Anemia or anaemia refers to a red blood cell count that is below normal. While white blood cells fight infection, red blood cells are responsible for transporting oxygen throughout the body. When red blood cell levels drop too low, the body feels tired due to lack of oxygen. Hence, someone with anemia is often referred to as having "tired blood."
Various factors can cause anemia, including blood loss, iron deficiency, poor diet, disease, and reactions to medications like chemotherapy, to name but a few. To treat anemia a doctor must first learn the cause. Anemia can be mild or severe, temporary or chronic. In the worst-case scenario, anemia can create a serious oxygen deficiency in bodily organs that can lead to heart attack.
Iron deficiency or menstrual bleeding can cause a mild anemia, accompanied by the symptoms such as weakness, fatigue and pallor. If anemia is due to major blood loss, then it results in sever anemia. Fatigue and weakness are the main symptoms of severe anemia due to low hemoglobin. Symptoms might start off as almost unnoticeable, but increase as the condition worsens.
A person suffering from anemia might notice some or all of the following symptoms:
Paleness
Shortness of breath
Tiring quickly or easily
Dizziness
Pain in the chest
Cold hands and feet
Confusion
Fatigue
Headaches
Increased heartbeat
Loss of appetite
Impaired memory
Sore tongue
Diarrhea
Weight loss
Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as anemia worsens.
Symptoms of severe anemia may include:
chest pain, angina, or heart attack
dizziness
fainting or passing out
rapid heart rate
Some of the signs that may indicate anemia in an individual may include:
Change in stool color, including black and tarry stools (sticky and foul smelling), maroon-colored, or visibly bloody stools if the anemia is due to blood loss through the gastrointestinal tract.
rapid heart rate
low blood pressure
rapid breathing
pale or cold skin
yellow skin called jaundice if anemia is due to red blood cell breakdown
heart murmur
enlargement of the spleen with certain causes of anemia
In case of aplastic anemia, due to low numbers of red blood cells, a person looks pale and feels weak or tired and shortness of breath. Due to low white blood cell count, there are frequent or severe infections. Decreased number of platelets can lead to easy bruising or bleeding and small red spots under the skin. In case of severe anemia, bleeding or infections can be life-threatening.
When to Seek Medical Care
Because anemia is typically a clue to another underlying disease, it needs to be fully evaluated by a doctor, and proper testing needs to be undertaken to determine the cause. Therefore, if signs and symptoms of anemia are present, one should contact his or her physician for evaluation.
In the elderly and people with chronic medical conditions, such as heart disease or lung disease, the symptoms of anemia may be more significant, and a prompt medical evaluation is prudent.
The diagnosis of anemia at home is difficult unless bleeding is obvious. If significant bleeding is clearly evident, as in a severe injury, immediate medical attention is required and one may consider going to the emergency room. Generally, this kind of acute (short onset) anemia is more likely to cause immediate symptoms than chronic (long-lasting) types of anemia.
Many individuals with chronic conditions, such as sickle cell anemia, know when they may be having an attack related to their disease (sickle cell crisis) and may opt to seek medical attention promptly.
Anemia occurs when your blood doesn't have enough red blood cells. This could result if:
Your body doesn't make enough red blood cells
Bleeding causes you to lose red blood cells more quickly than they can be replaced
Your body destroys red blood cells
What red blood cells do
Your body makes three types of blood cells — white blood cells to fight infection, platelets to help your blood clot and red blood cells to carry oxygen throughout your body.
Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body, and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled.
Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.
Many medical conditions cause anemia. Common causes of anemia include the following:
Anemia from active bleeding: Loss of blood through heavy menstrual bleeding or, wounds can cause anemia. Gastrointestinal ulcers or cancers such as cancer of the colon may slowly ooze blood and can also cause anemia.
Iron deficiency anemia: The bone marrow needs iron to make red blood cells. Iron plays an important role in the proper structure of the hemoglobin molecule. If iron intake is limited or inadequate due to poor dietary intake, anemia may occur as a result. This is called iron deficiency anemia. Iron deficiency anemia can also occur when there are stomach ulcers or other sources of slow, chronic bleeding (colon cancer, uterine cancer, intestinal polyps, hemorrhoids, etc). In these kinds of scenarios, because of ongoing, chronic slow blood loss, iron is also lost from the body (as a part of blood) at a higher rate than normal and can result in iron deficiency anemia.
Anemia of chronic disease: Any long-term medical condition can lead to anemia. The exact mechanism of this process in unknown, but any long-standing and ongoing medical condition such as a chronic infection or a cancer may cause this type of anemia.
Anemia related to kidney disease: The kidneys release a hormone called the erythropoietin that helps the bone marrow make red blood cells. In people with chronic (long-standing) kidney disease, the production of this hormone is diminished, and this in turn diminishes the production of red blood cells, causing anemia. This is called anemia related to chronic kidney disease.
Anemia related to pregnancy: Water weight gain during pregnancy dilutes the blood, which may be reflected as anemia.
Anemia related to poor nutrition: Vitamins and minerals are required to make red blood cells. In addition to iron, vitamin B12 and folate are required for the proper production of hemoglobin. Deficiency in any of these may cause anemia because of inadequate production of red blood cells. Poor dietary intake is an important cause of low folate and low vitamin B12 levels. Strict vegetarians who do not take sufficient vitamins are at risk to develop vitamin B12 deficiency.
Pernicious Anemia: There also may be a problem in the stomach or the intestines leading to poor absorption of vitamin B12. This may lead to anemia because of vitamin B12 deficiency known as pernicious anemia.
Sickle cell anemia: In some individuals, the problem may be related to production of abnormal hemoglobin molecules. In this condition the hemoglobin problem is qualitative, or functional. Abnormal hemoglobin molecules may cause problems in the integrity of the red blood cell structure and they may become crescent-shaped (sickle cells). There are different types of sickle call anemia with different severity levels. This is typically hereditary and is more common in those of African, Middle Eastern, and Mediterranean ancestry.
Thalassemia: This is another group of hemoglobin-related causes of anemia. There are many types of thalassemia, which vary in severity from mild (thalassemia minor) to severe (thalassemia major). These are also hereditary, but they cause quantitative hemoglobin abnormalities, meaning an insufficient amount of the correct hemoglobin type molecules is made. Thalassemia is more common in people from African, Mediterranean, and Southeast Asian ancestries.
Alcoholism: Poor nutrition and deficiencies of vitamins and minerals are associated with alcoholism. Alcohol itself may also be toxic to the bone marrow and may slow down the red blood cell production. The combination of these factors may lead to anemia in alcoholics.
Bone marrow-related anemia: Anemia may be related to diseases involving the bone marrow. Some blood cancers such as leukemia or lymphomas can alter the production of red blood cells and result in anemia. Other processes may be related to a cancer from another organ spreading to the bone marrow.
Aplastic anemia: Occasionally some viral infections may severely affect the bone marrow and significantly diminish production of all blood cells. Chemotherapy (cancer medications) and some other medications may pose the same problems.
Hemolytic anemia: The normal red blood cell shape is important for its function. Hemolytic anemia is a type of anemia in which the red blood cells rupture (known as hemolysis) and become dysfunctional. This could happen due to a variety of reasons. Some forms of hemolytic anemia can be hereditary with constant destruction and rapid reproduction of red blood cells (for example, as in hereditary spherocytosis, hereditary elliptocytosis, and glucose-6-phosphate dehydrogenase or G6GD deficiency) . This type of destruction may also happen to normal red blood cells in certain conditions, for example, with abnormal heart valves damaging the blood cells or certain medications that disrupt the red blood cell structure.
Anemia related to medications: Many common medications can occasionally cause anemia as a side effect in some individuals. The mechanisms by which medications can cause anemia are numerous (hemolysis, bone marrow toxicity) and are specific to the medication. Medications that most frequently cause anemia are chemotherapy drugs used to treat cancers. Other common medications that can cause anemia include some seizure medications, transplant medications, HIV medications, some malaria medications, some antibiotics (penicillin, chloramphenicol), antifungal medications, and antihistamines.
Other less common causes of anemia include thyroid problems, cancers, liver disease, autoimmune diseases (lupus), paroxysmal nocturnal hemoglobinuria (PNH), lead poisoning, AIDS, malaria, viral hepatitis, mononucleosis, parasitic infections (hookworm), bleeding disorders, and insecticide exposure. It is noteworthy that there are many other potential causes of anemia that are not included in this list as these are only some of the more common and important ones.
To diagnose anemia, your doctor may recommend:
Physical exam. During a physical exam your doctor may listen to your heart and your breathing. Your doctor may also place his or her hands on your abdomen to feel the size of your liver and spleen.
Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values vary from one medical practice to another, but are 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.
A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.
Additional
tests
If you receive a
diagnosis of anemia, your doctor may order additional tests to
determine the underlying cause. For example, iron deficiency anemia
can result from chronic bleeding of ulcers, benign polyps in the
colon, colon cancer, tumors, or kidney failure. Your doctor may test
for these and other conditions that may underlie the anemia.
Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.
Anemia treatment depends on the cause:
Iron deficiency anemia. This form of anemia is treated with changes in your diet and iron supplements. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.
Vitamin deficiency anemias. Folic acid deficiency anemia is treated with folic acid supplements. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.
Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.
Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells.
Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation.
Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or immune suppressant medications can help suppress your immune system's attack on your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure.
Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors may also recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.
Medications
Medications and treatments that correct the common underlying causes of anemia include the following:
Iron may be taken during pregnancy and when iron levels are low. It is important to determine the cause of iron deficiency and treat it properly.
Vitamin supplements may replace folate and vitamin B12 in people with poor eating habits. In people with pernicious anemia who are unable to absorb sufficient amounts of vitamin B12, monthly injections of vitamin B12 are commonly used to replete the vitamin B 12 levels and correct the anemia.
epoetin alfa (Procrit or Epogen) injection can be used to increase red blood cell production in people with kidney problems. The production of erythropoietin is reduced in people with advanced kidney disease, as described earlier.
Stopping a medication that may be the cause of anemia may also reverse anemia after consultation with a physician.
If alcohol is the cause of anemia, then in addition to taking vitamins and maintaining adequate nutrition, alcohol consumption needs to be stopped.
Self-Care at Home
Very little can be done to self-treat anemia and medical treatment is generally needed. It is important to continue to take any medication that is prescribed for other chronic (long-lasting) medical problems. If the reason for anemia is known, then measures to keep it under control are very important. For example, if anemia is caused by a stomach ulcer, then medications such as aspirin or ibuprofen should be avoided, unless otherwise directed by a doctor.
If left untreated, anemia can cause numerous complications, such as:
Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. You may be too exhausted to work or play.
Heart problems. Anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure.
Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.
Some common forms of anemia are most easily prevented by eating a healthy diet and limiting alcohol use. All types of anemia are best avoided by seeing a doctor regularly and when problems arise. In the elderly, routine blood work ordered by the doctor, even if there are no symptoms, may detect anemia and prompt the doctor to look for the underlying causes.