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Anemia

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia can make you feel tired and weak. There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

Signs & Symptoms of Anemia

  • Fatigue, or feeling extremely tired
  • Weakness
  • Trouble breathing
  • Dizziness
  • Fast or irregular heartbeats
  • Pounding or whooshing in your ears
  • Headache
  • Cold hands or feet
  • Pale or yellow skin
  • Chest pain

Who Is at Risk?

Anemia is a common condition. It occurs in all age, racial, and ethnic groups. Both men and women can have anemia. However, women of childbearing age are at higher risk for the condition because of blood loss from menstruation.

Anemia can develop during pregnancy due to low levels of iron and folic acid (folate) and changes in the blood. During the first 6 months of pregnancy, the fluid portion of a woman's blood (the plasma) increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia.

Older adults also are at increased risk for anemia. Researchers continue to study how the condition affects older adults. Many of these people have other medical conditions as well.

Major Risk Factors

Factors that raise your risk for anemia include:

  • A diet that is low in iron, vitamins, or minerals
  • Blood loss from surgery or an injury
  • Long-term or serious illnesses, such as kidney disease, cancer, diabetes, rheumatoid arthritis, HIV/AIDS, inflammatory bowel disease (including Crohn's disease), liver disease, heart failure, and thyroid disease
  • Long-term infections
  • A family history of inherited anemia, such as sickle cell anemia or thalassemia

Common Causes of Anemia

A variety of acute disease conditions can affect the hemoglobin concentration. Medical conditions and/or medications independently associated with anemia include:

Medical conditions

  • history of stroke or myocardial infarction
  • diabetes mellitus
  • hypertension
  • chronic kidney disease

Medications

  • angiotensin converting enzyme inhibitors
  • antiandrogenic medications
  • methyldopa
  • penicillin
  • sulfonamides
  • quinidine
  • alkylating agents
  • anthracyclines
  • antimetabolites
  • colchicine
  • zidovudine
  • anticonvulsants
  • hydroxyurea
  • methotrexate
  • proton pump inhibitors

Dangers of Untreated Anemia

The destructive consequences of anemia, even anemia with hemoglobin concentrations within the lower normal range, are associated with increased morbidity and mortality in a multitude of patient populations. In some cases, the lack of oxygen may be severe enough to be life-threatening. Anemia can cause the heart to work harder as it pumps more blood to compensate for the lack of oxygen in the blood. It may worsen heart conditions, and can lead to a rapid or irregular heartbeat -- an arrhythmia, or congestive heart failure. If a patient loses a lot of blood quickly, it can result in severe anemia and be fatal.

Most Common Types of Anemia

  • Iron Deficiency Anemia- the most common type
  • Vitamin Deficiency Anemia-caused by the wrong diet
  • Anemia and Pregnancy-being pregnant uses a lot of iron
  • Aplastic anemia-the body stops making enough red blood cells
  • Hemolytic anemia- red blood cells are killed in the blood stream
  • Sickle Cell anemia-abnormal red blood shapes that causes body tissues to starve
  • Anemia caused by other diseases-such as cancer, chronic illness or medications

How is Anemia Treated

Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss.

Goals of Treatment

The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.)

Another goal is to treat the underlying cause of the anemia.

Dietary Changes and Supplements

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions.

To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron.

Iron

Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meat—especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish.

Nonmeat foods that are good sources of iron include:

  • Spinach and other dark green leafy vegetables
  • Tofu
  • Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
  • Dried fruits, such as prunes, raisins, and apricots
  • Prune juice
  • Iron-fortified cereals and breads

You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.

Iron also is available as a supplement. It's usually combined with multivitamins and other minerals that help your body absorb iron.

Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow's milk, and infants who are fed breast milk only or formula that isn't fortified with iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with vitamin B12 supplements.

Good food sources of vitamin B12 include:

  • Breakfast cereals with added vitamin B12
  • Meats such as beef, liver, poultry, and fish
  • Eggs and dairy products (such as milk, yogurt, and cheese)
  • Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers

Folic Acid

Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.

Good sources of folic acid include:

  • Bread, pasta, and rice with added folic acid
  • Spinach and other dark green leafy vegetables
  • Black-eyed peas and dried beans
  • Beef liver
  • Eggs
  • Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.

Medicines

Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia. Some of these medicines include:

  • Antibiotics to treat infections.
  • Hormones to treat heavy menstrual bleeding in teenaged and adult women.
  • A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks.
  • Medicines to prevent the body's immune system from destroying its own red blood cells.
  • Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning.

Procedures

If your anemia is severe, your doctor may recommend a medical procedure. Procedures include blood transfusions and blood and marrow stem cell transplants.

Blood Transfusion

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient's blood.

Blood and Marrow Stem Cell Transplant

A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets.

During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells.

Surgery

If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes worn-out red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.

Hematologist