Am I Anemic?

What is Anemia?

Anemia is a condition that develops when your blood does not have a sufficient amount of healthy red blood cells. When your red blood cell count is low, the cells in your body do not get enough oxygen. The oxygen transported throughout your body is important because it removes the carbon dioxide from your body, a harmful waste product. Anemia is the most common blood condition in the United States and it affects about 3.5 million Americans. Anemia can be a temporary or long-term issue and can be mild to very severe.

Causes

There are several different causes for anemia including:

• Heavy periods
• Pregnancy
• Ulcers
• Colon polyps or colon cancer
• Inherited disorders
• A diet that does not have enough iron, folic acid, or vitamin B12
• Blood disorders such as sickle cell anemia and thalassemia, or cancer
• Aplastic anemia is an inherited condition.

 

To date, there are more than 400 different types of anemia. The many types are divided into three groups:

(1)   Anemia caused by blood loss– Red blood cells can be lost through substantial bleeding, which can sometimes occur slowly over a long period and go undetected in some cases. This kind of bleeding commonly results from:

• Gastrointestinal conditions like ulcers, hemorrhoids, inflammation of the stomach, and cancer.
• The use of common non-steroidal anti-inflammatory drugs or NSAIDs such as aspirin or ibuprofen. Both of these can cause ulcers and gastritis.
• Menstruation and childbirth, especially if menstrual bleeding is heavier than normal and if there are multiple pregnancies.

 

(2)    Anemia caused by decreased or abnormal red blood cell production– The body of an individual with this kind of anemia may produce too few blood cells or the blood cells may not be functioning correctly. The cells themselves may be faulty or low due to abnormal red blood cells or the lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following:

 

• Sickle cell anemia– Sickle cell anemia is a disorder that affects African Americans, transferred from parent to child. With sickle cell, red blood cells become crescent-shaped due to the genetic defect. Sickle cell causes red blood cells to break down rapidly, so oxygen does not get to the body’s organs fast enough. These crescent-shaped red blood cells can get stuck in tiny blood vessels and can cause pain.

 

• Iron deficiency anemia– Iron deficiency anemia occurs because of a lack of iron in the body. Bone marrow, located in the center of the bone, needs iron to make hemoglobin. Hemoglobin is the part of the red blood cell that transports oxygen to the body’s organs. Without the proper amount of iron, the body cannot produce enough hemoglobin for red blood cells. Iron-deficiency anemia can be caused by:
• A diet lacking in the proper amounts of iron. This is especially true for infants, children, teens, vegans, and vegetarians.
• The metabolic demands of pregnancy and breastfeeding in women.
• Menstruation
• Frequent blood donation
• Endurance training
• Digestive conditions like Crohn’s disease or the surgical removal of part of the stomach or small intestine
• Certain drugs, foods, and caffeinated beverages

 

• Vitamin deficiency– Vitamin deficiency anemia can sometimes occur when vitamin B12 and folate are lacking. These two vitamins are necessary to make red blood cells. Conditions that lead to anemia caused by vitamin deficiency include:
• Megaloblastic anemia is a condition in which vitamin B12 or folate or maybe both are deficient
• Pernicious anemia is a condition in which poor vitamin B12 absorption results due to conditions such as Crohn’s disease, surgical removal of part of the stomach or intestine, or an HIV infection.
• Dietary deficiency, which is eating little or no meat (a source of iron) may lead to a lack of vitamin B12. Overcooking or eating too few vegetables may also cause a folate deficiency.
• Other causes of vitamin deficiency include pregnancy, certain medications, alcohol abuse, and intestinal diseases such as tropical sprue and celiac disease.

During early pregnancy, sufficient amounts of folic acid can prevent the fetus from developing neural tube defects such as spina bifida.

• Bone marrow and stem cell issues– Bone marrow and stem cell problems may prevent the body from producing enough red blood cells. Some of the stem cells found in bone marrow develop into red blood cells. If the amount of stem cells is too few, defective, or replaced by other cells such as metastatic cancer cells, anemia may result. Anemia resulting from bone marrow or stem cell problems include:
  • Aplastic anemia occurs when there’s a reduction in the number of stem cells or an absence of cells. Aplastic anemia can be inherited, it can occur without cause, or come about when bone marrow is injured by medications, radiation, chemotherapy, or an infection.
  • Thalassemia happens when the red cells can’t mature and grow properly. Thalassemia is also an inherited condition that usually appears in people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition be anywhere from mild to life-threatening. The most severe form is Cooley’s anemia.
  • Lead exposure is toxic to bone marrow, leading to less red blood cell production. Lead poisoning occurs in adults mostly from work-related exposure and in cases where children consume paint chips. Improperly glazed pottery can also contaminate food and liquids with lead when the pottery is used to hold such things.

 

Other health conditions

Anemia associated with other conditions usually occurs when there are not enough hormones to create red blood cells. Conditions causing this type of anemia include:

• Advanced kidney disease
• Hypothyroidism
• Other chronic diseases, such as cancer, infection, lupus, and rheumatoid arthritis

 

(3)   Anemia caused by the destruction of red blood cells– When red blood cells are fragile and cannot hold up against the everyday stress of the circulatory system, they may prematurely rupture and cause hemolytic anemia. Hemolytic anemia can be there at birth or develop later. Sometimes there is no known cause however, currently known causes of hemolytic anemia include:

• Inherited conditions, like sickle cell anemia and thalassemia
• Stressors like infections, drugs, snake or spider venom, or particular foods
• Toxins from advanced liver or kidney disease
• A wrong attack by the immune system (this is called hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman)
• Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders
• In rare cases, a spleen that has grown in size can trap red blood cells and destroy them before their cycle is complete

Risks

Although anyone can develop anemia, there are certain conditions in which individuals are more likely to develop a form of anemia. This includes:

• A diet lacking certain vitamins. Eating a diet that is low in iron, vitamin B-12, and folate can increase your risk of anemia.
• Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine, like Crohn’s disease or celiac disease, puts you at risk of anemia. Surgical removal or surgery to the parts of your small intestine where nutrients are absorbed can also lead to nutrient deficiencies and anemia alike.
• Menstruation. Women who haven’t experienced menopause have a greater risk of iron deficiency anemia than men and postmenopausal women.
• Pregnancy. If pregnant, there is an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a source of hemoglobin for your growing fetus.

During the first year of life, some babies are at risk of iron deficiency anemia. This includes those who are born prematurely and infants who are fed breastfed only or formula that isn’t fortified with iron. The deficiency can be developed by 6 months of age.

Infants between 1 and 2 years are also at risk. Some may not be getting enough iron in their diets, especially if they drink a lot of cow’s milk, which is low in the iron needed for growth.

• Chronic conditions. Cancer, kidney failure, liver failure, or any other chronic condition, may put you at risk of what is called anemia of chronic disease. This is a shortage of needed red blood cells. Slow, consistent blood loss from something like an ulcer or other source inside your body can deplete your body’s amount of iron, leading to iron deficiency anemia.
• Family history. If your family has a history of some form of inherited anemia, such as sickle cell, you may also be at risk of the same condition.
• Other factors. A record of certain infections, blood diseases, autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

 

Signs and Symptoms

The most common symptom of anemia is fatigue. If you have anemia, you may find it difficult to find the energy to do normal activities.

Other signs and symptoms of anemia include:

• Shortness of breath
• Dizziness
• Headache
• Coldness in the hands and feet
• Pale skin
• Chest pain
• A fast or irregular heartbeat
• Cognitive problems

These symptoms occur because your heart has to work harder to pump oxygen-rich blood through your body, which it is lacking. Mild to moderate anemia may cause moderate-level symptoms or none at all but signs and symptoms will increase as anemia worsens.

 

Preparing for Your Appointment

You must make an appointment with your trusted doctor or a general practitioner if you have prolonged fatigue or other signs or symptoms that worry you. Because appointments can sometimes be short and there’s often a lot of information to go over, it’s a good idea to go prepared. Here’s some information to help you get ready.

 

What you can do

Be aware of any pre-appointment conditions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet, to prepare for any tests.

Write down any symptoms you’re experiencing. You should also include any that may seem unrelated to the reason for which you scheduled the appointment.

Write down information about any current conditions and any major stresses or recent life changes.

Make a list of all medications, vitamins, or supplements that you routinely take or recently started using.

Also, have questions ready to settle any other concerns you may have. Your health is very important so don’t hesitate to ask questions during your appointment.

 

What to expect from your doctor

Your doctor is likely to have some questions ready for you. This will help to move things along and evaluate what the true diagnosis may be. Your doctor may ask:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Is there anything that seems to improve your symptoms?
• Is there anything that appears to worsen your symptoms?

 

Diagnosis

To diagnose anemia, your doctor may ask if you have any of the common signs or symptoms of anemia. They may also ask whether you’ve had or have an illness or condition that could cause anemia. Let your doctor know about any medicines or vitamins you take, what you typically eat, and whether you have family members who have anemia or a history of it.

 

The following procedures may be administered to determine a diagnosis:

Physical exam. During a physical exam, your doctor may need to listen to your heart and your breathing rhythm. Your doctor may also need to feel your abdomen to size your liver and spleen.

Complete blood count (CBC). A CBC is s way to count the number of blood cells in your system by taking a sample of your blood. Your doctor will then examine the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values differ from one medical practice to another. They are, however, generally between 38.8 and 50 percent for men and 34.9 and 44.5 percent for women. Normal adult hemoglobin values are generally 13.5 to 17.5 grams per deciliter for men and 12 to 15.5 grams per deciliter for women.

The size and shape of your red blood cells test. Some of your red blood cells may also be examined for unusual sizes, shapes, and colors, which can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler than normal. With vitamin deficiency anemia, red blood cells are bigger and fewer.

Additional tests

If you receive a diagnosis for any of the forms of anemia, your doctor may require additional tests to determine the true issue. For example, iron deficiency anemia can result from excessive bleeding of ulcers, benign polyps in the colon, colon cancer, tumors, or kidney failure.

 

Treatment

The goal of anemia treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level and treating any abnormalities in the cells themselves.

Anemia treatment depends on the cause:

• Iron deficiency anemia. This form of anemia is treated with changes in your diet or by taking iron supplements. If the underlying cause of iron deficiency is loss of blood from something other than menstruation, the source of the bleeding must be located and stopped. This may involve surgery in some cases. As far as a change in diet, your body can more easily absorb iron from eating meats than it would from vegetables or other foods. Your doctor may suggest eating more meat, especially red meat, chicken, turkey, pork, fish, and shellfish.

Nonmeat foods that are good sources of iron are:

• Dark green leafy vegetables
• Tofu
• Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
• Dried fruits like prunes, raisins, and apricots
• Prune juice
• Iron-fortified cereals and breads

For extra help on what to include in an iron-rich diet, you can look at the Nutrition Facts label on packaged foods to find out how much iron the item contains. The amount is shown as a percentage of the total amount of iron you need every day.

Doctors may recommend a form of iron supplements for premature infants, infants, and young children who drink a lot of cow’s milk, and infants who are fed only breast milk or formula that isn’t fortified with iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes them to be taken.

 

• Vitamin deficiency anemias. Folic acid deficiency anemia is treated with folic acid supplements, just like iron. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections. Low levels of vitamin B12 can lead to an illness called pernicious anemia. This type of anemia often is treated with vitamin B12 supplements.

Good food sources of vitamin B12 include:

• Breakfast cereals with added B12
• Meats like beef, liver, poultry, and fish
• Eggs and dairy products
• Foods fortified with B12, such as soy-based beverages and vegetarian burgers

 

• Anemia of chronic disease. There is currently no specific treatment for this type of anemia. If symptoms become severe, a blood transfusion or an injection of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate your red blood cell production and ease fatigue.

 

• Aplastic anemia. Treatment for aplastic anemia might include blood transfusions to boost the amounts of red blood cells. A blood transfusion is a safe, common procedure in which blood is given through an intravenous (IV) line in one of your blood vessels. Transfusions use careful matching of donated blood with the recipient’s blood to ensure a successful procedure.

 

• Anemia is associated with bone marrow disease. Treatment of these various diseases can range from medication to chemotherapy to, of course, bone marrow transplantation. A blood and marrow stem cell transplant replaces faulty stem cells with healthy ones from a donor. Stem cells are made in the bone marrow where they develop into red and white blood cells.

 

• Hemolytic anemia. Suppressing and managing hemolytic anemia includes avoiding potential condition-inducing medications, treating any related infections, and taking drugs that suppress your immune system, which may be attacking your red blood cells. Treatment with steroids or various immune suppressant medications can assist in suppressing your immune system’s attack on your red blood cells. Depending on how bad the condition is, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure.

 

 

• Sickle cell anemia. Treatment for sickle cell anemia may include the administration of oxygen, pain-relieving drugs, and oral and IV fluids to reduce pain and prevent complications. Your doctor may also recommend blood transfusions, folic acid supplements, and antibiotics. Bone marrow transplants could treat the issues in certain circumstances and a cancer drug called hydroxyurea (Droxia, Hydrea) is also used as treatment.

 

Surgery

If you have serious or life-threatening bleeding due to a stomach ulcer, colon cancer, or other complications, you may need surgery. If your body is eliminating red blood cells at a high rate because of your spleen, you may need to have it removed. The spleen removes red blood cells from the body that are no longer good. An oversized or diseased spleen may be removing more good red blood cells than normal, causing anemia.

Prevention

Many types of anemia can’t be prevented. However, you can avoid iron deficiency anemia and vitamin deficiency anemia by choosing a diet that includes a variety of vitamins and nutrients, including:

• Iron. Iron-rich foods include beef and other red meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit.
• Folate. This nutrient, and its synthetic form of folic acid, can be found in citrus fruits and juices, bananas, dark green leafy vegetables, legumes, fortified breads, cereals, and pasta.
• Vitamin B-12. This vitamin is found naturally in meat and dairy products. It’s also been added to some cereals and soy products.
• Vitamin C. Foods containing vitamin C, such as citrus fruits like oranges, melons, and berries, help increase iron absorption.

Consider genetic counseling if you have a family history of anemia. If you do, talk to your doctor and perhaps a genetic counselor about your risk and what risks you may pass on to your children.