Anemia

Anemia, from Greek meaning „without blood“, is a deficiency of red blood cells and/or hemoglobin. Hemoglobin is an iron-rich protein that gives the red color to blood-carries oxygen from the lungs to the rest of the body.
This insufficiency of red blood cells (or hemoglobin) results in a reduced ability of blood to transfer oxygen to the tissues, causing tissue hypoxia. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences. Anemia is the most common disorder of the blood.

Main types of anemia are:

• excessive blood loss (hemorrhage, chronically through low-volume loss, ulcers, hemorrhoids, gastritis and cancer, menstruation, childbirth)
• excessive red blood cells destruction (hemolysis)
• inadequate (decreased or faulty) red blood cell production (aplastic anemia, physiologic anemia of infancy, ineffective hematopoiesis, iron deficiency anemia, sickle cell anemia)

Among many other causes, anemia can result from inherited disorders, nutritional problems, infections, some kinds of cancer, injury, or exposure to a drug or toxin.
In menstruating women, dietary iron deficiency is a common cause of deficient red blood cell production. 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.

Signs and symptoms
Anemia goes undetected in many people, and symptoms can be vague. Also the symptoms of anemia vary according the type of anemia, the underlying cause and the underlying health problems. The most common symptoms are:

• feeling of weakness or fatigue
• irritability, behavioral disturbances (decreased motor activity, problems with social interaction and attention to tasks)
• paleness
• cold hands and feet, low body temperature
• headaches
• brittle nails
• inflammation and soreness of the tongue
• general malaise and sometimes poor concentration
• poor appetite, especially in infants and children with iron deficiency anemia
• dizziness, lightheadedness, and a rapid heartbeat
• jaundice, a yellowing of the whites of the eyes
• an enlarged spleen
• dark tea-colored urine
• some people experience restless legs syndrome
• dyspnea on exertion (shortness of breath) – in severe cases
• cardiac output, leading to palpitations and sweatiness, and to heart failure – in very severe cases

In addition, tolerance of anemia is proportional to the anemia's rate of development. Symptoms and mortality associated with rapidly developing anemia are more profound than in slowly developing anemia.

Diagnosis
Generally, clinians request complete blood counts in the first batch of blood tests in the diagnosis of a suspected anemia (the size and color of the red blood cells). Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Normal levels of hemoglobin range between 11.1 and 15.0 grams per deciliter (g/dL). A lower than normal hemoglobin level indicates anemia. For women a low level is less than 10 g/dL, and for men a low level is less than 12 g/dL.
Examination of a stained blood smear using a microscope can also be helpful, and is sometimes a necessity in regions of the world where automated analysis is less accessible.
When the cause is not obvious, clinicians use other tests: ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12, hemoglobin electrophoresis, renal function tests, endoscopy, colonoscopy.
When the diagnosis remains difficult, a bone marrow examination allows direct examination of the precursors to red cells.
In addition to running these tests, doctor have to ask about a family history of anemia and the symptoms and medications.

Anemia and pregnancy
Anemia affects 20% of all females of childbearing age. Because of the subtlety of the symptoms, women are often unaware that they have this disorder, as they attribute the symptoms to the stresses of their daily lives. Possible problems for the fetus include increased risk of growth retardation, prematurity, intrauterine death, rupture of the amnion and infection.
During pregnancy the body demands more iron because of the growing needs from the fetus, the higher volume of blood, and blood loss during delivery.
During pregnancy, women should be especially aware of the symptoms of anemia, as an adult female loses an average of two milligrams of iron daily. Therefore, she must intake a similar quantity of iron in order to make up for this loss. Additonally, a women loses approximately 500 milligrams of iron with each pregnancy, compared to a loss of 4-100 milligrams of iron with each period. Possible consequences for the mother include cardiovascular symptoms, reduced physical and mental performance, reduced immune function, tiredness, reduced peripartal blood reserves and increased need for blood transfusion in the postpartum period.

Tips:

• make sure you get 27 mg of iron every day; take an iron supplement, it may be part of the prenatal vitamin, start taking it at the first prenatal visit
• get tested for anemia at the first prenatal visit

Diet and anemia
Consumption of food rich in iron is essential to prevention of iron deficiency anemia. The most richest sources of iron are:

• seafood (sardines, clams, oysters)
• fortified dry bread and cereals
• whole grains
• dried fruits (apricots, prunes, raisins)
• organ meat (liver, giblets)
• soybeans (mature, cooked)
• pumpkin and squash seed kernels (roasted)
• white beans (lima beans)
• blackstrap molasses
• lentils (cooked)
• green leafy vegetables (spinach, broccoli - cooked from fresh
• beef (chuck, rib)
• kidney beans
• chickpeas
• duck (meat only)
• lamb shoulder
• juices
• nuts
• baked potato with skin

Certain foods have been found to interfere with iron absorption in the gastrointestinal tract, and these foods should be avoided in persons with established iron deficiency. They include tea, coffee, wheat bran, egg yolks, rhubarb, chocolate, chewing gum, red wine, and milk.

In vegetarians the iron supply depends on the diet. Since it is easier to get iron from meat than from plant-derived foods, some vegetarians may need to take a higher amount of iron each day than what is recommended for other people. Vegetarians has to follow tips to prevent anemia, and try take vitamin C with other iron-rich foods.

Treatment
There are many different treatments for anemia and the treatment depends on severity and the cause.
Iron deficiency from nutritional causes is rare in non-menstruating adults (men and post-menopausal women). The diagnosis of iron deficiency mandates a search for potential sources of loss such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron deficiency anemia is treated by iron supplementation with oral ferrous sulfate or ferrous gluconate. Vitamin C may aid in the body´s ability to absorb iron. Corticosteroids are useful in the treatment of autoimmune hemolytic anemia.
In anemia of chronic disease, anemia associated with chemotherapy, or anemia associated with renal disease, some clinicians prescribe recombinant erythropoietin, epoetin alfa, to stimulate red cell production.
In severe cases of anemia, or with ongoing blood loss, a blood transfusion may be necessary.
Surgery is useful to control bleeding in patients who are anemic. Patients should be hemodynamically stable before and during surgery.
Splenectomy is useful in the treatment of autoimmune hemolytic anemias and in certain hereditary hemolytic disorders.
Bone marrow and stem cell transplantation have been used in patients with leukemia, lymphoma, Hodgkin disease, multiple myeloma, myelofibrosis, and aplastic disease.

Today, research on anemia is looking a new treatments for the disease. Researchers also are looking for a way to predict the severity of the condition.