Anemia develops when something disturbs the maturation of oxygen-carrying red blood cells.
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Staying Red-Blooded and Healthy
Overwhelming fatigue is often the first obvious sign of anemia. Jodi had been running for years, but since she began having trouble with irregular menstrual bleeding in her mid-40s, her regular running routine, previously a source of pleasure, seemed like an insurmountable obstacle. Jim, in his early 60s and nearing the end of chemotherapy for colon cancer, felt barely able to drag himself out of bed, even though he was making good progress.
Both Jodi and Jim are among an estimated 4.5 million Americans suffering from anemia, a condition rather than a disease. In fact anemia can be caused by a broad range of disorders, including kidney disease, blood loss and inherited conditions.
Anemia develops when something disturbs the maturation process of red blood cells, reducing their overall numbers or when something interferes with the oxygen-carrying capacity of red blood cells.
The main job of red blood cells (called erythrocytes) is to carry oxygen to the body’s tissues and then to return carbon dioxide back to the lungs so it can be expelled from the body.
A healthy blood supply depends on continuous cell replacement. New blood cells are produced in the bone marrow, replacing old ones at the rate of about one percent per day. The life span of a red blood cell is about 120 days.
To grow and mature, red blood cells need erythropoietin, a protein manufactured by the kidneys, as well as many other factors including amino acids, iron, folic acid and vitamin B12. When any of these factors is in short supply, either because of dietary inadequacies or because the body isn’t processing them efficiently, anemia can develop.
When Blood Lacks Iron
Most people recognize the importance of iron to healthy blood. Iron is necessary to form hemoglobin, the oxygen-carrying component of blood. Iron-deficiency anemia can occur in teens and adult women who have heavy menstrual periods. An estimated 15 percent of menstruating women have iron deficiency anemia, and it’s particularly common among women of South Asian origin.
Other causes of chronic bleeding can also lead to iron deficiency anemia. Gastrointestinal bleeding from peptic ulcers, esophagitis, cancer and inflammatory bowel disease can all cause blood loss and eventually overwhelm the body’s blood-making capacity.
Iron deficiency anemia can also develop when the diet is iron poor. This can occur in the elderly, persons who live in poverty and those who follow very restricted vegetarian or vegan diets.
Symptoms of iron-deficiency anemia include fatigue, pallor, dizziness, weakness and shortness of breath. A rapid heart beat can develop as the condition becomes more serious.
Anemia can be caused by a range of disorders, including kidney disease, blood loss or inherited conditions.
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A blood test can identify iron deficiency, and it can be treated with iron supplements. Depending on a patient’s age and symptoms, other tests may be needed to identify the underlying cause. Jodi’s anemia was caused by heavier than normal menstrual periods plus bleeding from a benign fibroid tumor. In addition to treatment with iron supplements, she was referred to a gynecologist for hormone therapy to alleviate the heavy menstrual periods and surgical removal of the fibroid tumor.
It is estimated that about 25 percent of all cases of anemia are the result of iron deficiency. Iron deficiency anemia is also the most common form of anemia in children.
With prompt diagnosis and treatment of anemia, a tired, pallid person readily reverts to her healthy red-blooded self.
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Other common nutritional anemias, including vitamin B12 and folate deficiency, can usually be treated with nutritional counseling and supplements. Folic acid deficiency is becoming far less common now that folate supplementation of many common food products has been mandated. The intent of the mandate was to protect the developing fetus by ensuring that women of childbearing age would have adequate levels prior to pregnancy. The result is a benefit to the general population.
Low vitamin B12 levels can occur due either to failed absorption or inadequate intake. Because all foods of animal origin contain vitamin B12, vegans and vegetarians face an added risk that they can offset by adding a supplement to their diet.
When anemia doesn’t respond to iron or vitamin supplements, physicians can prescribe a synthetic form of the human growth factor, erythropoietin. Epoetin alfa (sold under the trade names Epogen, Procrit) is structurally identical to the naturally occurring form.
The drug is frequently used to treat patients with anemia as a result of dialysis, chronic kidney failure, chemotherapy, and HIV/AIDS treatment. Treating anemia, which is a secondary problem in these patients, helps to preserve their quality of life.
A 2002 survey of 1275 cancer survivors found that 60 percent said bone-deep exhaustion was the worst side effect of chemotherapy that they experienced. Jim’s experience reflected that of other chemo patients. Like many others Jim was reluctant to complain, saying that he expected unpleasant side effects from chemotherapy.
Finally, at his wife’s insistence, he talked to his doctor about his continuing exhaustion. Within a couple of weeks of starting his prescription for epoetin alfa as well as iron supplements, Jim said he finally felt like a man with a good prognosis.
Anemia is a common problem for patients with congestive heart failure, rheumatoid arthritis and chronic kidney disease. One recently published study of persons who had anemia and impaired kidney function found that their risk of stroke increased more than seven fold, compared with individuals with normal kidney function and no anemia. Neither anemia alone nor kidney disease alone was associated with a significantly increased stroke risk, underlining the benefit of identifying and treating anemia in this population.
Anemia is a common and usually treatable problem. Left untreated it can sap energy and eventually lead to serious complications. More importantly, anemia is often a sign of an underlying problem such as an undiagnosed stomach ulcer, cardiovascular disease, diabetes or a factor interfering with the production of a healthy blood supply. With prompt diagnosis and treatment of anemia, a tired, pallid person readily reverts to her healthy red-blooded self.
REFERENCES:
“At a Glance– Iron Deficiency Anemia,” GP, April 28, 2003.
James Bergin, “Anemia: A Strategy for the Workup,” Consultant, June 2002.
James Bergin, “Anemia: Discerning the Cause in Different Clinical Settings,” Consultant, June 2002.
Annette Carley, “Anemia: When Is It Not Iron Deficiency?” Pediatric Nursing, May–June, 2003.
Edward J. Fitzsimmons and Roger Sturrock, “The Chronic Anemia of Rheumatoid Arthritis,” The Lancet, November 30, 2002.
“Getting the Iron Out,” Science News, January 4, 2003.
Timothy Kirn, “Anemia Due to GI Ills in Premenopausal Women,” Internal Medicine News, October 15, 2002.
Jordan Matus, “Tired All the Time,” Prevention, May 2003.
Heidi Splete, “Drug Update: Anemia,” Family Practice News, May 1, 2003.
G.L.Stark and P.J. Hamilton, “Dietary Folate Deficiency with Normal Red Cell Folate and Circulating Blasts,” Journal of Clinical Pathology, April 2003.
Beatrice Turkoski, “Tired Blood: Part 1,” Orthopaedic Nursing, May–June, 2003.
Kerry Wachter, “Anemia Common in CHF Patients,” Family Practice News, March 15, 2003.
Mitchel Zoler, “Anemia Plus Renal Disease Boosts Stroke Risk: New Risk Factor,” Internal Medicine News, April 1, 2003.
