Anemia

Anemia Overview

Anemia happens when you do not have enough red blood cells and the number of red blood cells circulating in the body decreases. Healthy red blood cells helps carry adequate oxygen to the body’s tissues. The red blood cells travel with iron and hemoglobin, which is a protein that helps carry oxygen through the bloodstream to the organs all around the body.

Anemia is a condition where the body either cannot make enough healthy red blood cells and/or has too little hemoglobin, the substance that enables red blood cells to transport oxygen around the body. WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anemic.

The hemoglobin levels chart below outlines normal hemoglobin ranges according to the World Health Organization:

6 months to 4 years: At or above 11 g/dL
5-12 years: At or above 11.5 g/dL
12-15 years: At or above 12 g/dL
Adult male: 13.8 to 17.2 g/dL
Adult female: 12.1 to 15.1 g/dL
During pregnancy: At or above 11g/dL

Anemia is the most common blood disorders, it can make you feel tired and weak. Anemia often develops as a result of other health issues that interfere with the body’s production of healthy red blood cells (RBCs) or increase the rates of the breakdown or loss of these cells.

Anemia occurs when there are not enough healthy red blood cells to carry oxygen to the body’s organs. As a result, it’s common to feel cold and symptoms of fatigue, tiredness or weakness. There are many different types of anemia, but the most common type is iron-deficiency anemia. Iron is a mineral that is important not only to all the cells in our body, but it is especially important to red blood cells. Red blood cells make hemoglobin, which carries oxygen to the tissues in our bodies.

Normal Iron levels are 40-150 ug/dL (female) and 50-160 ug/dL (male). Normal values may vary from laboratory to laboratory. Iron deficiency anemia occurs when there is a lack of iron in your body, causing primarily a low hemoglobin concentration.

When someone develops anemia, they are classified to be “anemic.” Being anemic might mean that you feel more tired and fatigued or cold than you usually do, or if your skin seems too pale. This is due to your organs not receiving the oxygen they need to do their jobs.

Anemia is associated with increased morbidity and mortality in older adults, anemia is often asymptomatic and discovered incidentally on laboratory testing. Causes of anemia in older adults include nutritional deficiency, chronic kidney disease, chronic inflammation, and occult blood loss from gastrointestinal malignancy, although in many patients the etiology is unknown.

Types of Anemia

There are many different types of anemia. These include, but are not limited to:

Anaplastic Anemia
Iron Deficiency Anemia
Sickle Cell Anemia
Thalassemia
Vitamin Deficiency Anemia
Hemolytic anemia, caused by red blood cells being destroyed at an increased rate
Megaloblastic anemia, often caused by a vitamin B12 deficiency or folic acid deficiency

Anemia is broadly classified as macrocytic, microcytic or normocytic, depending on the size and volume of the red blood cells (erythrocytes):

Macrocytic anemia: In this category of anemia, the red blood cells are larger than normal. This includes anemia caused by vitamin B12 deficiency or folate deficiency.
Microcytic anemia: In this category of anemia, the red blood cells are smaller than normal. This includes anemia caused by iron deficiency, thalassemia or sickle cell disease.
Normocytic anemia: In this category of anemia, the red blood cells are normal in size, but fewer than normal in number. This includes anemia caused by chronic conditions, e.g. kidney disease.

Causes of Anemia

The most common cause of iron deficiency are nutritional deficiencies bleeding or blood loss, usually from the gastrointestinal tract. Other causes include a lack of iron in the diet, or changes in the body due to pregnancy.

There are many possible causes of anemia. These include:

Dietary deficiencies of essential vitamins and minerals, such as vitamin B 12, folic acid and iron
Malabsorption of nutrients, e.g. in Celiac disease, Crohn’s disease
Substantial blood loss, e.g. from heavy menstruation or inflammatory bowel disease
Bone marrow problems and leukemia
Certain chronic conditions, e.g. Rheumatoid Arthritis, kidney disease (anemia of chronic disease)
Certain genetic disorders, e.g. Thalassemia
and Sickle Cell Disease
Certain infections, e.g. Malaria
Certain medications and therapies, e.g. some types of painkillers, antibiotics, drugs for hyperthyroidism and cancer treatments
Periods where the body needs more energy than usual, such as puberty and pregnancy

Signs and Symptoms of Anemia

Regardless of the type or cause of, common symptoms of anemia include:

Weakness (Tiredness and lethargy)
Breathlessness (shortness of breath)
Fast or irregular heartbeat (tachycardia)
Fatigue
Dizziness
Faintness
Weakness
Headache

Other less common symptoms of anemia may include:

Paleness (yellow skin)
Chest Pain
Cold hands or feet
Palpitations (the feeling that the heart is skipping a beat)
Pounding or “whooshing” in ears
Tinnitus (ringing in the ears)
Muscle cramps
Loss of appetite
Altered sense of taste

There may also be other symptoms, depending on the type of anemia. For example, iron deficiency anemia may cause wounds to heal slowly and brittle nails. VItamin-B12 deficiency anemia may cause pins and needles, confusion, fatigue and depression.

Risk Factors of Anemia

Many people are at risk for anemia because of poor diet, intestinal disorders, chronic diseases, infections, and other conditions. Women who are menstruating or pregnant and people with chronic medical conditions are most at risk for this disease. The risk of anemia increases as people grow older.

Patients with the following chronic conditions might be at greater risk for developing anemia:

Rheumatoid arthritis or other autoimmune diseases
Kidney disease
Cancer
Liver disease
Thyroid disease
Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

The signs and symptoms of anemia can easily be overlooked. In fact, many people do not even realize that they have anemia until it is identified in a blood test.

Diagnosis of Anemia

As the first step, a doctor will typically take the person’s medical history and perform a physical examination. They may then order a complete blood test to check:

Hemoglobin levels and red blood cell size (complete blood count)
Vitamin B12 and folic acid levels
Kidney function

The doctor may also ask for the following additional tests to be performed:

Urine tests
Stool (feces) tests
A bone marrow biopsy, removing a small sample for examination
A gastroscopy or colonoscopy to examine the digestive tract

As effective treatment of anemia depends on identifying the cause, the doctor will attempt to establish and identify the underlying causes of anemia. Further clinical investigation and tests may be required if the cause is not clear.

Treatment of Anemia

The treatment recommended for anemia depends on the underlying cause. In cases of iron or vitamin deficiency, treatment will typically involve dietary changes and sometimes the use of supplements or medications. In less common types of anemia, as well as severe cases, more complex approaches, such as blood transfusions, may be needed.

The outlook depends on the type, cause and severity of anemia, as well as the age and overall health of the person; but with appropriate and timely treatment, recovery or effective management can be expected in many cases. If left untreated, anemia can lead to complications, including reduced ability to function, lower quality of life, lung problems and even heart failure.

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