The reduction of hemoglobin (Hb) or hematocrit (Ht) levels should always be always associated with an etiological diagnosis to establish the triggering cause of anemia and its outcome over time.
A fast hematocrit reduction leads to the sudden onset of a clinical condition including asthenia, tachycardia, dizziness, sweating, and dyspnea on effort, with fainting in some cases
The gradual development of anemia can only be associated with growing fatigue and reduction of the tolerance to exercise.
Hypochromic microcytic anemia
It is mainly caused by iron deficiency, that in turn occurs in most cases due to chronic, particularly digestive, gynecological, or urologic bleeding.
It is also the anemia of the chronic disease associated with infections, autoimmune diseases, neoplasms, etc.
It is usually gradual, which means it causes tiredness, drowsiness, light-headedness and lack of attention only in advanced cases.
It is very common in middle-aged women, so its incidence is high in female drivers.
Iron supply and the control of the bleeding site usually improve anemia.
Advice on Hypochromic microcytic anemia
- Mild hypochromic anemia does not interfere with driving.
- Drowsiness, loss of attention and some light-headedness in moderate or severe cases of anemia with Hb < 8-10 g/dL can lead to a loss of control of the car, so it is advised against driving in these cases.
- The physician will inform the patient in subsequent revisions, if the treatment instituted has stabilized the anemia and controlled its cause, allowing for driving.
Megaloblastic for lack of vitamin B12 or of folic acid, and non-megaloblastic associated with systemic liver disease, alcoholism, hypothyroidism, or associated with bone marrow disease.
Anemia from vitamin B12 deficit usually occurs insidiously and progressively, and can be associated with gastrointestinal disorders such as anorexia, constipation, intermittent diarrhea and abdominal pain.
Peripheral nerves are frequently affected, with loss of vibratory sensitivity in the lower extremities, of proprioception, and ataxia. The upper extremities are later affected.
Spasticity and hyperactivity of reflexes are subsequently seen, and if treatment is not instituted early, neurological defects are irreversible.
Some patients show irritability, depression, or paranoia.
Blindness for the blue and yellow colors can occur.
Advice on Macrocytic anemia
- Megaloblastic anemia reverses with deficient supply, so in mild cases it does not interfere with driving.
- The symptoms of this anemia in advanced phases are disabling for driving due to the neurological, visual and mood involvement caused.
- After the treatment, the physician will confirm that the symptoms have reversed permitting driving through a report, that specifies the absence of sequels.
- Symptomatic non-megaloblastic macrocytic anemia associated with other diseases show a variable outcome depending on the causal disease.
- In these cases, the physician will also assess the clinical signs and symptoms of the primary disease, liver disease, alcoholism, etc, and will give recommendations, depending on the evolution of the patient, if the can drive.
Hypoproliferative, for bone marrow failure of primary origin, or secondary to chronic disorders such as uremia, liver disease, collagenosis, endocrine disorder, or disseminated neoplasms.
Hypoplastic, by reduction of the marrow mass, so it is usually associated with leukopenia and thrombocytopenia.
that can cause serious general symptoms, frequently associated with bleeding in the fundus of the eye, mucosal membranes and the skin, and infections.
In half of the cases it is associated with toxic substances or drugs such as antineoplastics, antiinflammatory agents, antibiotics, and anticonvulsants.
Myelophthisic, for replacement of the marrow by infiltrating neoplasms, granulomatous diseases, of deposit or fibrosis.
The symptoms of anemia are added to those of the underlying disease and, sometimes, massive splenomegaly frequently associated with hepatomegaly occurs.
Advice on Normocytic anemia
- In anemia from deficient erythropoiesis, the mild symptoms of anemia are added to those of the underlying disease, undermining the ability to drive.
- The physician will advise against driving in any anemia causing lightheadedness, drowsiness, and lack of attention.
- The clinical manifestations of the causal disease or of toxicity caused by the drugs will lead the physician to advise against driving until the patient is stabilized and without decreased ability to drive.
- Large splenomegaly involves an added risk in case of any impact, for the risk of rupture of the spleen and massive abdominal hemorrhage.