Anemia – Causes, Treatment and Prevention

What is Hemoglobin?

Oxygen is the life-force of human beings and it comes from the air we breathe. Oxygen is transported to all cells and tissues in the body through the blood, more specifically by the red blood cells (RBC) in the blood. RBCs contain a protein called hemoglobin which carries the oxygen. A hormone called erythropoietin secreted by the kidneys signals the bone-marrow to produce more RBCs whenever there is a need for more oxygen (as during strenuous activity) or some condition is causing hypoxia (low oxygen in the body’s cells).

The RBCs are generated by tissues in the bone marrow. The element iron is required to generate both RBCs and hemoglobin. Hemoglobin stores almost two-thirds of the iron found in the body, which is what gives it, the RBCs, and hence the blood – its red color. The remaining one-third of the iron is found in the liver, spleen and bone-marrow. In addition to iron, the body needs Vitamin B12, and folate to generate both hemoglobin and RBCs.

It is also important to note that old RBCs are destroyed and new RBCs generated, all the time. Further, RBCs are round in shape and also must be of a particular size, only then can they slide freely through tiny blood vessels and enable quick transport of oxygen.

What is Anemia?

Anemia is a condition in which there are not enough RBCs in the blood to transport oxygen. This is indicated by the RBC count, or hemoglobin concentration, in the blood. The normal range for hemoglobin concentration or RBC count varies from person to person based on age, gender, if the woman is pregnant or not, and if the person is having any other health problem. For a healthy adult woman, the normal hemoglobin reference range is between 12 to 15.5 gms per deciliter, while for a healthy adult man, its between 15 to 17.5 gms per deciliter.

Anemia is a serious health concern that affects many people in the world, both in developed and developing countries. According to the World Health Organization (WHO), 1 in 3 women in the reproductive age of 15-49 years are suffering from anemia, almost 40% of pregnant women are diagnosed with anemia, and 40% of children less than 5 years have anemia. Anemia is also quite common among adult men.

Symptoms and Complications

Hemoglobin plays a very important role in the general, physiological functioning of the human body. So, if hemoglobin is in short supply, the body cannot function at its optimum level. There is a wide range of symptoms, depending on the type of anemia. Symptoms for iron-deficiency anemia, which is the most common type, include:

Dizziness, light-headedness, or a feeling the person will pass out
Weakness and fatigue
Fast or irregular heartbeat
Chest pain
Headache
Sore or inflamed tongue
Skin that is pale, yellowish, dry or easily bruised
Restless Legs Syndrome (RLS) which results in unintended movement in the lower legs
Shortness of breath
Cold hands and feet
Pain in the bones, bone joints and belly
Growth-related issues in children and teens
Brittle or spoon-shaped nails
Strange cravings to eat ice, starch or dirt
Loss of appetite especially seen in infants and young children

Also Read: Restless Leg Syndrome: Symptoms, Causes, and Treatment

Complications from severe, or untreated anemia

Hair-loss
Pregnant women can have premature childbirth
Tinnitus or ringing in the ears
Loss of a sense of taste
Heart and lung problems, especially in people with sickle-cell anemia
Enlarged heart or heart-failure
Depression and mental health issues
In children: delay in development of motor skills, learning disabilities and lack of attention
Complications caused by sickle-cell anemia can lead to death, so also loss of a lot of blood can cause death

Types and Causes of Anemia

There are over 400 types of anemia, which can be divided into four groups:

Anemia caused by blood loss

Bleeding causes loss or depletion of RBCs. The bleeding may be due to:

Conditions in the digestive tract – such as gastritis (inflammation of the stomach), ulcers, cancer and hemorrhoids
Certain drugs, especially non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin as these can cause gastritis andulcers
In some women, menstrual blood-loss can be heavy, which could be due to fibroids or endometriosis
Trauma: Bleeding from injuries, accidents or post-surgery

Anemia caused by decreased or faulty RBC production

In this type, certain vital ingredients are missing, so RBC production is impaired, or the RBCs produced have some problem which is why they don’t work the way they should. This includes:

Bone marrow and stem cell problems: Some of the stem cells in the bone marrow develop into RBCs. Conditions such as cancer can prevent this, leading to inadequate RBCs being produced. The 3 most common types in this category include:– Aplastic anemia: Here, there are few or no stem cells at all in the bone marrow and this can be caused by cancer and/or cancer treatment.
– Lead poisoning: Lead that comes from the air, water or food we consume can be toxic to the bone marrow and destroy stem cells in the same.
– Thalassemia: Here there is a problem with the chemical structure of hemoglobin formed
Iron-deficiency anemia: Here, there isn’t enough iron in the body due to inadequate iron in the diet. Or some condition is preventing the iron from being absorbed properly by the body. This can happen from a wide range of causes.
Sickle cell anemia: Here, the RBCs become elongated or curved at the ends, giving it a sickle shape. The sickle-shaped RB cells cannot slide smoothly through narrow blood-vessels and get stuck in the same, thereby preventing proper transport of oxygen.
Vitamin-deficiency anemia, specifically B12 or folate: This again is of 3 types – dietary and megaloblastic anemia, where enough B12 or folate is not available in the diet, and pernicious anemia, where there is enough B12 in the diet but the body is not able to absorb them.

Anemia caused by destruction of red blood cells

This is also called Hemolytic anemia. In this, the RBCs are delicate and cannot handle the stress of travelling through the body, thereby breaking down or getting destroyed. This can happen due to a wide range of reasons such as infections, venom from animal bites, attacks on the immune system such as Lupus, inherited conditions, enlarged spleen, chronic kidney disease, chronic liver disease, clotting disorders, exposure to certain industrial chemicals, burn injuries, hypertension, certain cancers, and procedures such as prosthetic heart valves or vascular grafts.

Anemia caused by other chronic conditions

Certain conditions can cause long-term inflammation which leads to delayed or sluggish production of RBCs by the bone marrow. These conditions include diabetes, lupus, some infections, hypothyroidism, advanced kidney disease (stage 4 or 5), rheumatoid arthritis, and just old age.

Also Read: Bone Marrow Transplant: What you need to know?

Treatment for Anemia

Treatment options are largely medication or drug-based, and supplements. They vary depending on the type of anemia.

Iron-deficiency anemia: Oral iron or IV iron supplements are given, and in very severe cases, the person may require intravenous transfusion of blood. Women with excessive menstrual-flow would be investigated for fibroids and endometriosis, and if the condition is confirmed, treatment is given accordingly.
Vitamin deficiency anemia: The first line of treatment involves improving the diet so that more of natural Vitamin B12 or folate can be ingested by the body. But if there is a condition that prevents effective absorption of the same, supplements are prescribed to be taken once a day. Once the hemoglobin concentration improves, the shots can be taken once a month.
Anemia of chronic disease: Synthetic erythropoietin is given initially to increase RBC production and if that is not working, blood transfusions are the only option.
Aplastic anemia: Blood transfusions or a bone marrow transplant are the solution.
Bone-marrow related anemias: Medication is the first line of treatment, followed by chemotherapy if cancer is the cause. Finally, bone-marrow transplant is explored.
Hemolytic anemia: Infections are treated first. Then, some medications taken by the patient are cut down. Finally, drugs are given to suppress the immune system.
Sickle-cell anemia: There are a wide range of options such as folic-acid supplements, antibiotics, blood-transfusion and a drug called hydroxyurea. Pain is managed through oral or IV fluids, oxygen and OTC pain-relievers.
Thalassemia: Mild thalassemia requires no medication. Moderate thalassemia is treated with medication, blood transfusion and folic-acid supplements. Severe condition is treated with splenectomy (removing the spleen) and stem-cell transplant of the blood or bone-marrow.

Prevention

Most anemias cannot be prevented. However, iron-deficiency and vitamin-deficiency anemia can be prevented by consuming the right diet, about which a dietician can guide you well.

Iron: Sources include red meat, dark-green leafy vegetables, beans and lentils, dried-fruits and iron-fortified cereals.
Folate/Folic acid: Sources include dark-green leafy vegetables, whole fruits or fruit juices, kidney beans, green peas, peanuts and fortified products such as bread, cereal, pasta and rice.
Vitamin B-12: Sources include dairy products, meat, soy products and fortified cereal.
Vitamin C: Sources include all citrus fruits – whole or juiced, strawberries, peppers, broccoli, melons and tomatoes. All of these help the body absorb iron better.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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