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Anemia

DEFINITION

Anemia is the medical term used to describe low red blood counts. Blood is made of several components including white blood cells, red blood cells, platelets and plasma. The white blood cells have the job of fighting infection. The platelets have the job of helping stop bleeding. The plasma is the fluid part of blood that allows it to flow. The red blood cells are the cells that have a structure called hemoglobin which collects oxygen in the lungs and delivers it to the rest of the body as well as carry waste carbon dioxide from the body back to the lungs where you can exhale it. Anemia means that you do not have enough of the red blood cells in your body to carry blood to your tissues adequately. As you can imagine, this has effects all over the body as all of your tissues use oxygen. Anemia can range anywhere from mild (where you may not have any symptoms at all) to severe (causing you to pass out or even die). Anemia has many different causes ranging from producing too few red blood cells to losing blood cells from a bleeding source to destroying the blood cells. The most common form of anemia is iron deficiency anemia which is caused by having too little iron in the body. Generally, this iron is lost through bleeding somewhere in the body, but can also be too low due to dietary deficiencies. Deficiencies in other vitamins, specifically folate and vitamin B12, can cause decreased red blood cell production. Sometimes anemia is caused by certain chronic diseases such as cancer, kidney disease, rheumatologic disorders, HIV, inflammatory bowel diseases. A more rare type of anemia is aplastic anemia which is caused by malfunction of the bone marrow (where all blood cells are normally made) causing a decrease of red blood cells, white blood cells and platelets. Other diseases that affect the bone marrow can also cause anemia, like cancers, multiple myeloma or myelodyspasia. Anemia caused by destruction is called hemolytic anemia which can be caused by disorders where the body attacks itself (autoimmune disorders) or medications. Some genetic conditions like G6PD deficiency can make you more prone to hemolytic anemia. Another type of anemia is sickle cell anemia, which is a disorder caused by an abnormal form of hemoglobin that makes blood cells less stable and more likely to break. People of African, Mediterranean, and Arabic descent are more likely to have this type of anemia. Many other types of anemia, like alpha – and beta-thalassemia and other types of anemia resulting from defective hemoglobin. Other factors that make you have an increased risk of anemia include inadequate diet (especially those low in vitamins and minerals), intestinal conditions that prevent absorption of nutrients (like Crohn’s or celiac disease), menses (especially heavy menses), pregnancy, chronic disease, family history of inherited types of anemia, heavy use of alcohol, and people who follow a strict vegetarian diet. If not treated, anemia can have severe ramifications for the body including severe fatigue, arrhythmias (abnormal and sometimes life-threatening heartbeats), congestive heart failure, and even death.

SYMPTOMS
Feeling tired or fatigued, dizziness, shortness of breath, fast or irregular heartbeat, pale skin (pallor), difficulty thinking, chest pain, coldness in the hands and feet, headache

DIAGNOSIS
After a careful history and physical exam, your doctor will order some blood tests including a count of your red blood cells (called a hemoglobin or hematocrit) and the size of the red blood cells as well as a smear of your blood cells looked at under a microscope (called a peripheral smear) to look for any abnormalities in the cells including small size or abnormal shape. Surprisingly, these few tests can tell your doctor a great amount about the cause of your anemia. Your doctor may order additional blood tests, like iron studies, folate levels, and vitamin B12 levels. If not cause can be found for your anemia or the bone marrow is the suspected source, your doctor or hematologist (blood doctor) may recommend a bone marrow biopsy. This procedure involves putting a small needle into the hip bone to get a sample of the bone marrow and is done with local anesthesia. If you are found to have iron deficiency anemia, your doctor will try to find the source of your bleeding which may involve having a colonoscopy and upper endoscopy (both of which are scopes with cameras to look at the inside of the digestive tract to find source of bleeding like ulcers or polyps).

TREATMENT
The treatment of anemia depends on what type of anemia you have. If you have iron deficiency anemia, a source of bleeding needs to be found as described in the diagnosis section. Your doctor will likely have you start taking iron supplements to help your body produce more red blood cells. He or she may also recommend trying other medications, like birth control pills for heavy menses, or treatments to decrease your bleeding which can even include surgery to remove the source of the bleeding. If you have anemia cause by folate or vitamin B12 deficiency, your doctor will recommend changing your diet, taking supplements of either folate or vitamin B12, and decreasing your alcohol intake. You may even need injections of vitamin B12 if the problem is absorption of vitamin B12 in the digestive tract (pernicious anemia). If you have anemia of chronic disease, treating the underlying disease will help your anemia. Sometimes, your doctor may choose to give you injections of erythropoietin, a substance produced by the kidneys which stimulates red blood cell production. If you have aplastic anemia, you may need blood transfusions to bring your red blood cell count back up. Your doctor may also recommend treating yout bone marrow abnormality with drugs that block your immune system or even bone marrow transplantation. If you have a problem in your bone marrow, like leukemia, you may need treatment like chemotherapy. If you have hemolytic anemia, your doctor will work to change your medications around to see if any of them are the culprits, and treat infections or underlying cause of the blood breakdown. If you have an enlarged spleen that is causing your anemia, you may have the option of having surgery to remove your spleen. If sickle cell disease is the cause of your anemia, you may need oxygen, pain medication, and IV fluids as well as blood transfusion. For whatever type of anemia you have, you will need to discuss your treatment options with your doctor and likely a hematology specialist.

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