Anemia

Anemia a condition in which there aren't enough healthy red blood cells to carry adequate oxygen to your tissues can make you feel always tired. When anemia is severe enough, it may interfere with your ability to do everyday tasks. You may be too exhausted to work or play.

Although anemia is often treatable, it may take several weeks to months for red blood cell levels to return to normal following treatment. Ask your doctor what to expect from treatment.

Many types of anaemia exist, each with its own cause. Anaemia can be caused by an iron or vitamin deficiency, blood loss, a chronic illness, or a genetic or acquired defect or disease. It may also be a side effect of a medication. Anaemia can be temporary or chronic. It can range from mild to severe.

Although anaemia is common, it sometimes can be a complex problem to diagnose and treat because of its many causes. If you suspect you may have anaemia, it's important to pursue a diagnosis and treatment. Anaemia can signal certain illnesses. Left untreated, it can lead to complications, such as a heart rhythm irregularity.

Treatments for anaemia range from taking vitamin and iron supplements to undergoing serious medical procedures.

The main symptom of most anemias is fatigue. Other signs and symptoms of anemia in general include:

• Weakness
• Pale skin, including decreased pinkness of the lips, gums, lining of the eyelids, nail beds and palms
• Rapid heartbeat with mild exertion
• Shortness of breath with mild exertion
• Chest pain
• Dizziness, lightheadedness
• Irritability (in children with anemia)
• Numbness or coldness in hands and feet

Initially, anemia can be so mild as to go unnoticed. But signs and symptoms increase as the condition progresses. If you experience unexplained fatigue or other signs and symptoms suggestive of anemia, see your doctor for an evaluation.

Causes and Risk Factors 

Your blood performs a number of crucial functions, including transporting oxygen throughout your body. Blood consists of a liquid called plasma. Floating within this plasma are three types of blood cells red blood cells, white blood cells and platelets. White blood cells fight infection. Platelets help blood to clot after a cut. Red blood cells (erythrocytes), which are the most abundant of the three types, give blood its red color. They also carry oxygen from your lungs, via your bloodstream, to your brain and the other organs and tissues in your body. Your body needs a supply of oxygenated blood to function. Oxygenated blood helps give your body its energy and your skin a healthy glow.

Red blood cells contain hemoglobin a red, iron-rich protein. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body. Most blood cells, including red blood cells, are produced regularly in your bone marrow a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron and vitamins from the foods you eat.

Anemia is a state in which the number of red blood cells or the hemoglobin in them is below normal. When you're anemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues leaving you fatigued. Common types of anemia and their causes include:

• Iron deficiency anemia. Anemia can be caused by a shortage of the mineral iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body cannot produce enough hemoglobin for red blood cells. The result is iron deficiency anemia. Iron is recycled from old red blood cells, so your blood contains iron. Lose blood, and you lose iron. Women with heavy periods who lose a lot of blood each month during menstruation are at risk of iron deficiency anemia. Slow, chronic blood loss from a source within the body such as an ulcer, a colon polyp or even colon cancer also can lead to iron loss and iron deficiency anemia.
• Your body also gets iron from the foods you eat. An iron-poor diet or an inability to absorb iron from the foods you eat because of an intestinal disorder or surgery to your intestines can lead to this anemia. In pregnant women, a growing fetus can deplete the mother's store of iron, leading to iron deficiency anemia.
• Vitamin deficiency anemias. In addition to iron, your body needs folic acid and vitamin B12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. People who have an intestinal disorder that affects the absorption of nutrients are prone to this type of anemia. Some people are unable to absorb vitamin B12, for a variety of reasons. They develop vitamin B12 deficiency anemia (pernicious anemia). Vitamin deficiency anemias fall into a group of anemias called megaloblastic anemias, in which the bone marrow produces large, abnormal red blood cells (megaloblasts). Vitamin deficiency anemias can be related to the use of certain medications.
• Anemia of chronic disease. Certain chronic diseases, such as AIDS, cancer, liver disease and End Stage Renal Failure, can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure is a major cause of anemia. The kidneys produce a hormone called erythropoietin, which stimulates your bone marrow to produce red blood cells. A shortage of erythropoietin which can result from kidney failure or be a side effect of chemotherapy can result in a shortage of red blood cells.
• Aplastic anemia. This is a life-threatening anemia caused by a decrease in the bone marrow's ability to produce all three types of blood cells red blood cells, white blood cells and platelets. A serious infection such as hepatitis exposure to toxic chemicals or certain medications can trigger aplastic anemia.
• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Autoimmune disorders can cause your body to produce antibodies to red blood cells, destroying them prematurely. Certain medications, such as some used to treat infections, also can break down red blood cells. Hemolytic anemias may cause yellowing of the skin (jaundice) and an enlarged spleen.
• Sickle cell anemia. This inherited and serious anemia, which affects mainly blacks, is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells. Sickled red blood cells also can block blood flow through small blood vessels in the body, producing other, often painful, symptoms.
• Other anemias. There are other, rarer forms of anemia, many of which are caused by defective hemoglobin.

Anyone young or old whose diet is consistently low in iron and vitamins, is at risk of anemia. Your body needs iron and vitamins to produce sufficient numbers of red blood cells. Having an intestinal disorder such as Crohn's disease or celiac disease that affects the absorption of nutrients in the small intestine puts you at risk of anemia.

In general, women are at greater risk of iron deficiency anemia than men. That's because women lose blood and with it, iron each month during menstruation. Without iron supplementation, iron deficiency anemia occurs in virtually all pregnant women because their iron stores have to serve the increased blood volume of the mother as well as be a source of hemoglobin for the growing fetus.

If you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells.

Slow, chronic blood loss from an ulcer or other source within the body can deplete your body's store of iron, leading to iron deficiency anemia.

Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals and the use of some medications can affect red blood cell production and lead to an anemia. If your family has a history of an inherited anemia, you also may be at increased risk of the condition.

Diagnosis and Screening 

Doctors diagnose anemia with the help of a medical history, a physical exam and blood tests, including a complete blood count (cbc). This blood test measures levels of red blood cells and hemoglobin in your blood. Some of your blood may also be drawn and examined under a microscope to study the size, shape and color of your red blood cells, which may indicate a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of known or unknown ulcers, benign polyps in the colon, a colon cancer, or kidney or other types of tumors. Your doctor may test for these and other conditions that may underlie the anemia.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia. 

Management 

Treatment for anemia depends on the cause:

• Iron deficiency anemia. This form of anemia is treated with iron supplements, which you may need to take for several months or longer. If the underlying cause of iron deficiency is loss of blood and not menstruation the source of the bleeding must be located and stopped. This may involve surgery.
• Vitamin deficiency anemias. Pernicious anemia is treated with injections often lifetime injections of vitamin B12. Folic acid deficiency anemia is treated with folic acid supplements.
• Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. However, if symptoms become severe, injections of synthetic erythropoietin, a hormone normally produced by the kidneys, helps stimulate red blood cell production and ease fatigue.
• Aplastic anemia. Treatment for this serious anemia may include blood transfusions to boost levels of red blood cells. A bone marrow transplant may be necessary if the body's own bone marrow is diseased and unable to make healthy blood cells. Because aplastic anemia also causes a decrease in disease-fighting white blood cells, you may also be given medications to help fight or treat infections.
• Hemolytic anemia. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress the immune system, which may be attacking your red blood cells. If the condition has caused an enlarged spleen, the spleen may need to be removed. The spleen a small organ below your rib cage on the left side filters out and stores defective red blood cells. It can become enlarged with damaged red blood cells with certain hemolytic anemias.
• Sickle cell anemia. Treatment for this incurable anemia may include the administration of oxygen, pain-killing drugs, and oral and intravenous fluids to reduce pain and prevent complications. Blood transfusions and antibiotics are also commonly used. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) is also used to treat sickle cell anemia in adults.

With treatment, many anemias can be eliminated. Iron deficiency anemia should go away once iron stores are restored and any source of internal bleeding is stopped. Vitamin deficiency anemias often can be successfully treated with supplements. However, pernicious anemia will reoccur if vitamin B12 injections are stopped. Anemia of chronic disease, aplastic anemia and hemolytic anemias can be managed if not corrected. Sickle cell anemia and other inherited anemias are incurable, but symptoms can be helped with treatment.

Frequently Asked Questions (FAQ)

How chemotherapy causes anemia?

The medicines that are used to treat your cancer work by attacking and destroying the cancer cells. These cancer cells are different from the other cells in your body in that they multiply and grow very quickly. Chemotherapy targets all quick-growing cells.

However, there are normal cells in your body that also grow quickly, like the cells in your scalp (the hair follicles) and the cells in your bones (bone marrow cells or blood cells). Unfortunately, as chemotherapy works to destroy the cancer cells in your body, it also can affect other cells, namely, red blood cells. And that's where anemia comes in.

Chemotherapy attacks red blood cells and actually interrupts the process of cell development that takes place deep inside your bones.

When this happens, the number of red blood cells circulating throughout your body drops lower and lowerthe amount of oxygen available to your lungs and other organs is less and lessand you begin to feel more tired, more fatigued. Eventually, if left untreated, the number of red blood cells remains low and results in anemia.

How can I fight FATIGUE?

Tips for managing fatigue and anemia :

• Have your hemoglobin checked regularly
• Eat a well-balanced diet including plenty of fluids and seek nutritional advice about iron- and vitamin-rich foods and dietary supplements
• Plan your daily activities and do only what you absolutely must do
• Include short periods of rest and relaxation (take naps!) every day
• Ask for help from others, especially when you are feeling fatigued
• Do light exercises every day (always check with your health care provider about exercises that are best for you)
• Join support groups and share your feelings and concerns
• Find new hobbies that are physically less demanding, like reading or listening to music

Ask your doctor about a prescription medicine that allows your body to make more red blood cells and helps give you back your strength.