ANAEMIA
Anaemia is a condition that affect many people worldwide. It is estimated that one (1) in five (5) menstruating women are anaemic. Anaemia is caused when you don’t have enough red blood cells (RBCs) or haemoglobin – the part of your RBCs that carries oxygen – to meet your body’s needs. . If you have anaemia, you may not have any symptoms at all. If you do have symptoms, they’ll differ depending on the type of anaemia that you have. Some general symptoms of anaemia include feeling tired, weak, dizzy and short of breath. It could also precipitate chest pain. To treat anaemia you have to treat the underlying cause. Your treatment will therefore differ depending on the type that you have.
You may get anaemia because:
If you are a senior, look for ways to keep yourself healthy, strong and flexible. Staying healthy is an important way for you to keep your independence. There are five determinants that play key roles in healthy aging:
your body doesn’t have enough vitamins and minerals that it needs to make haemoglobin
your body makes red blood cells that don’t work properly
your red blood cells are destroyed or lost from your body - for example, when you bleed
What is Anaemia?
Anaemia is a deficiency in the number or quality of red blood cells. The red blood cells carry oxygen around the body, using a particular protein called haemoglobin. Anaemia means that either the level of red blood cells or the level of haemoglobin is lower than normal.
When a person is anaemic, their heart has to work harder to pump the quantity of blood needed to get adequate oxygen around their body. During heavy exercise, the cells may not be able to carry enough oxygen to meet the body’s needs and the person can become exhausted.
Anaemia isn’t a disease in itself, but a result of a malfunction somewhere in the body. This blood condition is common, particularly in females. Some estimates suggest that around one in five menstruating women and half of all pregnant women are anaemic.
Red blood cells explained
Blood cells are produced in the bone marrow. You need certain nutrients in your diet to make and maintain red blood cells. Each red blood cell contains a protein called haemoglobin. This protein gives red blood cells their characteristic colour. Oxygen molecules attach themselves to haemoglobin. The body’s cells need oxygen to live and perform their various duties. The bone marrow needs enough dietary iron and some vitamins to manufacture haemoglobin. If you don’t have enough iron in your diet, the body will draw on the small reserves of iron stored in your liver. Once this reservoir is depleted, the red blood cells will not be able to carry oxygen around the body effectively.
Causes of anaemia
Anaemia can have many causes, including:
Dietary deficiency – lack of iron, vitamin B12 or folic acid in the diet.
Malabsorption – where the body is not able to use the nutrients in the diet, caused by conditions such as coeliac disease.
Inherited disorders – such as thalassaemia or sickle cell disease.
Autoimmune disorders – such as autoimmune haemolytic anaemia, where the immune cells attack the red blood cells and decrease their life span.
Chronic diseases – such as rheumatoid arthritis and tuberculosis.
Hormone disorders – such as hypothyroidism.
Bone marrow disorders – such as cancer or infection.
Blood loss – due to trauma, surgery, cancer, peptic ulcer, heavy menstruation, bowel cancer or frequent blood donations.
Drugs and medications – including alcohol, antibiotics, anti-inflammatory drugs or anti-coagulant medications.
Infection – such as malaria and septicaemia, which reduce the life span of red blood cells.
Periods of rapid growth or high energy requirements – such as puberty or pregnancy.
Types of Anaemia
Anaemia is caused when you don’t have enough red blood cells (RBCs) or haemoglobin – the part of your RBCs that carries oxygen – to meet your body’s needs. There are many different types of anaemia, which are all caused by different things. Some of the different types of anaemia are outlined below.
Iron deficiency anaemia
This type of anaemia is the most common and happens if your body doesn’t have enough iron. Your body needs nutrients like iron to make something called haemoglobin. Haemoglobin is a key part of your RBCs and without it, they can’t work properly. You may become deficient in iron if:
you lose a lot of blood
you’re not getting enough iron in the foods that you’re eating
your body is using more iron than usual - for example, if you’re pregnant
Treatment
If you’re iron deficient, it’s important to find out why this may be so you can get the right type of treatment. Some people have iron deficiency anaemia because they aren’t getting enough iron from the foods they eat. If this is the case, you can start to make a difference at home by eating foods rich in iron. These include:
dark green vegetables - for example, spinach or chard
red meat
apricots
prunes
raisins
Your family doctor may also recommend that you take iron supplements. Side-effects of taking iron supplements may include constipation, heartburn, nausea, tummy (abdominal) pain or diarrhea. If you have these side-effects contact your doctor or pharmacist for advice. You may need a lower dose or a different type of iron supplement. If this type of iron supplement isn’t working, or you can’t tolerate the effects, you may be offered treatment with iron injections.
If this isn’t the case, you may need further tests to find out what’s causing your iron deficiency so that you can get the best possible treatment.
Vitamin B12 deficiency anaemia
You need vitamin B12 for many important processes inside your body. It helps to keep your nerves healthy and is used to make RBCs. If your body lacks vitamin B12, it can’t make as many RBCs as normal. The ones it does make are larger and get removed from your bloodstream quicker than usual.
Your body may lack vitamin B12 if:
the foods you eat don’t contain enough vitamin B12 - a common problem for vegetarians and vegans
your body can’t absorb the vitamin - an immune condition called pernicious anaemia can cause this.
Treatment
Finding out why you have vitamin B12 deficiency anaemia is important so you can get the right type of treatment. If you’re deficient because you have an underlying condition called pernicious anaemia, you’ll need to have vitamin B12 injections. You’ll need injections because pernicious anaemia stops you from being able to take in (absorb) vitamin B12.
If you have this type of anaemia because you’re not getting enough vitamin B12 from the foods you eat, your doctor will recommend eating more vitamin B12-rich foods. Products that come from animals such as meat, fish, milk and eggs are all good sources. Others include some fortified soy products and cereals. These products have vitamin B12 and other nutrients added to them, making them ideal for vegans and vegetarians.
As well as keeping an eye on the foods you’re eating, you may also need supplements to replace the vitamin B12 in your body. If your body’s vitamin B12 levels go back to normal and your diet has improved, this treatment may be stopped.
Folate deficiency anaemia
Your body uses folate to make cells (including your RBCs). If you don’t have enough folate, your body can’t make enough RBCs to meet its needs.
You may have folate deficiency anaemia if you’re not getting enough folate from the foods you eat. Brussels sprouts, asparagus and peas are all good sources of folate. Overcooking these vegetables may destroy the folate in them, so avoid this where you can. You may also be deficient in folate when you’re pregnant. This is because your body uses more folate than usual. If this happens, you’ll usually be given a folate supplement to correct this. Some medicines can also cause folate deficiency.
Treatment
To treat folate deficiency anaemia your family doctor will advise you to eat foods containing lots of folate, including:
broccoli
Brussels sprouts
asparagus
peas
chickpeas
brown rice
You may also need to take folate (folic acid) supplements to help get your folate levels back to normal. Most people take an oral supplement, meaning the supplement is swallowed or ingested rather than being injected into your body. Treatment usually lasts for around four months.If you have folate deficiency anaemia as a result of another underlying condition, you may need to explore other treatment options.
Anaemia of chronic diseases (ACD)
Some conditions like HIV and hepatitis C can cause ACD. If your body gets injured, for example, during surgery or after an accident, this can also cause ACD. These can result in anaemia because the inflammation they cause interferes with the iron that’s kept in your body. Fewer RBCs are made and sometimes those that are don’t last as long in your bloodstream as they should.
Treatment
If your anaemia is being caused by another underlying condition, it’s important that you get treatment for it to help improve your symptoms.
If your anaemia is manageable, it’s possible that you won’t need to have any treatment at all. But if your anaemia is interfering with your day-to-day life, or is a risk to your health, there are treatment options available.
Erythropoietin stimulating agents (ESAs). This type of treatment is used to help your bone marrow make more red blood cells (RBCs).
Blood transfusion.
Anaemia of chronic kidney disease
If you have kidney damage, this can cause anaemia. This is because your kidneys make something called erythropoietin that’s needed for your body to make RBCs. If you have kidney damage, you won’t produce as much erythropoietin, and therefore RBCs.
Treatment
Your kidneys produce something caled erythropoietin that’s needed to make RBCs. If you have kidney damage, you won’t have enough erythropoietin, and therefore RBCs, to meet your body’s needs.
To treat anaemia of chronic kidney disease you may have erythropoietic-stimulating agent (ESA) therapy to help your bone marrow make more RBCs. If ESA works for you, you may also be given iron supplements. This is because iron is used up when making RBCs and so you may become deficient in iron during ESA treatment.
You may also be treated for iron deficiency more generally as iron deficiency can contribute to anaemia of chronic kidney disease. For example, some people with chronic kidney disease have trouble using the iron that’s already stored inside their body or absorbing iron in the first place.
Haemolytic Anaemia
Haemolytic anaemia is a type of anaemia that happens when your RBCs are prematurely destroyed and removed from your blood. Usually, it’s because your body makes an antibody (part of your immune system that usually protects your body) that then breaks down your own RBCs. Some people have haemolytic anaemia because they have inherited certain qualities or genes from their parents. Others may get haemolytic anaemia at a later stage and acquire it.
Treatment
If you have haemolytic anaemia, the type of treatment you have will depend on what the cause is. You may need to stop taking certain drugs or get treatment for any underlying infections or conditions that could be causing your symptoms. You may also need to take folate supplements. This is because haemolytic anaemia can cause you to become folate deficient. Some people with haemolytic anaemia may also need to have a blood transfusion, but this will only happen if it’s absolutely necessary.
Aplastic Anaemia
Aplastic anaemia is rare. It’s a condition that affects your bone marrow – the soft, spongy part inside your bones where your blood cells (including your RBCs) are made. If you have aplastic anaemia, you produce fewer RBCs than normal. Your other blood cells (including your white cells and platelets) are usually affected too.
For some people symptoms of aplastic anaemia are quite mild, but for others it can be a life-threatening condition. Lots of different things can cause aplastic anaemia, including some medical conditions and certain types of drugs. But most commonly, the cause of aplastic anaemia isn’t known.
Treatment
Most cases of aplastic anaemia are mild and don’t need any treatment. However, if your anaemia is severe you may need any of the following:
immune suppressive therapy (IST)
stem cell transplant
blood transfusion
If you’ve been diagnosed with aplastic anaemia and need treatment, talk to your doctor about your options.
Sickle cell Anaemia
Sickle cell anaemia is a condition that is inherited from your parents. If you have this condition, your body makes faulty haemoglobin which causes your RBCs to form an unusual crescent shape. If you have sickle cell anaemia, your RBCs may clot under certain conditions. These blood clots then interfere with the flow of blood around your body. This is called a sickle cell or vaso-occlusive crisis.
Treatment
If you have sickle cell anaemia, treatment is based around stopping your symptoms from coming on and managing them if they do. Treatments include things like managing your pain with painkillers, taking a drug called hydroxycarbamide, blood or exchange transfusions and taking antibiotics to stop you getting infections. A bone marrow transplant can cure patients with sickle cell anaemia, but because of its complications, very careful thought will be given before you have this treatment.
To stop your symptoms from coming on, you should avoid things that can trigger them. Make sure you:
keep hydrated
don’t push yourself too much when doing exercise
avoid the cold
avoid high altitudes
treat infections promptly
Symptoms of Anaemia
Depending on the severity, the symptoms of anaemia may include:
Pale skin
Fatigue
Weakness
Tiring easily
Breathlessness
Drop in blood pressure when standing from a sitting or lying position (orthostatic hypotension) – this may happen after acute blood loss, like a heavy period
Frequent headaches
Racing heart or palpitations
Becoming irritated easily
Concentration difficulties
Cracked or reddened tongue
Loss of appetite
Strange food cravings.
Groups at high risk
Certain people are at increased risk of anaemia, including:
Menstruating women
Pregnant and breastfeeding women
Babies, especially if premature
Children going through puberty
Vegetarians
People with cancer, stomach ulcers and some chronic diseases
People on fad diets
Athletes.
Diagnosis of Anaemia
Depending on the cause, anaemia is diagnosed using a number of tests including:
Medical history – including any chronic illnesses and regular medications
Physical examination
Blood tests – including complete blood count and blood iron levels, vitamin B12, folate and kidney function tests
Urine tests – for detecting blood in the urine
Gastroscopy or colonoscopy - Sometimes
Bone marrow biopsy
Faecal occult blood test – examining a stool sample for the presence of blood.
A blood film test - This involves looking at your blood under a microscope to check the size and shape of your red blood cells.
Treatment for Anaemia
Treatment depends on the cause and severity, but may include:
Vitamin and mineral supplements – in the case of deficiency.
Iron injections – if the person is very low on iron.
Vitamin B12 (by injection) – required for pernicious anaemia.
Antibiotics – if infection is the cause.
Altering the dose or regimen of regular medications – such as anti-inflammatory drugs, if necessary.
Blood transfusions – if required.
Oxygen therapy – if required.
Surgery to prevent abnormal bleeding – such as heavy menstruation.
Surgery to remove the spleen (splenectomy) – in cases of severe haemolytic anaemia.
Please note: Take iron supplements only when advised by your doctor. The human body isn’t very good at excreting iron and you could poison yourself if you take more than the recommended dose.
Prevention of anaemia
Some forms of anaemia can’t be prevented because they are caused by a breakdown in the cell-making process. Anaemia caused by dietary deficiency can be prevented by making sure that certain food groups are consumed on a regular basis, including dairy foods, lean meats, nuts and legumes, fresh fruits and vegetables. Vegetarians who prefer not to eat any dairy foods (vegans) should consider taking vitamin and mineral supplements regularly.
Things to remember
Anaemia means that either the level of red blood cells or the level of haemoglobin is lower than normal, which deprives the body of adequate oxygen.
Anaemia isn’t a disease in itself, but a result of malfunction somewhere in the body.
Anaemia can have many causes, including certain diseases or conditions and medications or poor diet.
Iron deficiency is the most common cause of anaemia.
Anaemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status.
Iron deficiency is thought to be the most common cause of anaemia globally, although other conditions, such as folate, vitamin B12 and vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited disorders can all cause anaemia. In its severe form, it is associated with fatigue, weakness, dizziness and drowsiness. Pregnant women and children are particularly vulnerable.
Anaemia is a lack of red blood cells. These cells are important because they carry oxygen from the lungs around the body. It’s important to find and treat the cause of the anaemia as well as the anaemia itself.
References
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaemia
http://www.who.int/topics/anaemia/en/
http://www.bupa.co.uk/health-information/directory/a/anaemia
http://www.healthdirect.gov.au/anaemia
