Anemia means lack of blood in the body. This disorder occurs in the body when red blood cells (RBC) count decreases in body. Red blood cells contain a proteinaceous compound bounded by iron. It is known as hemoglobin. As the name also suggest, hemoglobin is composed of two things, heme - the iron compound and globin- the protein part. The main and the foremost utility of hemoglobin in body is to carry oxygen from lungs and then supply it to the various tissues of the body. It is also responsible in imparting red color to our blood. Formation of the hemoglobin very much depends on the amount of proper and nutritive diet intake. There may also be some pathological conditions which also effects the hemoglobin formation. Normal values of hemoglobin vary from 13 to 16 mg/dl in adult male and 11 to 15 mg/dl in normal adult female.
Classification of anemia:
1. Aplastic anemia: It is the condition in the body when production of red blood cells ceases.
2. Megaloblastic anemia: An anemic condition caused by vitamin deficiency specially folic acid and vitamin B12 deficiency. This condition effects the proper production of hemoglobin and the hemoglobin formed is weak in nature. This weak hemoglobin lacks the capability of carrying the oxygen properly hence leads to anemia.
Iron deficiency anemia: The most common category of anemia countered world wide. It occurs due to less amount of oxygen in body due various factors like dietary, metabolic etc.
Pernicious anemia: This type of anemia occur when the body is not able to absorb cyanacobalamin i.e. vitamin B12 which is extremely important in production of hemoglobin.
Inherited anemia: This is a condition which is been passed on through gene in a family. The common types of the disease that are included in this category are: Sickle cell anemia: In this the cells shapes like sickle which is incapable of carrying oxygen thus depriving the body tissue from being supplied with the required nutrition and oxygen.
Thalassemia: This is the condition in which codons lack the certain genes that are very essential for formation of hemoglobin.
Diseased condition: Certain diseased conditions like that of kidneys, liver etc are some times responsible in the decreased production of red blood cells hence leading to anemia.
A person with anemia will feel tired and weak because the body's tissues are being starved of oxygen. In fact, fatigue is the main symptom of most types of anemia. The severity of symptoms is in part related to the severity of anemia. Mild anemia can occur without symptoms and may be detected only during a medical exam that includes a blood test.
Symptoms of anemia include:
5. Heart palpitations (rapid or irregular beating).
8. Ringing in the ears (tinnitus).
9. Difficulty sleeping.
10. Difficulty concentrating.
Common signs include:
1. Pale complexion.
2. The normally red lining of the mouth and eyelids fades in color
3. Rapid heartbeat (tachycardia).
4. Abnormal menstruation (either absence of periods or increased bleeding)
Other signs depend on the cause of the anemia. These can include spoon-shaped finger nails and toenails in iron-deficiency anemia, mild jaundice in hemolytic anemias, and leg ulcers in sickle cell anemia.
Very little can be done to self-treat anemia, 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.
Medical treatment of anemia varies widely and depends on the cause and the severity of anemia. If anemia is mild and associated with no symptoms or minimal symptoms, a thorough investigation by a doctor will be done in the outpatient setting. If any cause is found, then treatment will be started. For example, if anemia is mild and is found to be related to low iron levels, then iron supplements may be given during further investigation to determine the cause of the iron deficiency is carried out.
On the other hand, if anemia is related to sudden blood loss from an injury or a rapidly bleeding stomach ulcer, then hospitalization and transfusion of red blood cells may be required to relieve the symptoms and replace the lost blood. Further measures to control the bleeding may occur at the same time to stop further blood loss.
Blood transfusion may be required in other less critical circumstances as well. For example, an individual who is receiving chemotherapy for a cancer may be expected by the treating physician to have bone marrow problems related to the chemotherapy. Therefore, the doctor may check blood counts routinely, and if the levels get to a low enough level, he or she may order a red blood cell transfusion to help with the symptoms of anemia.
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.
There are no specific surgical interventions for the treatment of anemia. However, depending on the causes of the anemia, surgery may be a treatment option. For example, if colon cancer or uterine cancer that slowly bleeds is the cause of anemia, then surgical removal of the cancer would potentially treat the anemia.
Causes and Risk factors:
Blood Loss: When you lose blood, you lose iron. If you don't have enough iron stored in your body to make up for the iron loss, you'll develop iron-deficiency anemia. In women, low iron levels may be due to blood loss from long or heavy menstrual periods or bleeding fibroids in the uterus. Blood loss that occurs during childbirth is another cause for low iron levels in women.
Internal bleeding (bleeding inside the body) also may lead to iron-deficiency anemia. This type of blood loss isn't always obvious, and it may occur slowly.
Some causes of internal bleeding are:
1. A bleeding ulcer, colon polyp, or colon cancer.
2. Regular use of aspirin or other pain medicines, such as nonsteroidal anti-inflammatory drugs (for example, ibuprofen and naproxen)
3. Urinary tract bleeding.
4. Blood loss from severe injuries, surgery, or frequent blood drawings also can cause iron-deficiency anemia.
The best sources of iron are meat, poultry, fish, eggs, and iron-fortified foods (foods that have iron added). If you don't eat these foods regularly, or if you don't take an iron supplement, you're more likely to get iron-deficiency anemia.
Vegetarian diets can provide enough iron if the right foods are eaten. For example, good non-meat sources of iron include spinach and other dark green leafy vegetables, certain types of beans, dried fruits, and iron-fortified breads and cereals.
During some stages of life, such as pregnancy and childhood, it may be hard to get enough iron in your diet. This is because your need for iron increases during these times of growth and development.
Inability to Absorb Enough Iron: Even if there's enough iron in your diet, your body may not be able to absorb it. This may be due to intestinal surgery or diseases of the intestine, such as Crohn's disease or celiac disease.
Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures. Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you.
Mild to moderate iron-deficiency anemia may have no signs or symptoms. Thus, you may not know you have it unless your doctor discovers it from a screening test or while checking for other problems.
Primary care doctors often diagnose and treat iron-deficiency anemia. These doctors include pediatricians, family doctors, gynecologists/obstetricians, and internal medicine specialists. A hematologist (a blood disease specialist), a gastroenterologist (a digestive system specialist), and other specialists also may help treat iron-deficiency anemia.
Physical Exam: Your doctor will do a physical exam to look for signs of iron-deficiency anemia. He or she may look at your skin, gums, and nail beds to see whether they're pale or yellowish.
Listen to your heart for a rapid or irregular heartbeat.
Listen to your lungs for rapid or uneven breathing.
Feel your abdomen to check the size of your liver and spleen.
Do a pelvic and rectal exam to check for internal bleeding.
Diagnostic Tests and Procedures:
Complete Blood Count: Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many different parts of your blood.
This test checks your hemoglobin and hematocrit levels. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of infection, a blood disorder, or another condition.
Finally, the CBC looks at mean corpuscular volume (MCV). MCV is a measure of the average size of your red blood cells. The results may be a clue as to the cause of your anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than normal.
Other Blood Tests:
If the CBC results confirm you have anemia, you may need other blood tests to find out what's causing the condition, how severe it is, and the best way to treat it.
A reticulocyte count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate.
Your doctor also may order a peripheral smear. For this test, a sample of your blood is examined under a microscope. In people who have iron-deficiency anemia, the red blood cells will look smaller and paler than normal.
Your doctor may recommend tests to measure iron levels in your blood and body. These tests can show how much iron has been used from your body's stored iron. These tests include:
Serum iron: This test measures the amount of iron in your blood. The level of iron in your blood may be normal even if the total amount of iron in your body is low. For this reason, other iron tests also are done.
Serum ferritin: Ferritin is a protein that helps store iron in your body. A measure of this protein helps your doctor find out how much of your body's stored iron has been used up.
Transferrin level or total iron-binding capacity: Transferrin is a protein that carries iron in your blood. Total iron-binding capacity measures how much of the transferrin in your blood isn't carrying iron. If you have iron-deficiency anemia, you'll have a high level of transferrin that has no iron.
Tests and Procedures for Gastrointestinal Blood Loss: To check whether internal bleeding is causing your iron-deficiency anemia, your doctor may suggest a fecal occult blood test. This test looks for blood in the stools and can detect bleeding in the intestines. If the test finds blood, you may have other tests and procedures to find the exact spot of the bleeding. These tests and procedures may look for bleeding in the stomach, upper intestines, and colon or pelvic organs.
Medicine and medications:
1. Dexamethasone oral, Decadron, DexPak.
2. Epoetin alfa, Epogen, Procrit.
3. Folic acid-oral, FA-8.
4. Iron supplements-oral, Femiron, Feosol, Fer-In-Sol.
5. Iron with ascorbic acid-oral chewable tablet, Hemocyte-C, Vitron-C.
6. Iron with ascorbic acid-oral sustained release, Fero-Folic, Fero-Grad.
7. Iron with ascorbic acid-oral tablets capsules, Ferralet Plus, Polytinic, and Tolfrinic.
8. Iron with stool softener-oral sustained release capsule, tablet.
9. LEUPROLIDE-INJECTION, Lupron.
10. Prednisolone, Pediapred Oral Liquid, Medrol.
11. SARGRAMOSTIM-INJECTION, Leukine.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.