Anemia

Definition

Anemia occurs when blood does not have enough hemoglobin. Hemoglobin is the oxygen-carrying pigment found in red blood cells.

Description

Although there are over 400 different forms of anemia, this health profile will only address the three most common: iron-deficiency anemia, vitamin B12 anemia and folic acid deficiency.

Causes and Risk Factors

Iron deficiency anemia

Iron deficiency anemia arises from too little iron in the body to make sufficient hemoglobin. There are three (3) causes of iron deficiency anemia:

1. Loss of iron at a greater rate than normal (blood loss)

2. Poor absorption of iron from the diet

3. Eating a diet low in iron.

Blood loss is usually the result of slow, persistent bleeding from inside the body, such as gastritis, peptic ulcers, ulcerative colitis, inflammatory bowel disease, polyps, gastrointestinal tumors (such as stomach or colon cancer), heavy menstrual periods, kidney tumors, bladder tumors, cystitis, prostatitis, and hemorrhoids. Additionally, the frequent use of aspirin, ibuprofen or other non-steroid anti-inflammatory drugs, as well as chronic alcohol abuse, can also cause iron deficiency anemia.

Poor absorption of iron from the diet is usually as a result of surgical removal of part or all of the stomach or celiac sprue (a condition in which the lining of the small intestine is damaged by a protein found in wheat or rye called gluten).

The third cause is not eating enough iron-rich foods, such as fruit, whole-grain bread, beans, lean meat and green vegetables.

Vitamin B12 anemia

Vitamin B12 anemia is the result of an impaired ability of the digestive tract to absorb the B12 that is a normal part of the diet. B12 is essential for the production of red blood cells, as well as the maintenance of the nervous system, and is found in food of animal origin such as meat, fish and dairy products. There are four (4) causes.

1. Failure of the stomach lining to produce intrinsic factor

2. Rremoval of small intestine where vitamin B12 is absorbed

3. Crohn's disease - a chronic inflammatory disease that affects any part of the gastrointestinal tract

4. Eating a vegan diet which excludes eggs, diary products, meat and fish

Intrinsic factor is a chemical produced by the stomach lining and combined with vitamin B12 in the small intestine. Due to an autoimmune disorder (a disorder caused by a person's own immune system attacking the body's organs and tissues), the production of intrinsic factor is blocked.

Folic acid deficiency

Folic acid deficiency is usually caused by an inadequate intake of folic acid, a vitamin mainly supplied by the fresh green leafy vegetables, mushrooms, lima beans and kidney beans. This disorder is most common in the poor and elderly (due to poor eating habits), in heavy alcohol drinkers, and in persons afflicted with intestinal disorders such as Crohn's disease or celiac sprue.

Symptoms

The symptoms of iron deficiency anemia (if any) are:

• Paleness

• Weakness

• Tiredness

• Chest pains (in severe cases)

• Shortness of breath (in severe cases)

• Heart palpitations (in severe cases)

• An increased heart rate especially during exertion (in severe cases)

The symptoms of vitamin B12 anemia are similar to those of iron deficiency anemia but can also cause:

• Jaundice

• Numbness and tingling in the hands and feet

• Equilibrium difficulties

• Confusion

• Personality changes and depression

The symptoms of folic acid deficiency are similar to vitamin B12 anemia.

Diagnosis

Anemia is diagnosed from the patient's symptoms and by a blood test that measures the level of hemoglobin in the blood, as well as substances such as folic acid, bilirubin and vitamin B12. Additionally, the size of the red cells provide further clues to the type of anemia.

Other methods of diagnosis may include a bone marrow biopsy, which is the removal of bone marrow for further examination under a microscope.

Bone marrow biopsy is helpful in diagnosing vitamin B12 anemia. Some dietitians suggest that the doctor also check for levels of ferritin in the blood of premenopausal women. Ferritin is a protein that stores iron before the mineral circulates in the bloodstream.

Treatment

Iron-deficiency anemia

Treatment will depend upon whether an individual is not getting enough iron in the diet (increase iron intake); not absorbing iron (surgery for celiac sprue, etc.); or losing small amounts over time due to anything from alcoholic gastritis to medication abuse to tumors. The doctor will often recommend iron-rich foods (such as liver, seafood, dried fruits, lima beans, whole grains, green leafy vegetables and blackstrap molasses) or iron pills. In the more severe cases of iron deficiency anemia caused by blood loss, surgery, blood transfusions or hormone injections may be recommended.

Vitamin B12 deficiency

Current treatment of vitamin B12 deficiency consists of a life-long regimen of monthly B-12 injections. Unfortunately, neither diet or iron pills will help, but if diagnosed early a full recovery is promising.

Folic acid deficiency

Treatment is frequently a dietary correction. Main sources of folic acid include meat, poultry, cheese, milk, eggs, liver, green leafy vegetables, raw fruits, lima and kidney beans, and yeast. Folic acid tablets cure the anemia quickly. If intestinal disorders impede folic acid absorption, a supplement may be needed for a time. In rare instances, injections of folic acid are necessary.

Prevention

Consumption of a healthy diet including iron-containing foods and those with B-complex vitamins is essential to developing and maintaining a satisfactory blood count.

Questions to Ask Your Doctor

What tests need to be done to diagnose the condition and to determine the cause?

What type of anemia is it?

What is the cause of the anemia?

How serious is this type of anemia?

Has any permanent damage been done?

What treatment will you be recommending?

Will you be prescribing any medications? What are the side effects?

Will treatment need to be continued for life?