Anemia

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow. Anemia is caused essentially through two basic pathways. Anemia is caused by either:

  1. a decrease in production of red blood cells or hemoglobin, or
  2. an increase in loss or destruction of red blood cells.

Can inadequate iron cause anemia?

Iron Deficiency is a very common cause of anemia. This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body’s iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia.

Young women are likely to have low grade iron deficiency anemia because of the loss of blood each month through normal menstruation This is generally without any major symptoms as the blood loss is relatively small and temporary.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness,  fatigue,  confusion,shortness of breadth and even loss of consciousness can occur with severe, sudden blood loss anemia.

What are other causes of anemia?

Some of the most common causes include:

  • Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
  • Strict vegetarians are at risk if they do not take adequate vitamin supplements.
  • Long-term alcoholics.
  • There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia.
  • A wide assortment of bone marrow diseases can cause anemia.
  • For example,  cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple lyeloma can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
  • Certain chemotherapy  for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
  • Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.

Can anemia be hereditary?

Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin.

What are the symptoms of anemia?Some patients with anemia have no symptoms. Others with anemia may feel:

  • Tired
  • Fatigue easily
  • Appear pale
  • Develop palpitations (feeling of heart racing)
  • Become short of breath

Additional symptoms may include:

  • Hair loss
  • Malaise (general sense of feeling unwell)
  • Worsening of heart problems

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC) count. A CBC test may be ordered by a physician as a part of routine general checkup and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Six component measurements make up a CBC test:

  1. Red blood cell (RBC) count
  2. Hematocrit
  3. Hemoglobin
  4. White blood cell (WBC) count
  5. Differential blood count (the “diff”)
  6. Platelet count

Only the first three of these tests — the red blood cell (RBC) count, the hematocrit, and the hemoglobin — are relevant to the diagnosis of anemia.

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.

Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.

In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.

If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).

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