According to the World Health Organization (WHO), anemia affects nearly a quarter of the world’s population; which equates to over 1.6 billion people. Sadly, the demographic group with the highest prevalence is preschool-aged children. It is a condition that is similarly correlated with malnutrition around the world, principally due to the role of iron deficiency in many cases of anemia.
In the United States, anemia is less prevalent, but it is nevertheless the most common blood condition amongst Americans and is a significant problem for approximately 5-6% of the population. In general, anemia is often associated with poor health outcomes, and the Centers for Disease Control and Prevention estimate that it claims the lives of over 5000 people per year.
What is anemia?
Anemia isn’t a specific disease but rather the term used for any time there is a decrease in the total number of red blood cells or a decrease in the hemoglobin found in blood cells. It is also used in cases where the blood’s ability to effectively carry oxygen throughout the body is impaired in some way. Because this is a blanket term, it can be associated with a wide range of conditions and underlying causes.
To really understand anemia, you need to consider the role our blood plays in normal bodily functions. At a basic level, the cells in the blood are responsible for carrying oxygen and nutrients to all parts of the body via the circulatory system. The circulatory system is composed of two subsystems: pulmonary circulation and systemic circulation. Pulmonary circulation involves blood flowing from the heart to the lungs, where oxygen is absorbed by red blood cells. Oxygenated blood is pumped from the lungs all over the body and distributed to cells and organs through veins and capillaries.
Hemoglobin, a cellular protein that contains iron, is the component of red blood cells that actually absorbs and carries the oxygen it is exposed to in pulmonary circulation. Because all cells rely on oxygen to perform their basic functions, hemoglobin is naturally a critically important part of a healthy circulatory system. This is why a deficiency in hemoglobin or a low red blood cell count (as in anemia) can be a dangerous problem.
As noted earlier, children are one of the groups who are most likely to develop anemia, often as a result of an iron deficiency (a key element in hemoglobin). Women are twice as likely to develop anemia than men, especially if they are pregnant or menstruating. Additionally, older people are also more likely to develop anemia because of either an iron deficiency or a general proclivity towards the kinds of chronic diseases that can lead to anemia.
What causes anemia?
Anemia almost always comes about because of some underlying condition, but the primary cause typically falls into one of the following categories:
- Impaired red blood cell production: When red blood cell production is impaired, the body’s overall count is lower and is incapable of producing sufficient numbers for normal functioning.
- Increased red blood cell destruction: Some underlying conditions actually target too many cells for destruction by the spleen, usually because something has caused widespread damage to the cells. This also leads to an overall lower red blood cell count.
- Blood loss: Blood loss can occur from either a disease that causes bleeding or some kind of trauma. If the bleeding is ongoing, it can lead to an overall decreased red blood cell count. This is often a temporary problem that will resolve once the bleeding stops.
- Fluid overload: Also known as hypervolemia, fluid overload happens whenever excessive fluid or sodium intake and the blood leads to a lower than normal concentration of hemoglobin in the blood. With lower hemoglobin, the blood is not able to absorb and transport as much oxygen as the body requires.
Each of these categories has a series of other related conditions or types of anemia that are the underlying cause. There are many different diseases and disorders that affect blood cells, but some are more common than others:
- Impaired red blood cell production:
- Iron deficiency anemia
- Pure red cell aplasia
- Aplastic anemia
- Pernicious anemia
- Folate deficiency
- Myelodysplastic syndrome
- Increased red blood cell destruction:
- Sickle cell anemia
- Hereditary spherocytosis
- Malaria (and some other infections)
- Hemolytic anemia
- Blood loss:
- Trauma (can include during or after surgery)
- Gastrointestinal tract lesions (such as peptic ulcers)
- Menstruation in women who have fibroids
- A parasitic infection (such as a hookworm)
- Cancer (colorectal or urinary cancer, for example)
- Fluid overload:
- IV therapy with too much sodium
- Blood transfusion
- High blood sodium content
- Complications during pregnancy
Symptoms of Anemia
When anemia develops slowly, or when it is mild or moderate, many patients aren’t necessarily even aware that they have it because the symptoms are either mild or nonexistent. Additionally, because it is often a side effect of a chronic condition, or because the symptoms may be similar to a chronic condition, it may be difficult for a doctor to make a diagnosis. Nevertheless, here are some of the more common symptoms:
- Irregular heartbeat
- Shortness of breath
- Chest pain
- Extremities feel cold
- Pale or yellow skin
Since anemia fundamentally involves a decrease in red blood cells or hemoglobin, this means that your body essentially lacks sufficient oxygen to operate effectively. Each of these symptoms, then, is a direct effect of that lack of oxygen.
Treatments for Anemia
As with many conditions like anemia that can be involved in a wide range of ailments, the treatment is heavily dependent on the underlying condition. For example, iron deficiency remains a common cause of anemia around the world, though the deficiency usually has different sources depending on whether the person is from the developing world or a first world country. In the US, an iron deficiency is often due to blood loss, so the treatment will center around stopping the bleeding; in some cases, a doctor will prescribe an oral iron supplement or a specialized diet.
Some more serious conditions, as in diseases that involve problems with bone marrow, a blood transfusion or a bone marrow transplant may be necessary. Also depending on the nature of the underlying condition, a doctor may prescribe a variety of medications; one such example is immune-related hemolytic anemia that may require either steroids or immunosuppressants. These are just a couple of examples of the very different approaches a doctor would need to take in order to effectively treat anemia.
How do I reduce the likelihood of anemia?
Many types of anemia are based on genetic factors or are simply unavoidable depending on other health problems you may have. There are, however, a few types that are related to dietary nutrients, and there are changes you can make to your eating habits that will decrease the chances of developing anemia.
Iron deficiency anemia, as the name implies, involves a lack of iron in your red blood cells. By eating iron-rich foods like meats, dark leafy green vegetables, beans, lentils, or dried fruits, you can ensure that you have a sufficient amount of iron in your daily diet. Similarly, pernicious anemia is due to a lack of vitamin B12; meats, dairy, and soy products are excellent sources. Also, folate deficiency can be mitigated by eating dark leafy green vegetables, beans, peanuts, and enriched grains like cereals, rice, and pasta.
When should I see a doctor?
While the symptoms of anemia can sometimes be mistaken for other conditions, they are still good indicators that you might need to see a doctor. If you feel especially weak or fatigued, or if any of the other symptoms are present, you should tell your doctor. And since women are much more likely to develop anemia, particularly those who are pregnant or menstruating, they should be more wary of anemia symptoms. If you have been experiencing any of these symptoms and would like to talk with a gynecologist, contact The Woman’s Clinic today to make an appointment.