From the Guidelines
Postural anemia is not a recognized medical term, however, a condition that is often referred to in a similar context is orthostatic hypotension, which occurs when a person experiences a sudden drop in blood pressure upon standing up from a sitting or lying position. This condition causes temporary symptoms like lightheadedness, dizziness, blurred vision, and sometimes fainting due to reduced blood flow to the brain. It happens because when we stand up, gravity pulls blood downward into the legs, and normally our body compensates by constricting blood vessels and increasing heart rate. In orthostatic hypotension, this compensatory mechanism fails or responds too slowly. Common causes include dehydration, prolonged bed rest, certain medications (especially blood pressure medications, antidepressants, and diuretics), neurological disorders, heart problems, and aging. Management typically involves simple measures like standing up slowly, staying hydrated, avoiding alcohol, wearing compression stockings, increasing salt intake (if appropriate), and in some cases, medications like fludrocortisone or midodrine may be prescribed to raise blood pressure, as noted in studies such as 1. Elderly individuals are particularly susceptible to this condition due to age-related changes in blood pressure regulation. The definition and management of orthostatic hypotension have been outlined in various guidelines, including those from the American College of Cardiology, American Heart Association, and Heart Rhythm Society, as seen in 1 and 1. It's essential to note that while the term "postural anemia" is not used in medical literature, orthostatic hypotension is a well-defined condition that requires proper diagnosis and management to prevent complications and improve quality of life, as discussed in 1.
Key Points
- Orthostatic hypotension is a condition characterized by a sudden drop in blood pressure upon standing
- Common causes include dehydration, prolonged bed rest, and certain medications
- Management involves simple measures like standing up slowly and staying hydrated, as well as medications like fludrocortisone or midodrine in some cases
- Elderly individuals are particularly susceptible to this condition due to age-related changes in blood pressure regulation
- Proper diagnosis and management are essential to prevent complications and improve quality of life, as noted in studies such as 1, 1, and 1.
Management and Treatment
- Non-pharmacological measures, such as gradual staged movements and increased fluid and salt intake, are often the first line of treatment
- Medications like midodrine and fludrocortisone may be prescribed to raise blood pressure in some cases, as discussed in 1
- It's crucial to weigh the potential risks and benefits of each treatment option and individualize care for each patient.
From the Research
Definition of Postural Anemia
- Postural anemia, also known as postural pseudoanemia, refers to a condition where changes in posture lead to substantial changes in hematocrit (Hct) levels 2.
- This condition is characterized by a decrease in plasma volume (PV) and an increase in Hct when changing from a lying to a standing position.
- The absolute increase in Hct can be mistakenly attributed to blood loss or acute anemia, resulting in unnecessary diagnostic costs.
Causes and Effects
- Postural pseudoanemia is a normal physiological response to a change in position from standing to lying (and vice versa) 2.
- Iron deficiency anemia, on the other hand, is a condition characterized by low hemoglobin levels due to low iron stores, and can cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating 3.
- Postural control disorders have been observed in young women with iron deficiency anemia, which may be related to fatigue, muscle weakness, and cognitive and neurological functions alteration 4.
Diagnosis and Treatment
- Testing for iron deficiency is indicated for patients with anemia and/or symptoms of iron deficiency, and should be considered for those with risk factors such as heavy menstrual bleeding, pregnancy, or inflammatory bowel disease 3.
- Oral iron supplementation has been shown to improve postural control in young women with iron deficiency anemia 5.
- Physical examination can be used to assess for anemia and hypovolemia, with indicators including supine or postural hypotension, increase in heart rate, and decrease in central venous pressure 6.