What Is Anemia?

What Is Anemia?

Anemia is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs. If red blood cells are also deficient in hemoglobin, then your body isn't getting enough iron. Symptoms of anemia -- like fatigue -- occur because organs aren't getting enough oxygen.

Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. Women and people with chronic diseases are at increased risk of anemia. Important factors to remember are:



What Are the Symptoms of Anemia?

The symptoms of anemia will vary according to the type of anemia, the underlying cause and your underlying health problems. Anemia may be associated with other medical conditions such as hemorrhage, ulcers, menstrual problems or cancer -- and specific symptoms of those conditions may be noticed first.

Symptoms common to many types of anemia are:

The body also has a remarkable ability to compensate for early anemia. If your anemia is mild or developed over a long period of time, you may not notice any symptoms.
Easy fatigue and loss of energy.
Unusually rapid heart beat, particularly with exercise.
Shortness of breath and headache, particularly with exercise.
Difficulty concentrating.

Related Anemia Terms

sickle cell, pernicious, aplastic, iron deficiency,
causes, hemolytic, anemia and pregnancy, treatment, types, Fanconi, Macrocytic

Certain forms of anemia are hereditary and infants may be affected from the time of birth.
Women in the childbearing years are particularly susceptible to a form of anemia called iron-deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during pregnancy.
Seniors also may have a greater risk of developing anemia because of poor diet and other medical conditions.

There are many types of anemia. All are very different in their causes and treatments. Iron-deficiency anemia, the most common type, is very treatable with diet changes and iron supplements. Some forms of anemia -- like the anemia that develops during pregnancy -- are even considered normal. However, some types of anemia may present lifelong health problems


treatment

There are more than 400 types of anemia, which are divided into 3 groupings:
Anemia caused by blood loss
Anemia caused by decreased or faulty red blood cell production
Anemia caused by destruction of red blood cells

Anemia Caused by Blood Loss

Red blood cells can be lost through bleeding, which can occur slowly over a long period of time, and can often go undetected. This kind of chronic bleeding commonly results from the following:
Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the stomach) and cancer
Use of nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin or Motrin
Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies

Anemia Caused by Decreased or Faulty Red Blood Cell Production

The body may produce too few blood cells or the blood cells may not work properly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or the a 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
Iron deficiency anemia
Vitamin deficiency
Bone marrow and stem cell problems
Other health conditions

Sickle cell anemia is an inherited disorder that affects African-Americans. Red blood cells become crescent-shaped because of a genetic defect. They break down rapidly, so oxygen does not get to the body's organs, causing anemia. The crescent-shaped red blood cells also get stuck in tiny blood vessels, causing pain.

Iron deficiency anemia occurs because of a lack of the mineral iron in the body. Bone marrow in the center of the bone needs iron to make hemoglobin, the part of the red blood cell that transports oxygen to the body's organs. Without adequate iron, the body cannot produce enough hemoglobin for red blood cells. The result is iron deficiency anemia. Iron deficiency anemia can be caused by the following:
An iron-poor diet, especially in infants, children, teens and vegetarians
The metabolic demands of pregnancy and breastfeeding that deplete a woman's iron stores
Menstruation
Frequent blood donation
Endurance training
Digestive conditions such as Crohn's disease or surgical removal of part of the stomach or small intestine
Certain drugs, foods, and caffeinated drinks

Vitamin deficiency anemia may occur when vitamin B-12 and folate are deficient. These two vitamins are needed to make red blood cells. Conditions leading to anemia caused by vitamin deficiency include the following:
Megaloblastic anemia: Vitamin B-12 or folate or both are deficient
Pernicious anemia: Poor vitamin B-12 absorption caused by conditions such as Crohn's disease, an intestinal parasite infection, surgical removal of part of the stomach or intestine, or infection with HIV
Dietary deficiency: Eating little or no meat may cause a lack vitamin B12, while overcooking or eating too few vegetables may cause a folate dificiency
Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse, intestinal diseases such as tropical sprue and gluten-sensitive enteropathy (celiac disease)

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

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 stem cells are 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 the following:
Aplastic anemia occurs when there's a marked reduction in the number of stem cells or absence of these cells. Aplastic anemia can be inherited, can occur without apparent cause, or can occur when the bone marrow is injured by medications, radiation, chemotherapy, or infection.
Thalassemia occurs when the red cells can't mature and grow properly. Thalassemia is an inherited condition that typically affects people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition can range in severity from mild to life-threatening; the most severe form is called Cooley's anemia.
Lead exposure is toxic to the bone marrow, leading to fewer red blood cells. Lead poisoning occurs in adults from work-related exposure and in children who eat paint chips. Improperly glazed pottery can also taint food and liquids with lead.

Anemia associated with other conditions usually occur when there are too few hormones necessary for red blood cell production. Conditions causing this type of anemia include the following:
Advanced kidney disease
Hypothroidism
Other chronic diseases – examples include cancer, infection, and autoimmune disorders such as lupus or rheumatoid arthritis

Anemia Caused by Destruction of Red Blood Cells

When red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing hemolytic anemia. Hemolytic anemia can be present at birth or develop later. Sometimes there is no known cause (spontaneous). Known causes of hemolytic anemia may include any of the following:
Inherited conditions, such as sickle cell anemia and thalassemia
Stressors such as infections, drugs, snake or spider venom, or certain foods
Toxins from advanced liver or kidney disease
Inappropriate attack by the immune system (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, an enlarged spleen can trap red blood cells and destroy them before their circulating time is up

How Do I Know If I Have Anemia?

To diagnose anemia, your doctor will likely do the following:
Take your medical history
Perform a physical exam
Order laboratory tests

You can help by providing detailed answers about your symptoms, family medical history, diet, medications you take, alcohol intake, and ethnic background. Your doctor will look for symptoms of anemia and other physical clues that might point to a cause.

Blood tests will not only confirm the diagnosis of anemia but also help point to the underlying condition. Blood tests may include the following:
Complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of red blood cells
Blood iron level and your serum ferritin level, the best indicators of your body's total iron stores
Levels of vitamin B-12 and folate
Special blood tests to detect rare causes of anemia, such as an immune attack on your red blood cells, red blood cell fragility, and defects of enzymes, hemoglobin and clotting
For suspected hemolytic anemia, tests to identify the breakdown products of red blood cells in your blood and urine

Only in rare cases will a doctor need to remove a sample of bone marrow to determine the cause of your anemia.
What Are the Treatments for Anemia?

Your doctor will not treat your anemia until the underlying cause has been established. The treatment for one type of anemia may be both inappropriate and dangerous for another type of anemia.

Anemia Caused by Blood Loss
If you suddenly lose a large volume of blood, you may be treated with fluids, blood transfusion, oxygen, and possibly iron to help your body build new red blood cells. Chronic blood loss is treated by identifying the source of bleeding, stopping the bleeding, and, if necessary, giving treatment for iron-deficiency anemia.

Anemia Caused by Decreased Red Blood Cell Production
The type of treatment you receive depends on the cause of decreased red blood cell production.

With iron deficiency anemia your doctor will probably recommend iron supplements that contain the ferrous form of iron, which your body can absorb easily. Timed-release iron supplements are not a good choice for most people because iron is primarily absorbed in the upper part of the digestive tract. If you use iron supplements, remember the following cautions:
Always consult with your doctor before taking iron supplements. Excess iron intake can be harmful. Symptoms of iron overload include fatigue, vomiting, diarrhea, headache, tability and joint problems.
Iron supplements -- like all supplements and any medication -- should be kept out of the reach of children. Iron poisoning is the most common cause of accidental poisoning in young children. Very few tablets can prove fatal in a matter of hours. Symptoms of poisoning in a child include dizziness, confusion, nausea, vomiting, and diarrhea. Seek medical help immediately.
Watch for side effects. You may need to continue taking iron supplements for up to one year. Taking iron supplements with food can help prevent common side effects, which may include nausea, diarrhea, constipation, and stomach pain. Let your doctor know if you continue to have side effects. Different formulations are available.
Watch for medication interactions. Tell your doctor if you are being treated for another condition. For exalmple, calcium supplements interfere with iron absorption so it is best to take them at different times of the day.

Your doctor may also recommend that you increase the amount of iron in your diet. Good dietary sources of iron include red meat, beans, egg yolk, whole-grain products, nuts and seafood.

Your doctor will monitor your red blood cell counts, including hematocrit, hemoglobin, and ferritin levels during treatment. If your anemia doesn't improve with iron supplements, your doctor will look for some other underlying cause. In rare cases, your doctor may prescribe iron injections or give you iron intravenously (through a needle in the vein). In extremely rare cases of life-threatening iron-deficiency anemia, treatment may involve blood transfusion.

For vitamin B-12 and folate deficiency anemia, the treatment depends on the cause of the deficiency. If your body stores are depleted of vitamin B-12, your doctor will most likely prescribe vitamin B-12 injections and may also recommend high doses of B-12 supplements or a B-12 nasal spray. There is a good chance that many of the symptoms of deficiency will improve once the body is provided with the needed B-12.

Most people with vitamin B-12 deficiency have a permanent inability to absorb vitamin B-12 and will need injections every one to three months or pills daily for the rest of their lives.

Your doctor may also recommend that you increase the amount of vitamin B-12 in your diet. Good dietary sources of vitamin B-12 are meat, liver, and kidney; fish, oyster, and clams; and milk, cheese and eggs.

If you have a folate deficiency, your doctor will prescribe folate supplements and may recommend you increase the amount of folate in your diet. Good dietary sources of folate include fresh fruits, green leafy vegetables, cruciferous vegetables (cauli, broccoli and brussel sprouts), liver and kidney, dairy products, and whole grain cereals. Vegetables should be eaten raw or lightly cooked.

For anemia caused by problems of the bone marrow and stem cells,
anemia tends to be more persistent and difficult to treat. The treatments for hereditary anemias, such as thalassemia, vary widely and depend on the specific condition and the severity of symptoms. Some anemias will not require any treatment while others may require repeated transfusion and other aggressive measures. Although aplastic anemia will occasionally go into spontaneous remission, people with this disorder generally require bone marrow transplantation.

Lead poisoning is treated by discontinuing exposure to lead and administering a drug that binds and draws lead out of the body.

For people with anemia as a result of chronic disease, the best way to alleviate the anemia is often to treat the underlying condition. Shots of Epogen, a hormone that stimulates the production of red blood cells, may also help in some instances. People who have anemia as a result of kidney failure will require adequate dialysis, take Epogen, and possibly have a kidney transplant.

Anemia Caused by Increased Red Blood Cell Destruction

The treatment of hemolytic anemia will be tailored to the underlying cause. Mild cases of hemolytic anemia may not require any treatment at all. If an offending environmental agent can be identified -- a chemical, for example -- exposure to this agent should stop immediately. People with hemolytic anemia may need surgery to replace faulty heart valves, remove a tumor, or repair abnormal blood vessels.

Supportive treatment -- like intravenous fluids and pain medication -- will often be administered. Blood transfusion may be necessary in some cases. Steroids can halt the body's immune attack on its own red blood cells. Certain damaging factors can be removed from the blood by a treatment called plasmapheresis.

If hemolytic anemia persists despite treatment, your doctor may recommend splenectomy --surgical removal of the spleen -- as a last resort. Most people can lead a normal life without their spleen.

Gallbladder surgery may also be required if you have longstanding hemolytic anemia and symptoms of gallstones. Hemolytic anemia that damages the kidneys may make dialysis necessary. In extremely rare cases, bone marrow transplantation may be the only solution for certain types of hemolytic anemia.

Sickle Cell Anemia
While there is no cure for sickle cell anemia, drugs can help ease the pain. And a drug called hydroxyurea appears to stimulate the formation of an alternate form of hemoglobin that isn't susceptible to the sickling.


How Can I Prevent It?

You can prevent iron-deficiency anemia by eating a well-balanced diet that includes good sources of iron, vitamin B-12 and folate. Steps to take include the following:
If you are a vegetarian, talk to your doctor or a nutritionist about your diet and any possible need for supplements.
Ask your doctor or nutritionist if you should take vitamin C. Vitamin C makes the stomach more acidic and can improve the absorption of iron in your diet.
Decrease your consumption of caffeinated products and tea. These substances can decrease iron absorption. Other offenders include the preservative EDTA, fiber, large amounts of calcium, and the phytates found in some vegetables.
Select iron-fortified cereals and breads.
Carefully follow safety guidelines if your occupation involves work with lead-containing materials such as batteries, petroleum, and paint.
Ask your doctor or local public-health authorities about lead-testing the pottery you use for food or beverage preparation.