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Anemia: The Basics

Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Jan 23, 2019
Last Modified Date: Jan 23, 2019
Published Date: Dec 23, 2018

TABLE OF CONTENTS

Chapter 1: Anemia: The Basics
Chapter 2: Know the Signs of Anemia to Protect Your Health
Chapter 3: Treating Anemia


Anemia: The Basics

What Is Anemia?

Anemia is a condition that occurs when the body cannot produce enough red blood cells to move necessary oxygen towards tissues and organs. It can also occur when there is a large amount of red blood cells; but, some are deformed. This is the case of sickle cell anemia that is a problem often making patients feel weak, dizzy or tired. It can cause breathing difficulties, cold extremities, pale or sallow skin and frequent headaches.

The risk of anemia increases as patients age. In younger people, the problem is often a sign of bad nutrition. Older people with poor diets can become anemic too; but they may also get this blood disorder because of a more severe medical condition like kidney disease. Cancer patients and other people with serious problems also frequently develop anemia. It is essential for anyone who is feeling such symptoms to have their health checked by a professional. Anemia has to be addressed and the best way to do is to get your blood tested.

Anemia is a blood disorder

Types of Anemia

While the symptoms and end result of anemia are the same in all types of this condition, the causes can be very different. For instance, nutritional anemia is usually caused by a lack of vitamins or other important nutrients in the diet. Low folic acid or iron are common, for instance. Many people can correct these issues by consuming more dark leafy green vegetables, nuts, dried fruit and red meat, as well as fortified grains, citrus fruits and beans. Supplementation is also possible; but, many supplements come with some risk and should be taken only under the supervision of a qualified medical professional. This is especially applicable in older patients.

Not all iron deficiency anemia is caused by a poor diet. Many patients suffering from blood loss also develop this problem. If the source of the blood loss isn’t immediately apparent, taking iron supplements can mask the true cause of the problem. For instance, a patient suffering from an internal hemorrhage who uses supplements to treat anemia may have normal ranges in a blood test, but the blood loss will continue to be a problem. While iron deficiency is the most common cause of anemia all over the world, it may not be the most common causative agent among older patients. Professionals explain that only a third of anemic cases in older people are due to iron deficiency. It is essential to be tested and not delay seeking help when you think you might be anemic. For those to pick to put this condition on hold, further complication would start developing such as starting to develop some severe kidney problems, among many others. Talking with your doctor, or other medical professional, as soon as possible, increases the chance of patients getting the right treatment.

Anyone who has a blood test indicating anemia, in the results, should take steps immediately. Finding out the root cause of anemia, especially for older patients, should always take precedence. In some cases, it may be necessary to contact a hematologist or other blood disorder specialist. The cost of additional testing may seem daunting, but it’s worth it on the long run. Patients who take the time to find out the cause of their anemia are more likely to stay healthy and avoid kidney trouble as well as other serious conditions.

Know the Signs of Anemia to Protect Your Health

Anemia is a condition in which there are fewer red blood cells in the body than normal, It is also when red blood cells present in the body do not function properly. Since red blood cells transport oxygen throughout the body, a shortage or malfunction of these vital cells can have serious effects on health. Anemia is one of the most common blood disorders, affecting more than 3 million Americans. Symptoms of anemia vary according to the type and severity of the disorder and its underlying causes.

What is Anemia?

Red blood cells carry hemoglobin, an iron-rich protein that bonds with oxygen in the lungs and transports it to cells throughout the body. Anemia is a family of disorders that affect the red blood cells, reducing the amount of them in the bloodstream or the amount of hemoglobin they carry. Some of the main causes of anemia include:

Blood loss – While blood loss from acute injuries can cause anemia, the more common cause is gradual, often undetected, blood loss. Many women suffer borderline anemia with blood loss during the monthly menstrual cycle, and GI bleeding, which can occur with conditions like ulcerative colitis, diverticulitis and colon cancer, or with daily use of certain medications, such as aspirin or NSAIDS. Hemorrhoids, gastric ulcers and intestinal parasites are other common causes of blood loss that can lead to anemia.

Impaired red blood cell production – If the body fails to produce an adequate supply of replacements for aging red blood cells, anemia can occur as the overall number of red blood cells in the bloodstream diminishes. Inadequate red blood cell production can be caused by nutritional deficiencies, such as low levels of iron, vitamin B-12 and folic acid in the body. Damage or disease in the bone marrow, where red blood cells are produced, can be the underlying cause as well, and can stem from autoimmune diseases, radiation, viral hepatitis, kidney disease and some medications, among other causes.

High rates of red blood cell destruction – Anemia can occur when red blood cells are destroyed at a faster rate than healthy bone marrow can produce new cells to replace them. The spleen is primarily responsible for the destruction of aging red blood cells, filtering them from the bloodstream to be broken down. A variety of diseases and health conditions, including malaria, lupus and tuberculosis, can cause the spleen to enlarge, which can lead to accelerated red blood cell destruction and anemia. In inherited forms of anemia, such as sickle cell disease or thalassemia, red blood cells are deformed, causing the spleen to trap and destroy them. Over time, this heavy work load typically results in spleen enlargement, which steadily increases the rate of red blood cell destruction.

Other causes include a hormone deficiency, vitamin deficiency due to a chronic condition like Crohn's, and pregnancy.

Common symptoms of anemia

Symptoms of Anemia

  • Frequently reported symptoms of anemia include:
  • Weakness
  • Fatigue
  • Lightheadedness or dizziness
  • Shortness of breath
  • Rapid or irregular heartbeat
  • Headache
  • Cold hands and feet
  • Abnormally pale skin, nail beds and/or mucus membranes
  • Jaundice, or yellowing of the skin and/or whites of the eyes
  • Chest pain
  • Ringing, pounding or whooshing sounds in the ears
  • Mental confusion
  • Irritability, depression or mood swings

Since the symptoms of anemia can also be risk factors of other diseases and disorders, they could possibly be overlooked or misdiagnosed. In fact, anemia is usually discovered through abnormal blood test results, rather than recognized by means of its signs and symptoms.

Diagnosis and Treatment

Diagnosis of anemia is done by means of a physical examination to detect any signs or symptoms of anemia; and, one will need some blood testing. Initial screening is generally done with a blood test called a Complete Blood Count, or CBC, which measures the number, size, hemoglobin content and volume of red blood cells in the bloodstream. Other blood tests that may be used to confirm an anemia diagnosis and/or help determine causes of the disorder include testing of blood iron, B-12 and folate levels, and testing for indicators of autoimmune disorders, red blood cell fragility, enzyme defects and red blood cell abnormalities that can lead to anemia.

Treatment depends largely on the type, severity and causes of anemia, and can include medications, blood transfusions, dietary changes and supplementation. When the cause of anemia lies in chronic diseases or health conditions, treating those underlying causes can often improve or resolve anemia.

Treating Anemia

Treating Anemia Effectively Means Finding Its Source

Anemia is a blood disorder in which an individual's blood does not contain enough red blood cells to circulate oxygen efficiently or the red blood cells in the bloodstream do not contain enough hemoglobin to carry oxygen in sufficient quantities. The chief goals of anemia treatment are:

  • To raise an affected individual's red blood cell count or hemoglobin
  • To treat the underlying causes of anemia
  • To prevent complications of the disorder, which can include heart and nerve damage
  • To alleviate anemia symptoms which may include fatigue, shortness of breath and cardiac symptoms, among others.

The means of reaching those goals differs according to the type of anemia diagnosed and its underlying causes, as determined by medical testing.

Iron Deficiency Anemia

Iron is essential to the production of a protein in red blood cells called hemoglobin, which, in turn, is essential to oxygen transportation to all cells within the body via the bloodstream. Iron deficiency can happen due to a supply problem, such as inadequate amounts of dietary iron consumption or poor iron absorption, or can be a demand issue, with the body producing more new red blood cells than normal to compensate for blood loss, growth spurts or pregnancy, depleting the body's iron stores.

The two most common forms of iron deficiency anemia treatment are dietary changes and iron supplements. Supplements are generally used to accomplish a rapid increase in iron stores in the body or in cases of severe deficiency. They are available in prescription and over-the-counter forms, and may be necessary for several months or longer.

Dietary changes include the addition of iron-rich foods to the diet, such as lean meats, seafood, iron-fortified cereals, cooked dry beans, and dark green leafy vegetables. Doctors generally recommend that iron-rich foods be combined with foods rich in vitamin C, like citrus fruits or tomatoes, since it boosts iron absorption.

When iron deficiency anemia is severe or is linked to certain health conditions, other treatments may be necessary. Among the possibilities are blood transfusions, medications to increase red blood cell production or surgical intervention to address sources of internal bleeding.

Pernicious Anemia

Another nutrition-related form of anemia, pernicious anemia occurs when the body is deficient in vitamin B-12 due to poor absorption. Since B-12 is essential to the production of healthy red blood cells, deficiency decreases the number of them in the bloodstream. Absorption can be hindered by intestinal problems, poor dietary intake or a lack of intrinsic factor, a protein made in the stomach that facilitates B-12 absorption.

Pernicious anemia treatment involves taking care of one’s B-12 deficiency, most commonly done with B-12 shots. High-dose B-12 oral supplement or nasal sprays may be an option for some patients. Increasing dietary intake of B-12 rich foods in the diet, such as meat, fish, eggs, and dairy products is typically recommended.

Aplastic Anemia

Aplastic anemia stems from damaged bone marrow, which manufactures red blood cells, and impairs production of red blood cells, as well as white blood cells and platelets. Aplastic anemia is rare, but serious, and can be inherited or caused by certain diseases, treatments, drugs or toxins, among other factors. Treatment may include blood transfusions, stem cell transplants and medications.

Hemolytic Anemia

This is a condition in which the body destroys red blood cells too early, before their average lifespan of 120 days is complete. When so many are destroyed that the body cannot replace them, anemia occurs. It can be caused by hereditary red blood cell abnormalities, such as sickle cell or thalassemias, autoimmune disorders and certain diseases, infections, drugs, or toxins. Treatment depends upon the underlying causes, but may include medications, nutritional supplements, blood transfusions, and stem cell transplants.

Testing and Diagnosis: An Essential First Step to Appropriate Anemia Treatment

While these are the major forms of anemia, there are many others, and an accurate diagnosis is essential to appropriate and successful treatment of anemia and its underlying causes. For that reason, a patient who shows symptoms of anemia or has had signs of the disorder discovered during routine medical care should be thoroughly evaluated before any treatment begins.

Typically, that evaluation begins with a blood test called a Complete Blood Count, or CBC. This test is used to determine the number of red blood cells in the bloodstream, as well as their size, volume and hemoglobin content. Depending upon CBC results and other factors, such as personal and family health history, other testing may be indicated, such as B-12 and folate levels, testing for antibodies and other factors that can indicate autoimmune disorders, bone marrow tests, enzyme testing or liver function testing, among others. Additionally, in cases of anemia due to blood loss, various imaging procedures may be used to locate sources of internal bleeding.

Dietary changes include the addition of iron-rich foods to the diet, such as lean meats, seafood, iron-fortified cereals, cooked dry beans, and dark green leafy vegetables. Doctors generally recommend that iron-rich foods be combined with foods rich in vitamin C, like citrus fruits or tomatoes, since it boosts iron absorption.

When iron deficiency anemia is severe or is linked to certain health conditions, other treatments may be necessary. Among the possibilities are blood transfusions, medications to increase red blood cell production or surgical intervention to address sources of internal bleeding.

References:

Your guide to anemia. National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov/files/docs/public/blood/anemia-yg.pdf

Marx JA, et al., eds. Anemia, polycythemia and white blood cell disorders. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014.

Schrier. S,L. Approach to the adult patient with anemia. www.uptodate.com/home

Anemia. National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov/health-topics/anemia

World Health Organization. Micronutrient deficiencies. (n.d.).

U.S. Department of Health & Human Services -National Heart, Lung and Blood Institute. Other names for anemia. (2012). Retrieved from www.nhlbi.nih.gov/health-topics/anemia

U.S. Department of Health & Human Services -National Heart, Lung and Blood Institute. What are the signs and symptoms of iron-deficiency anemia? (2014). Retrieved from www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia#Signs,-Symptoms,-and-Complications

U.S. Department of Health & Human Services -National Heart, Lung and Blood Institute. What is anemia? (2012). Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/anemia/