Anaemia

Anaemia

What is anaemia?

Anaemia isn’t classified as a disease as such, but is more so a condition that signals something wrong in the body.

Anaemia occurs when the normal production of red blood cells (RBCs) which carry essential nutrients (haemoglobin – Hb or Hgb) and oxygen throughout the body is too low. Haemoglobin is a protein in the RBCs that aids in carrying oxygen throughout the bloodstream in the body. This protein forms the main component of the body’s RBCs and helps bind oxygen.

The body needs this oxygen for healthy function. When RBCs are too low, the body is deficient in the level of oxygen and simply isn’t getting what it needs to function sufficiently. Symptoms that occur are as a direct result of decreased oxygen levels in the body’s tissues and vital organs, and can cause a domino effect of damage throughout the body.

Medical professionals measure the amount of haemoglobin in the body to determine conditions such as anaemia. Those more susceptible to anaemia include women (with heavy menstrual cycles and during pregnancy when blood supply increases significantly and the rate of plasma production is disproportionate to the red blood cell count), young children and individuals with chronic diseases.

Some young children are anaemic from the time they are infants due to hereditary forms of the condition. Women, in particular are more prone to being anaemic during their childbearing years as a result of blood loss experienced during menstruation. During pregnancy, women can also experience anaemia as the blood supply in the body increases significantly to accommodate a growing baby, placing additional demands on the normal function of the body. Seniors are also at higher risk due to insufficiently nutritious diets and various medical concerns.

There are over 400 variations of anaemia and all fall into categories which will be approached differently in their underlying causes and necessary treatment plans. Of the various forms, iron-deficiency anaemia is the most common. Some variations of the condition are simpler to treat with effective means over a short period of time (a temporary condition). Other types unfortunately have longer lasting health concerns (due to an underlying illness which may be chronic or hereditary) that require treatment on an ongoing basis.

Blood – understanding the basics

3-D illustration of red blood cellsTo understand how anaemia develops and how it affects the body, it is a good idea to learn how blood works in the body and why it is so vital for life.

Blood is made up of a fluid, known as plasma, cells which comprises of red blood cells known as RBCs (cells which carry oxygen throughout the body), white blood cells (cells which defend the body against infection, forming part of the body’s immune system), proteins, and platelets (aiding blood to clot when the body becomes injured).

Spongy tissue inside of bones, known as bone marrow (located in the inner portion of the femur, pelvic bones and other bones), contains stem cells and produces a constant flow of new RBCs to replace older ones that typically break down after 120 days. Inside each RBC is the protein compound, haemoglobin which assists the cells in carrying oxygen by binding it to the cell.

Erythropoietin, is another molecule which is secreted by the kidneys and also helps to promote the production of new RBCs in the bone marrow. These round-shaped cells are then able to easily flow through the bloodstream and effectively deliver oxygen to all parts of the body’s tissues and organs, enabling proper function.

The body, thus needs healthy bone marrow to enable this process to function as it should. Without sufficient nutrients, such as iron and vitamins (vitamin B-12 and folate) which we ingest through food, our bone marrow production becomes deficient and thus has a debilitating effect on our blood and its necessary functions.

If bone marrow isn’t healthy and there is insufficient iron in the system, the body will typically ‘look for iron’ elsewhere. Small reserves of iron are stored in the liver and the body will try and draw from this in order to attempt keeping up RBC production. This break in the normal chain of function can easily deplete the body’s iron reserves, hinder RBC production and effectively result in problems due to an insufficient supply of oxygen reaching tissues and vital organs.

What are some of the different types of anaemia?

Of the many types of anaemia, the condition is typically broken down into three major type classifications. Anaemia is classified according to the size of RBCs in the body. This ultimately ties in with underlying causes, types and reasons for the malfunction.

The three main type classifications are:

  • Microcytic anaemia: RBCs are smaller than normal in size and are caused by low levels of iron in the system. This often results in conditions such as iron-deficiency anaemia and inherited disorders of haemoglobin, such as thalassemia.
  • Normocytic anaemia: RBCs are normal in size but are lacking in the number produced to replenish older cells ultimately excreted from the body. This type is commonly associated with chronic conditions such as kidney disease.
  • Macrocytic anaemia: RBCs are larger in size than is normal. Often, excessive alcohol consumption is an underlying factor and results secondary to conditions, such as pernicious anaemia. Macrocytic anaemia occurs when there is a deficiency of vitamin B12 or folate.

Anaemia medical diagram showing normal and abnormal blood cell count and human circulation in an artery or vein

What causes anaemia?

Essentially, anaemia is as a result of one of three things:

  • The body isn’t producing enough RBCs for healthy function (i.e. the body is lacking in RBC's and therefore has low haemoglobin)
  • RBCs are being lost (old cells) at a faster rate than they are being produced in the bone marrow, usually due to bleeding in the body
  • The body is actively destroying RBCs due to a deficiency or illness

From the type classifications and fundamental causes, anaemia can be broken down into more specifically labelled type groups.

Some of the main cause types include:

  • Iron-deficiency anaemia: An insufficient amount of iron in the body (sometimes due to an iron-poor diet, commonly seen in infants, young children, teens, vegetarians and vegans) causes a decreased production of RBCs. This type is common worldwide and is often diagnosed in women who experience heavy menstrual bleeding during their reproductive years, and others suffering bleeding from ulcers, cancer, haemorrhoids, gastritis or use of medications, such as aspirin and ibuprofen, and other over-the-counter pain relievers relievers (these cause anaemia by perpetuating gastritis or peptic ulcers). Bleeding during childbirth and sometimes multiple pregnancies (due to increased metabolic demands in the body) and breastfeeding (which may deplete a woman’s iron levels) can bring about anaemia as well. Those who donate blood frequently or place their bodies through endurance fitness training (endurance sports) may be at risk of this type of anaemia.
  • Vegetarian dietVitamin-deficiency anaemias: A lack of vitamin B-12 and folate can also hinder healthy RBC production. It may be that a person is not getting enough of these key nutrients in their diet or their body is having trouble processing these vitamins. Common variations of this type include pernicious anaemia (poor vitamin B-12 absorption), megaloblastic anaemia (deficiency in vitamin B-12 or folate, or both). Those who eat little or no meat in their diets may lack vitamin B-12 which can cause this type of anaemia. Vegetables which are overcooked or not consumed often enough can also lead to a deficiency of folate in the system. If pregnant and lacking folate (folic acid), a developing baby runs the risk of neural tube defects, such as spina bifida.
  • Chronic disease anaemia: Chronic diseases can also have an impact on the sufficient production of RBCs and by association then cause a type of anaemia. Conditions such as cancer, rheumatoid arthritis, HIV-AIDS, kidney disease, hypothyroidism, lupus, diabetes and Crohn’s disease are some that can interfere with the RBC production process.
  • Anaemia associated with bone marrow disease: Diseases that affect by RBC production in the bone marrow include leukaemia and myelofibrosis. Cancer (metastatic cancer cells) and cancer-like conditions range from mild to life-threatening and cause malfunctions in the bone marrow that ultimately have a domino effect of deficiency throughout the body. Rare, but life-threatening, aplastic anaemia occurs when the body is incapable of producing enough RBCs. The condition typically occurs as a result of infections (such as hookworm), existing autoimmune diseases, exposure to toxic chemicals and as an adverse reaction to medications. The bone marrow may also be affected by exposure to lead, which is toxic for the system. Poisoning can lead to anaemia affecting the bone marrow’s normal functionality.
  • Haemolytic anaemias: This group type relates to a high number of RBCs that are destroyed at a faster rate than the bone marrow can replenish with new cells. This group type is often inherited, but can also develop at a later stage in life if a person falls ill with a blood disease that increases the RBC destruction rate, causing an imbalance. Also known as sickle cell disease, sickle cell anaemia is one such inherited condition that causes an irregularity in the way RBCs are formed. A defective form of haemoglobin causes the shape of cells produced to ‘sickle’ (creating a banana or crescent moon shape) instead of the normal round shape, which causes them to experience difficulty in travelling through the bloodstream. Often, these cells are prematurely destroyed which causes a chronic shortage of RBCs (both normal and sickle) in the bloodstream. Other underlying causes for haemolytic anaemias include infection stressors (snake or spider venom, infections or drugs, medications or condition treatments such as chemotherapy), toxins associated with advanced kidney or liver disease, vascular grafts, prosthetic heart valves, severe burns, tumours, exposure to chemicals, clotting disorders, severe hypertension and an enlarged spleen (rare).

What are the signs you may be anaemic?

Signs and symptoms

Senior lady feeling unwell (headache)Overall symptoms will vary according to the type and underlying cause of anaemia. Symptoms may be mild at first, but will typically worsen as the condition worsens and include signs of cardiac-related difficulties in the body (due to the lack of oxygen in the blood and the heart having to work harder to pump blood to the body’s organs).

General symptoms may include:

  • A pale complexion or yellowish colour to the skin (jaundice)
  • Fatigue and body weakness
  • Shortness of breath
  • Irregular heartbeats, heart murmurs or an increased heart rate
  • Light-headedness or a dizzy sensation
  • Headache
  • Chest pain
  • Cold or numb hands and feet
  • Unusual cravings (such as ice, dirt or clay)
  • Concentration problems
  • Constipation
  • Fainting (severe cases of anaemia)
  • Brittle nails
  • High or low blood pressure
  • Enlarged lymph nodes
  • Enlarged spleen or liver
  • Cracked or reddened tongue
  • Loss of appetite
  • Black or tarry stools (sticky and foul smelling) / bloody or maroon-coloured stools

Anaemia signs and symptoms should always be evaluated and monitored by a medical professional. It is often the case that anaemia is an indication of an underlying condition that requires medical intervention and treatment. Once a cause is determined through a physical exam and testing, treatment can be effectively implemented without a high risk of complications.

Risk factors and potential complications

Risk factors for anaemia include:

  • A diet lacking in iron, vitamin B-12 and folate, such as vegans and vegetarians, as well as those on fad diets
  • An iron deficiency due to chronic blood loss (slow), such as from an ulcer which consistently depletes the body’s store of iron
  • Women going through heavy menstruation (regular loss of RBCs with heavy bleeding)
  • Pregnancy and breastfeeding moms (without a sufficient intake of folic acid or an iron-deficiency)
  • Intestinal disorders, such as Crohn’s disease or celiac disease that affect the absorption of nutrients in the small intestine
  • Chronic conditions such as cancer or kidney problems which cause a shortage of RBCs in the bloodstream
  • Inherited anaemic conditions
  • A history of blood diseases, autoimmune disorders, infections, exposure to toxic chemicals, medications that disrupt the production of RBCs and alcoholism
  • Seniors (over the age of 65)
  • Endurance athletes

Anaemia and young children

Babies and young children under the age of 2 are quite susceptible to anaemia. At such an early age, young children typically don’t have enough iron in their system or don’t get enough from their diet. Some of the unusual cravings anaemic individuals (including children) get include ice and starch as well as an urge to eat inappropriate things such as clay or dirt.

During routine visits to the paediatrician, your little one is likely to be assessed or tested for anaemia. This is important because if there is any deficiency, prompt treatment can help to reduce the risk of any complications and permanent development damage, especially to the brain.

Anaemia and teens

Teenage girl feeling tired and weakAlong with all the transition changes a teenage body will go through during puberty, iron-deficiency anaemia is another thing to keep in mind. Teenagers are prone to sudden growth spurts which can lead to anaemia. Teenage girls are more susceptible to deficiency-related anaemia (particularly a lack of iron) than boys due to their menstrual periods (loss of blood, which can be heavy during puberty, and iron).

Health problems and complications can include:

  • Severe fatigue and an inability to perform or complete everyday tasks
  • Premature birth (a pregnant woman with a folate deficiency form of anaemia)
  • Arrhythmia (rapid or irregular heartbeat)
  • Heart problems (the body attempts to compensate for a lack of oxygen in the blood by pumping more blood – this can lead to an enlarged heart or heart failure)
  • Death (more commonly associated with inherited anaemia disorders where life-threatening complications occur or where severe blood loss occurs over a short period of time)

Diagnosing anaemia

The doctor’s visit

No instance of anaemia should ever be treated based on assumption. If you experience any symptoms common with the condition, you must seek medical assessment.

Due to the nature of anaemic symptoms, there is often an underlying medical condition which will, more often than not, require testing. If this is the case, the illness cause will require careful treatment. Anaemia will be resolved in the process.

A general practitioner (GP or family physician) will want to begin by making a compete assessment of your medical history (including your family medical history) and perform a physical exam.

Your doctor will typically ask you a series of specific questions. These can include:

  • When did you start experiencing symptoms?
  • Have you ever experienced anaemia before?
  • Has anyone in your family had, and been treated for anaemia?
  • Are you taking any medications or supplements?
  • Have you noticed any changes to the nature or colour of your stool or urine?
  • Have you noticed any bleeding issues?
  • What is your occupation?
  • Do your social habits involve a lot of alcohol consumption?

Your doctor will then move on to performing a physical examination to check various things associated with your overall symptoms. Your doctor will assess your overall appearance and look for signs of fatigue, a paleness to your skin (perhaps even jaundice) and examine the nail beds. Your doctor will also physically assess you for signs of an enlarged spleen or liver, listen to your heart (assessing your heart rhythm and sounds) as well as check your lymph nodes.

Testing for anaemia

Once a discussion and a physical exam have been completed, it is more than likely that your doctor will recommend a series of tests to help determine an underlying cause of your anaemia and make a final diagnosis.

Depending on the nature of your symptoms, your physical exam and your medical history discussion, your doctor will recommend tests most appropriate to either help confirm a diagnosis or rule out potential health conditions. The severity of anaemia is also taken into account before tests are recommended as some causes may need to be determined immediately for emergency treatment.

Blood sample for a complete blood count (CBC) test

Common tests include:

  • CBC (complete blood count) and Peripheral blood smear: Your doctor can assess the type of anaemia and the severity of the condition using these laboratory blood tests based on the size of your RBCs, shape, appearance and the number being produced to replenish the body. Your doctor will also look at your white blood cells and platelets, as well as measure your haemoglobin (Hgb). All of these factors will help to accurately determine an anaemic condition.
  • Reticulocyte count: This blood test measures the amount of new RBCs being produced in the body’s marrow.
  • Liver and kidney function tests: A portion of your blood sample will be looked at to assess how well your liver or kidneys are functioning. These tests will help your doctor to determine whether your liver function is having any impact on your anaemic condition, or if you have an underlying kidney dysfunction. The kidney test will measure levels of urea, creatinine and dissolved salts in your system which form from the breakdown of proteins in the body before being passed as waste.
  • Bone marrow biopsy: If necessary your doctor may request a sample of your bone marrow to evaluate the production of RBCs. This will generally only be requested when your doctor strongly suspects a problem with your bone marrow.
  • Serum iron level: This test enables your doctor to assess whether your underlying cause may be related to an iron deficiency. This test is typically done in conjunction with others that measure the body’s iron stores such as a transferrin level test (looks at the proteins that carry iron in the body) and a ferritin level test (measures the total iron capacity that is available in the body).
  • Vitamin B-12 and folate: Your doctor will look at your vitamin levels to assess whether there is a deficiency or not, so as to establish or rule out an underlying cause.
  • Bilirubin test: Your doctor may request this test (from a blood sample) to assess the amount of this yellow pigment (chemical compound) in your blood. The purpose is to determine any signs of haemolytic anaemia (RBCs are being destroyed at a faster rate than they are being replenished and flushed from the body’s system). Bilirubin is found in bile and is produced by the liver. It will be elevated when the breakdown products of RBCs in the blood are elevated.
  • Stool haemoglobin test, faecal occult blood test and urine tests: Your doctor may request a sample of your stool (faeces) to look for any signs of bleeding. Other tests related to this include a stool occult blood test or a stool Guaiac test. If there are signs of blood in your sample it will indicate that there is a bleed occurring somewhere in the gastrointestinal tract (between the mouth and the rectum) and could point to a cause, such as colon cancer, stomach ulcers or ulcerative colitis. If necessary, your doctor may recommend other tests to help determine a diagnosis. Additional tests could be an upper GI endoscopy (gastroscopy), colonoscopy, barium enema, chest X-ray or CT scan. Your doctor may also wish to evaluate a sample of your urine for the same purpose.
  • Lead level test: This test may be recommended to assess the potential for lead toxicity levels.
  • Haemoglobin electrophoresis: If it is determined in the initial evaluation that there is a possibility of a family history of anaemia, this test may be recommended to determine or rule out a possible inherited condition.

Treatment procedures

Once an underlying cause and the severity of anaemia has been determined, an appropriate treatment plan can be recommended to ensure that an anaemic condition is effectively handled, and potential complications are avoided.

We’ve listed some of the more common causes and their treatment plans below:

  • Cause > Iron-deficiency anaemia: Dietary changes and recommended iron supplements are generally advised where the body is found to be lacking in iron. Where it is also determined that an iron deficiency is occurring as a result of high loss of blood (other than through menstruation), the source of the bleeding will need to be located and stopped (sometimes through surgery). No iron supplements should be taken without the express knowledge or prescribed recommendation of your doctor. This needs to be monitored as too much iron is toxic for the body and can result in poisoning if the body isn’t able to easily excrete it as waste.
  • Cause > Vitamin deficiency anaemias: Dietary supplements of vitamin B-12 and folic acid will be recommended to ensure a healthy supply for your system to use effectively in your RBC production. If it is determined that you have a normal supply but your body has a deficiency in absorbing it from the food you consume, your doctor may recommend vitamin B-12 injections (shots). These may be administered every other day, or once a month. In some instances, these injections may form part of a chronic treatment plan for the rest of your lifetime. The nature of your condition and severity of anaemia will help to determine the frequency of these injections.
  • Cause > An associated chronic condition: In this case your doctor is likely to implement a treatment plan that manages the underlying disease or condition causing the anaemia, rather than treating the anaemia itself. Severe situations may involve blood transfusions or synthetic erythropoietin injections (a hormone that is normally produced by the kidneys) to assist with RBC production (which may help alleviate severe fatigue symptoms).
  • Cause > Haemolytic anaemias: If the cause is potentially due to a medication, these may be discontinued. Infections and medications that suppress the immune system will need to be carefully managed or treated to alleviate anaemia symptoms and reduce the debilitating effect on the body’s RBCs (attacking the blood cells). In severe instances, blood transfusions or plasmapheresis (a type of blood-filtering treatment) may be recommended. In other instances of severe anaemia, the spleen may be removed to encourage symptom relief.
  • Cause > Aplastic anaemia and related bone marrow disease and dysfunctions: Common treatment options may include blood transfusions (to help replenish RBCs) or a bone marrow transplant if severe damage is determined and the body can’t produce a healthy supply of RBCs. Other treatments associated with bone marrow disease include medications and chemotherapy.
  • Cause > Hereditary anaemic conditions: If the underlying cause is sickle cell disease (sickle cell anaemia), treatment may involve oral and intravenous fluids and medications, such as hydroxyurea (commonly used to treat cancer) to help alleviate symptoms of debilitating pain associated with the condition. Oxygen (oxygen therapy) may also be administered, as well as doses of folic acid supplements, antibiotics and blood transfusions. Bone marrow transplants are also an option. Thalassemia is another condition that may be treated with blood transfusions, medications, folic acid supplements, a bone marrow / stem cell transplant and even a splenectomy (removal of the spleen).

Follow-up treatment

This will also depend on the anaemia type and underlying cause. Your doctor may recommend more blood testing (such as a CBC – complete blood count test) and follow-up consultations to assess your overall response to treatment. It is important that you keep these consultations, so that your doctor is able to ensure any necessary treatment adjustments for your overall well-being.

Living with anaemia

Are there ways to prevent anaemia?

It is not advisable to try and self-treat anaemia. Medical treatment is the best way to alleviate symptoms and reduce the risk of complication occurrences. It is important that you follow your doctor’s treatment recommendations so that symptoms are reduced or kept under control, particularly if the underlying cause is chronic or an inherited condition. Where necessary, aggravators such as medications will be necessary to avoid altogether for the rest of your lifetime.

You can take steps in your daily life to help your body along and help to enhance your quality of life, especially where there is a deficiency. In this way, anaemia symptoms can be prevented. Other types of anaemia may not be avoided due to the nature of their underlying causes (i.e. an illness or disease).

Foods high in Iron, including eggs, nuts, spinach, beans, seafood, liver, sesame, chickpeas, tomatoes

Nutritional means you can be more mindful of as you manage anaemia include:

  • Iron intake: Daily requirements differ between males and females. Females may require more iron due to blood loss during menstruation and the demands of pregnancy or while breastfeeding. Men may require supplements if it is found that they are unable to get the correct amount through their diet alone. Good sources of iron include beef and chicken liver, red meats (such as beef), dark turkey meat, seafood, oatmeal, fortified cereals, spinach and other dark green leafy veggies, dried fruit, beans and lentils. Tannins, chemical compounds found in tea, coffee, beer,  wine,  fruit juices, berries, pomegranates, nuts, smoked foods, legumes, and some herbs and spices should be limited or avoided as they can considerably inhibit the absorption of iron.
  • Vitamin B-12 and folate supplements: Good sources of foods rich in vitamin B-12 include poultry, meat (especially beef liver), fish, clams, eggs and dairy products. Fortified cereal and soy products can also help to up your intake. Good sources of folate include beef liver, asparagus, lentils, spinach and dark green leafy veggies, green peas, fruits and fruit juices, kidney beans, peanuts as well as fortified cereals and breads, rice and pasta. Supplements may also be taken if diet alone isn’t sufficiently helping. Your doctor will help with prescribing a suitable dosage for your condition.
  • Vitamin C: It is also good to ensure your diet is rich in vitamin C as it helps with the absorption of iron. Good sources include citrus fruits and juices, broccoli, peppers, melons, strawberries and tomatoes.
  • Supplements and multivitamins: These can be recommended by your doctor should you have dietary restrictions (an allergy or eating choice such as vegetarianism or veganism) contributing to your iron and vitamin deficiency.
  • Limiting alcohol consumption

Other things you can do include:

  • Booking regular check-ups with your doctor
  • Consider genetic counselling – especially if there is a family history of anaemic related disorders and diseases.
  • Take precautions with conditions such as malaria: Anaemia can occur as a complication of malaria as well. Antimalarial medications are highly recommended if travelling to high risk areas.

What is the outlook for anaemia?

The long-term outlook for anaemia is directly related to the underlying cause, severity and success of treatment. If the cause can be stopped in its tracks and treatment is effective, there should not be any long-term complications as a result of anaemia. If there is any tissue or organ damage associated with symptoms of anaemia, long-term monitoring or treatment may be necessary.

As a rule of thumb, younger individuals typically recover more easily than seniors do. The effects of anaemia in older people tend to be more severe due to an underlying chronic condition. Symptoms of anaemia tend to worsen the effects of the chronic condition in seniors.

All in all, anaemia is a treatable condition, but it can become highly complicated and even life-threatening if not sufficiently managed. It’s important to pay attention to your body and talk to your doctor if any symptoms concern you. Relapses can occur, but if the underlying cause is easily treatable, it can be as resolved fairly quickly.

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