Anemia occurs when blood does not have enough red blood cells or when the blood does not have enough hemoglobin. Hemoglobin is the oxygen-carrying pigment found in red blood cells. Anemia can be life-threatening.
Although there are over 400 different forms of anemia, this health profile will only address the three most common: iron-deficiency anemia, vitamin B12 anemia and folic acid deficiency.
Anemias can also be caused by such conditions as external bleeding, chronic disease, pregnancy, alcoholism, bleeding disorders, infection and hereditary conditions.
Iron deficiency anemia
Iron deficiency anemia arises from too little iron in the body to make sufficient hemoglobin. There are three (3) causes of iron deficiency anemia:
1. Loss of iron at a greater rate than normal (blood loss). Blood loss is usually the result of slow, persistent bleeding from inside the body, such as gastritis, peptic ulcers, ulcerative colitis, inflammatory bowel disease, polyps, gastrointestinal tumors (such as stomach or colon cancer), heavy menstrual periods, kidney tumors, bladder tumors, cystitis, prostatitis, and hemorrhoids. Additionally, the frequent use of aspirin, ibuprofen or other non-steroid anti-inflammatory drugs, as well as chronic alcohol abuse, can also cause iron deficiency anemia.
2. Poor absorption of iron from the diet. Poor absorption of iron from the diet is usually as a result of surgical removal of part or all of the stomach or celiac sprue (a condition in which the lining of the small intestine is damaged by a protein found in wheat or rye called gluten).
3. Eating a diet low in iron. This anemia can happen from not eating enough iron-rich foods, such as fruit, whole-grain bread, beans, lean meat and green vegetables.
Vitamin B12 anemia
Vitamin B12 anemia is the result of an impaired ability of the digestive tract to absorb the B12 that is a normal part of the diet. B12 is essential for the production of red blood cells, as well as the maintenance of the nervous system, and is found in food of animal origin such as meat, fish and dairy products. There are four (4) causes.
1. Failure of the stomach lining to produce intrinsic factor. Intrinsic factor is a chemical produced by the stomach lining and combined with vitamin B12 in the small intestine. Due to an autoimmune disorder (a disorder caused by a person's own immune system attacking the body's organs and tissues), the production of intrinsic factor is blocked.
2. Rremoval of small intestine where vitamin B12 is absorbed
3. Crohn's disease - a chronic inflammatory disease that affects any part of the gastrointestinal tract
4. Eating a vegan diet which excludes eggs, diary products, meat and fish
Folic acid deficiency
Folic acid deficiency is usually caused by an inadequate intake of folic acid, a vitamin mainly supplied by the fresh green leafy vegetables, mushrooms, lima beans and kidney beans. This disorder is most common in the poor and elderly (due to poor eating habits), in heavy alcohol drinkers, and in persons afflicted with intestinal disorders such as Crohn's disease or celiac sprue.
The symptoms of iron deficiency anemia (if any) are:
- Chest pains (in severe cases)
- Shortness of breath (in severe cases)
- Heart palpitations (in severe cases)
- An increased heart rate especially during exertion (in severe cases)
- Rapid breathing
- Low blood pressure
The symptoms of vitamin B12 anemia are similar to those of iron deficiency anemia but can also cause:
- Numbness and tingling in the hands and feet
- Equilibrium difficulties
- Personality changes and depression
The symptoms of folic acid deficiency are similar to vitamin B12 anemia.
Symptoms of anemia may also include:
- Back, maroon or bloody stool
- Abdominal pain
- Weight loss
- Chest pain
Anemia is diagnosed from the patient's symptoms and by a blood test that measures the level of hemoglobin in the blood, as well as substances such as folic acid, bilirubin and vitamin B12. Additionally, the size of the red cells provide further clues to the type of anemia.
Other methods of diagnosis may include a bone marrow biopsy, which is the removal of bone marrow for further examination under a microscope.
Bone marrow biopsy is helpful in diagnosing vitamin B12 anemia. Some dietitians suggest that the doctor also check for levels of ferritin in the blood of premenopausal women. Ferritin is a protein that stores iron before the mineral circulates in the bloodstream.
Treatment will depend upon whether an individual is not getting enough iron in the diet (increase iron intake); not absorbing iron (surgery for celiac sprue, etc.); or losing small amounts over time due to anything from alcoholic gastritis to medication abuse to tumors. The doctor will often recommend iron-rich foods (such as liver, seafood, dried fruits, lima beans, whole grains, green leafy vegetables and blackstrap molasses) or iron pills. In the more severe cases of iron deficiency anemia caused by blood loss, surgery, blood transfusions or hormone injections may be recommended.
Vitamin B12 deficiency
Current treatment of vitamin B12 deficiency consists of a life-long regimen of monthly B-12 injections. Unfortunately, neither diet or iron pills will help, but if diagnosed early a full recovery is promising.
Folic acid deficiency
Treatment is frequently a dietary correction. Main sources of folic acid include meat, poultry, cheese, milk, eggs, liver, green leafy vegetables, raw fruits, lima and kidney beans, and yeast. Folic acid tablets cure the anemia quickly. If intestinal disorders impede folic acid absorption, a supplement may be needed for a time. In rare instances, injections of folic acid are necessary.
Overall treatment considerations
Other therapies for anemia may include oxygen, fluids, fresh frozen plasma, platelet replacement and vasopressors (medication to elevate blood pressure). This will depend upon the underlying cause of the anemia.
Consumption of a healthy diet including iron-containing foods and those with B-complex vitamins is essential to developing and maintaining a satisfactory blood count.