care [Internet]. 2023 Jul 20;46(10):e151–99. Available from: https://pubmed.ncbi.nlm.nih.gov/37471273
Pan ML, Chen LR, Tsao HM, Chen KH. Relationship between Polycystic Ovarian Syndrome and Subsequent Gestational Diabetes Mellitus: A Nationwide Population-Based Study. Wolfe A, editor. PLOS ONE. 2015 Oct 21;10(10):e0140544. https://pubmed.ncbi.nlm.nih.gov/26488176/
Okoshi C, Kyozuka H, Fukuda T, Yasuda S, Murata T, Isogami H, et al. Risk of gestational diabetes in women with PCOS based on body mass index: The Japan Environment and Children’s Study. The Journal of Clinical Endocrinology and Metabolism [Internet]. 2024 May 4 [cited 2024 Jun 12];dgae293. Available from: https://pubmed.ncbi.nlm.nih.gov/38703083
Have you ever wondered what would happen if we didn’t sleep? Imagine a life without enough sleep. Sounds tempting, right?
You’d have so much more time to pursue your passions, tackle projects, and explore the world. But here’s what you do not know: the consequences are far from inspiring.
First, let’s talk about cognitive function. Without sleep, our ability to concentrate and make decisions is affected. Remember that important meeting or exam you prepared for? The lack of sleep can leave you struggling to focus and retain information. It’s not just about productivity. Hold on! There’s more. Our immune system is weakened when we don’t sleep, making us more prone to infections and illnesses. And the physical consequences are alarming, too. Lack of sleep increases your risk of obesity, diabetes, cardiovascular problems, and more. Quality sleep is important for good cognitive ability, creativity, and physical well-being. So, sleep tight, and have sweet dreams.
Iron deficiency anemia occurs when your body lacks enough iron to produce healthy red blood cells.
Women of childbearing age, pregnant women, young children, and people with chronic health conditions are at higher risk for iron deficiency anemia.
Iron deficiency anemia can cause depression, anxiety, and difficulty concentrating, particularly in adolescents.
People with iron deficiency anemia, especially children and pregnant women, may develop pica, a condition where they crave non-food items like dirt or ice.
Iron deficiency anemia is typically treated with a diet rich in iron, iron supplements, or, in some cases, iron infusions or blood transfusions.
What is Iron Deficiency Anemia?
Iron deficiency anemia (IDA) is an anemia where your body doesn’t have enough iron to make healthy red blood cells. This is the most common form of anemia, affecting almost 30% of people worldwide, making it a major public health issue. [1]
IDA develops when you lack enough iron in your body, which is required to form hemoglobin, a part of red blood cells. Hemoglobin carries oxygen and removes carbon dioxide from the body. Therefore, a lack of iron in the body affects the proper functioning of your overall body as it does not get enough oxygen to work with. [2]
Causes of Iron Deficiency Anemia
IDA usually occurs when there is a lack of iron in the diet, a loss of iron, or a problem with iron absorption in the body.
1. Low Iron Diet
Your body gets iron from the food you eat. If your diet doesn’t have enough iron-rich foods, your iron levels can drop over time. This is common if you eat mostly plant-based foods, avoid meat or poultry, or follow a restrictive diet such as a vegan or vegetarian diet without proper substitutes. The recommended daily dietary intake of iron is around 8 mg for an adult male and 18 mg for an adult female. However, only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. [3-4]
2. Blood Loss
Iron is lost when you lose blood. If you lose more iron than your body can replace, you can develop IDA. Common causes of blood loss include gastrointestinal (GI) bleeding, urinary tract bleeding, heavy menstrual bleeding, traumatic injury, and surgeries, etc. People who regularly use aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) are prone to GI bleeding, leading to anemia. [5]
3. Absorption Difficulty
Even if you eat enough iron, sometimes your body might not be able to absorb it well. This means that you could be getting enough iron from your diet, but it isn’t reaching your bloodstream to be used by your cells. This could be because of conditions like celiac disease, Crohn’s disease, or ulcers, as they can damage the lining of your intestine, making it harder for you to absorb iron from food. Other such conditions can be surgical procedures. [6]
4. Other Causes
Other less common causes of IDA include chronic kidney diseases (CKD), cancer such as Hodgkin’s lymphoma, bone marrow disorders, intravascular hemolysis, heart failure, parasitic infections like hookworm, long-term illnesses such as HIV/AIDS, hepatitis B and C, obesity, etc. These conditions may directly or indirectly affect your body’s ability to produce red blood cells from the body, leading to anemia. [7-8]
Who is at Risk for Iron Deficiency Anemia?
Certain people are at increased risk of developing iron-deficiency anemia. People at higher risk for iron-deficiency anemia include:
IDA can cause several symptoms because your body isn’t getting enough oxygen due to low iron levels. The symptoms, however, may be very mild in the beginning and later become worse. One of the most common signs is extreme fatigue and weakness. You may feel unusually tired, even after enough rest, or have trouble completing daily tasks. This happens because your red blood cells, which carry oxygen, are reduced in number and unable to do their job efficiently, leaving you feeling drained and low on energy. [10]
Other symptoms of IDA include pale or yellowish skin, shortness of breath, and dizziness. [11] As your iron levels drop, your skin might appear paler than usual, and you may notice you feel winded or out of breath after activities that wouldn’t usually tire you out. Some people also experience headaches, cold hands or feet, increased heart rate, and a taste for unusual stuff like ice, wood, and soil, a condition called pica. [12]
Diagnosis of Iron Deficiency Anemia
The most common tests for diagnosing IDA are:
1. Complete Blood Count (CBC)
This test measures the number of red blood cells in your blood. In IDA, your red blood cell count, hemoglobin, and hematocrit (the percentage of blood made up of red blood cells) will be lower than normal. [13]
2. Iron Studies
Iron studies are a group of blood tests used to assess the amount of iron in your body and how well it uses and stores it. Common tests in iron studies include the serum iron test, which measures the level of iron circulating in your blood, and the serum ferritin test, which shows how much iron is stored in your body. The Total Iron-Binding Capacity (TIBC) test also measures how much transferrin (the protein that carries iron) can bind with iron. These iron studies help your doctor determine whether you have an iron deficiency, its severity, and any underlying causes for the imbalance. [14]
3. Peripheral Smear Examination
A peripheral smear examination is a laboratory test where a blood sample is spread on a microscope slide and examined for abnormalities in the shape, size, and number of blood cells. In IDA, the peripheral smear may show microcytic (smaller-than-normal) red blood cells that are also hypochromic (pale due to less hemoglobin). This examination helps identify the characteristics of your red blood cells. It can reveal clues about the underlying cause of anemia, such as whether it’s due to iron deficiency, a chronic disease, or another condition. [6]
4. Bone Marrow Aspiration and/or Biopsy
Bone marrow aspiration and biopsy are procedures used to collect a small sample of bone marrow to check for abnormalities in blood cell production. In cases of IDA, these tests can show reduced iron stores in the marrow, confirming the lack of sufficient iron for red blood cell production. While it is not typically the first test for diagnosing IDA, bone marrow examination is helpful in complex cases or when other underlying conditions, such as bone marrow disorders, must be ruled out. These procedures help provide a clearer picture of the cause of anemia when standard tests are inconclusive. [15]
5. Endoscopy
Endoscopy is a procedure used to check for hidden causes of IDA, especially when internal bleeding is suspected. It helps your doctor to look inside your digestive tract to find problems like stomach ulcers, inflammation, or bleeding in the intestines. There are two main types: upper endoscopy, where a small camera is passed through your mouth to check your stomach and upper intestines, and colonoscopy, where a camera is inserted through the rectum to examine the colon. Endoscopy is usually recommended if your anemia is unexplained or if your doctor suspects slow, long-term blood loss from your digestive system. [6]
Treatment of Iron Deficiency Anemia
The treatment of IDA focuses on restoring iron levels and addressing the underlying cause of the deficiency. The main approaches include:
1. Iron-rich Diet
Eating foods high in iron helps replenish your body’s iron stores. Good sources include red meat, poultry, fish, leafy green vegetables (like spinach), beans, lentils, nuts, and iron-fortified cereals. Pairing these with vitamin C-rich foods (like citrus fruits or tomatoes) helps improve iron absorption. [14]
2. Oral Iron Supplements
If diet alone is insufficient, you might need oral iron supplements (such as ferrous sulfate, ferrous fumarate, or ferrous gluconate). These are usually taken on an empty stomach with vitamin C for better absorption. But they come with side effects like constipation, nausea, or stomach upset. Because of these side effects, alternate-day dosing has been suggested if someone is not tolerating iron supplements. Alternate-day dosing was found to have greater efficacy with iron absorption and hemoglobin improvement. [16]
3. Intravenous (IV) Iron
If you cannot tolerate oral iron, you have absorption issues and severe anemia, and iron injections might be recommended. It helps to replenish iron absorption quickly. However, it is more costly than oral iron and has a small risk of allergic reactions. [17]
4. Blood Transfusions
The American Society of Hematology recommends transfusing blood only for those with severe and symptomatic anemia who cannot maintain blood pressure. This means it is reserved for a severe case only. [14]
5. Erythropoiesis-Stimulating Agent (ESA)
ESAs are sometimes used to treat IDA, especially in patients with CKD, cancer, or other conditions that affect red blood cell production. ESAs, such as erythropoietin and darbepoetin alfa, help stimulate the bone marrow to produce more red blood cells, reducing the need for blood transfusions. However, ESAs are usually given alongside iron supplements because the body needs enough iron to support increased red blood cell production. These medications are typically used in cases where anemia is severe, persistent, or not improving with iron therapy alone. [18]
Complications of Iron Deficiency Anemia
Milder cases of IDA have no complications. But when left untreated, iron-deficiency anemia can cause severe complications such as:
1. Heart Failure
When iron levels are low, your heart has to work harder to pump oxygen-poor blood. Over time, this extra stress can cause irregular heartbeats, an enlarged heart, or even heart failure in severe cases. If you already have a heart condition, you are at a higher risk of complications of IDA. [19]
2. Complications in Pregnant Women
Pregnant women need extra iron to support the baby’s growth. If IDA is left untreated during pregnancy, it increases the risk of premature birth, low birth weight, and developmental problems in the baby. It can cause complications during delivery and increase the risk of postpartum depression in mothers. [20–21]
3. Complications in Infants and Children
Iron is essential for brain development in children. If a child has untreated IDA, they may have slower growth, learning difficulties, and problems with memory or concentration. This can affect their school performance and overall development. [20]
Prevention of Iron Deficiency Anemia
You can prevent IDA by ensuring you get enough iron in your diet. Eating iron-rich foods and pairing them with vitamin C helps your body absorb iron better. At the same time, try to limit tea and coffee during meals since they can block iron absorption. Parasitic infections, like hookworms, can cause blood loss and lead to anemia, so maintaining good hygiene, drinking clean water, and deworming treatments can help. Some foods are fortified with iron to ensure people get enough from their diet. Regular check-ups, treating any health issues that cause blood loss, and taking iron supplements if needed are good ways to keep your iron levels healthy and prevent anemia. [22]
Screening for Iron Deficiency Anemia in Pregnancy
Screening for IDA in pregnancy is important to ensure the health of both the mother and the baby. Pregnant women are at higher risk for IDA due to increased iron requirements to support the growing fetus and the expanded blood volume. Routine screening typically involves blood tests such as hemoglobin level and serum ferritin to assess iron stores. Screening for IDA is generally done during the first prenatal visit and again around the 24th to 28th week of pregnancy. Early detection allows timely treatment with iron supplements or dietary changes to prevent complications. Pregnant women, particularly those with a history of heavy menstrual periods or poor nutritional intake, should be regularly monitored throughout their pregnancy to ensure they maintain adequate iron levels. [23]
Iron Deficiency Anemia and Depression in Adolescents
Adolescents with IDA are likely to experience depression and anxiety. Studies have shown a clear link between low iron levels and mental health problems, as iron is essential for brain function and the production of mood-regulating chemicals like serotonin and dopamine. [24] When iron levels drop, the brain may not function properly, leading to feelings of sadness, fatigue, and difficulty concentrating. [11] Research also suggests that adolescents, especially those from multiracial backgrounds, may have higher rates of depression and anxiety if they have IDA. Since teenagers are already going through many physical and emotional changes, untreated iron deficiency can make these struggles even worse. [24]
Pica and Iron Deficiency Anemia
Pica is a condition where people crave and eat non-food items like dirt, ice, or chalk, and it often occurs in individuals with IDA. While IDA is the most common cause, pica can also occur due to other nutritional deficiencies, such as zinc or calcium. In some cases, pica may be linked to mental health disorders like obsessive-compulsive disorder or schizophrenia. It can also be seen in pregnancy, where cravings for non-food items like ice (a form of pica called pagophagia) are relatively common. The exact reason this happens is unclear, but it’s believed the body may crave these non-food items to cope with nutrient deficiencies. People with IDA may experience pica as a response to low iron levels, which can lead to further complications if left untreated. [12]
Questions To Ask Your Doctor
How do I know if I’m getting enough iron from my diet, or should I take supplements?
How long will it take for me to feel better after starting iron treatment?
Are there any foods, drinks, or medication I should avoid when taking iron supplements?
Can stress or lack of sleep make my anemia worse?
Will I need regular blood tests?
References
Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron Deficiency anemia: Pathophysiology, assessment, Practical Management. BMJ Open Gastroenterology. 2022 Jan 7;9(1):1–9. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8744124/
Moisidis-Tesch CM, Shulman LP. Iron Deficiency in Women’s Health: New Insights into Diagnosis and Treatment. Advances in Therapy. 2022 Apr 30; Available from: https://pubmed.ncbi.nlm.nih.gov/35488139
MF;Yano R. Anemia in Infants and Children: Evaluation and Treatment. American family physician [Internet]. 2024 [cited 2025 Mar 23];110(6). Available from: https://pubmed.ncbi.nlm.nih.gov/39700365
Siu AL. Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine [Internet]. 2015 Oct 6 [cited 2020 Jan 3];163(7):529. Available from: https://pubmed.ncbi.nlm.nih.gov/26344176
Petraglia F, Dolmans MM. Iron deficiency anemia: Impact on women’s reproductive health. Fertility and Sterility. 2022 Oct;118(4):605–6. Available from: https://pubmed.ncbi.nlm.nih.gov/36182259
Ko CW, Siddique SM, Patel A, Harris A, Sultan S, Altayar O, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020 Sep;159(3):1085–94. Available from: https://pubmed.ncbi.nlm.nih.gov/32810434
Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron Deficiency anaemia: Pathophysiology, assessment, Practical Management. BMJ Open Gastroenterology. 2022 Jan 7;9(1):1–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34996762/
Yasmeen T, Ali J, Khan K, Siddiqui N. Frequency and causes of anemia in Lymphoma patients. Pakistan Journal of Medical Sciences. 2018 Dec 22;35(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30881397/
Cohen CT, Powers JM. Nutritional strategies for managing iron deficiency in adolescents: Approaches to a challenging but common problem. Advances in Nutrition [Internet]. 2024 Mar 29;15(5):100215. Available from: https://pubmed.ncbi.nlm.nih.gov/38556251
Weckmann G, Kiel S, Chenot JF, Angelow A. Association of Anemia with Clinical Symptoms Commonly Attributed to Anemia—Analysis of Two Population-Based Cohorts. Journal of Clinical Medicine [Internet]. 2023 Jan 24;12(3):921. Available from: https://pubmed.ncbi.nlm.nih.gov/36769569
Manckoundia P, Konaté A, Hacquin A, Nuss V, Mihai AM, Vovelle J, et al. Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment. Clinical Interventions in Aging [Internet]. 2020 Oct 7 [cited 2022 Dec 23];15:1927–38. Available from: https://pubmed.ncbi.nlm.nih.gov/33116447
Auerbach M, Adamson JW. How We Diagnose and Treat Iron Deficiency Anemia. American Journal of Hematology [Internet]. 2015 Nov 17;91(1):31–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26408108
Marah Alzubi, Hisham Bawaneh, Alaa Al-Shorman, Jawad Alrawabdeh, Odeh N, Yazan Hamadneh, et al. Defining an optimal cut-off point for reticulocyte hemoglobin as a marker for iron deficiency anemia: An ROC analysis. PLOS ONE. 2023 Jul 13;18(7):e0288505–5. Available from: https://pubmed.ncbi.nlm.nih.gov/37440537
DeLoughery TG, Jackson CS, Ko CW, Rockey DC. AGA clinical practice update on management of iron deficiency anemia: Expert review. Clinical Gastroenterology and Hepatology. 2024 Jun 1;22(8). Available from: https://pubmed.ncbi.nlm.nih.gov/38864796
Stoffel NU, Cercamondi CI, Brittenham G, Zeder C, Geurts-Moespot AJ, Swinkels DW, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. The Lancet Haematology. 2017 Nov;4(11):e524–33. Available from: https://pubmed.ncbi.nlm.nih.gov/29032957
Nicholson L, Axon E, Jahnavi Daru, Ewelina Rogozińska. Effect and safety of intravenous iron compared to oral iron for treatment of iron deficiency anaemia in pregnancy. Cochrane library. 2024 Dec 9;2024(12). Available from: https://pubmed.ncbi.nlm.nih.gov/39651609
Batchelor EK, Kapitsinou P, Pergola PE, Kovesdy CP, Jalal DI. Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment. Journal of the American Society of Nephrology. 2020 Feb 10;31(3):456–68. Available from: https://pubmed.ncbi.nlm.nih.gov/32041774/
Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Heart Failure. 2020 Jun 30;7(5):2007–11. Available from: https://pubmed.ncbi.nlm.nih.gov/32602663/
Saudatu Faruk, Kamaldeen Olalekan Sanusi, Kasimu Ghandi Ibrahim, Abubakar B, Ibrahim Malami, Muhammad Bashir Bello, et al. Age and sex-based impacts of maternal iron deficiency on offspring’s cognitive function and anemia: A systematic review. European Journal of Clinical Nutrition. 2024 Feb 29; Available from: https://pubmed.ncbi.nlm.nih.gov/38424158
Pai RD, Chong YS, Clemente-Chua LR, Irwinda R, Huynh TNK, Wibowo N, et al. Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus. Nutrients [Internet]. 2023 Jan 1;15(14):3125. Available from: https://pubmed.ncbi.nlm.nih.gov/37513543/
Siu AL. Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine [Internet]. 2015 Oct 6;163(7):529. Available from: https://pubmed.ncbi.nlm.nih.gov/26344176
Fiani D, Engler S, Ni Y, Fields S, Calarge C. Iron Deficiency and Internalizing Symptoms Among Adolescents in the National Health and Nutrition Examination Survey. Nutrients [Internet]. 2024;16(21):3643. Available from: https://pubmed.ncbi.nlm.nih.gov/39519476/
