Anemias Health Article

Causes and symptoms

Anemia is caused by bleeding, decreased red blood cell production, or increased red blood cell destruction. Poor diet can contribute to vitamin deficiency and iron deficiency anemias in which fewer red blood cells are produced. Hereditary disorders and certain diseases can cause increased blood cell destruction. However, excessive bleeding is the most common cause of anemia, and the speed with which blood loss occurs has a significant effect on the severity of symptoms. Chronic blood loss is usually a consequence of:

• cancer
• gastrointestinal tumors
• diverticulosis
• polyposis
• heavy menstrual flow
• hemorrhoids
• nosebleeds
• stomach ulcers
• long-standing alcohol abuse Acute blood loss is usually the result of:
• childbirth
• miscarriage of pregnancy
• injury
• a ruptured blood vessel
• surgery

When a large volume of blood is lost within a short time, blood pressure and the amount of oxygen in the body drop suddenly. Heart failure and death can follow.

Loss of even one-third of the body's blood volume in the space of several hours can be fatal. More gradual blood loss is less serious, because the body has time to create new red blood cells to replace those that have been lost.

Symptoms

Weakness, fatigue, and a run-down feeling may be signs of mild anemia. Skin that is pasty or sallow, or lack of color in the creases of the palm, gums, nail beds, or linings of the eyelids are other signs of anemia. Someone who is weak, tires easily, is often out of breath, and feels faint or dizzy may be severely anemic.

Other symptoms of anemia are:

• angina pectoris (chest pain, often accompanied by a choking sensation that provokes severe anxiety)
• cravings for ice, paint, or dirt (called pica)
• headache
• inability to concentrate, memory loss
• inflammation of the mouth (stomatitis) or tongue (glossitis)
• insomnia
• irregular heartbeat
• loss of appetite
• nails that are dry, brittle, or ridged
• rapid breathing
• sores in the mouth, throat, or rectum
• sweating
• swelling of the hands and feet
• thirst
• tinnitus (ringing in the ears)
• unexplained bleeding or bruising

In pernicious anemia, the tongue feels unusually slick. A patient with pernicious anemia may have problems with movement or balance, tingling in the hands and feet, confusion, depression, and memory loss.

Pernicious anemia can damage the spinal cord. A doctor should be notified whenever symptoms of this condition occur.

A doctor should also be notified if a patient who has been taking iron supplements develops diarrhea, cramps, or vomiting.

Diagnosis

Personal and family health history may suggest the presence of certain types of anemia. Laboratory tests that measure the percentage of red blood cells or the amount of hemoglobin in the blood are used to confirm diagnosis and determine which type of anemia is responsible for a patient's symptoms. X rays and examinations of bone marrow may be used to identify the source of bleeding.

Treatment

Anemia due to nutritional deficiencies can usually be treated at home with appropriate supplements, under a health professional's guidance. People with iron deficiency should take iron supplements. People with folic acid anemia should take oral folic acid replacements. Vitamin C deficiency anemia can be cured by the recommended daily allowance of vitamin C. People with pernicious anemia may be able to self-administer injections of vitamin B₁₂.

Surgery may be necessary to treat anemia caused by excessive loss of blood. Transfusions of red blood cells may be used to accelerate production of red blood cells in the body.

Medication or surgery may also be necessary to control heavy menstrual flow, repair a bleeding ulcer, or remove polyps (growths or nodules) from the bowels.

Patients with thalassemia usually do not require treatment. However, people with a severe form may require periodic hospitalization for blood transfusions or bone marrow transplantation.

Alternative therapies for iron deficiency anemia focus on adding iron-rich foods to the diet or on techniques to improve circulation and digestion. Herbal remedies to improve digestion include Gentian (Gentiana lutea), which is widely used in Europe to treat anemia and other nutritionally based disorders, as well as anise (Pimpinella anisum), caraway (Carum carvi), cumin (Cuminum cyminum), and licorice.

SICKLE CELL ANEMIA. Treatment for sickle cell anemia involves regular eye examinations, immunizations for pneumonia and infectious diseases, and prompt treatment for sickle cell crises and infections of any kind. Psychotherapy or counseling may help patients deal with the emotional impact of this condition.

VITAMIN B₁₂ DEFICIENCY ANEMIA. A life-long regimen of B₁₂ shots is necessary to control symptoms of pernicious anemia. The patient may be advised to limit physical activity until treatment restores strength and balance.

APLASTIC ANEMIA. People who have aplastic anemia are especially susceptible to infection. Treatment for aplastic anemia may involve blood transfusions and bone marrow transplant to replace malfunctioning cells with healthy ones.

SIDEROBLASTIC ANEMIA. X-linked sideroblastic anemia often improves with pyridoxine (vitamin B₆) therapy. In cases of extreme anemia, whole red blood cell transfusion may be required.

If anemia is acquired, removal of the offending agent or treatment for the primary disorder may allow the anemia to disappear.

ANEMIA OF CHRONIC DISEASE. There is no specific treatment for anemia associated with chronic disease, but treating the underlying illness may alleviate this condition. This type of anemia rarely becomes severe. If it does, transfusions or hormone treatments to stimulate red blood cell production may be prescribed.

HEMOLYTIC ANEMIA. There is no specific treatment for cold-antibody hemolytic anemia. About one-third of patients with warm-antibody hemolytic anemia respond well to large doses of intravenous and oral corticosteroids, which are gradually discontinued as the patient's condition improves. Patients with this condition who don't respond to medical therapy must have the spleen surgically removed. This operation controls anemia in about half of the patients on whom it's performed. Immune system suppressants are prescribed for patients whose surgery is not successful.