Definition

Anemia is a blood disorder that occurs when red blood cell levels (RBCs) become abnormally low in the blood. It can also occur when the RBCs do not have enough hemoglobin. Hemoglobin is a protein that delivers oxygen from the lungs throughout the body. The low RBC's or hemglobin means the blood can’t deliver enough oxygen to the rest of the body. This causes tiredness and other symptoms characteristic of anemia.

There are several specific types of anemia, including:

• Anemia of chronic disease
• Anemia of inflammation
• Aplastic anemia—bone marrow doesn’t make enough new cells to replenish blood cells
• Iron-deficiency anemia
• Macrocytic B12 deficient anemia and pernicious anemia—lack of intrinsic factor, which is needed to absorb vitamin B-12
• Sickle cell anemia

	Red Blood Cells
	© 2008 Nucleus Medical Art, Inc.

Causes

The main causes of anemia are:

• Blood loss, such as that caused by:
  • Heavy menstrual periods
  • Bleeding in the digestive tract
  • Bleeding in the urinary tract
  • Surgery
  • Trauma
  • Cancer
• Abnormally low RBC production, due to:
  • Kidney disease
  • Cancer
  • Infection
  • Medication
  • Radiation
  • Pregnancy
  • Lead intoxication
• Abnormally high RBC destruction, caused by inherited disorders such as:
  • Sickle cell anemia
  • Thalassemia—difficulty in manufacturing hemoglobin
  • Enzyme deficiencies

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors may increase your risk of anemia:

• Women of childbearing age
• Pregnancy
• Older adults with other medical condition
• Infants younger than two years
• Poor diet low in iron, vitamins, and minerals
• Blood loss (eg, due to surgery or injury)
• Chronic or serious illness
• Chronic infections
• Family history of inherited anemia (eg, sickle cell anemia, thalassemia)

Symptoms

Symptoms of anemia may include:

• Tiredness
• Lethargy
• Feeling faint
• Paleness
• Shortness of breath
• Dizziness
• Headache
• Coldness in the hands and feet
• Pale skin
• Chest pain
• Rapid or irregular heartbeat

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Other tests may include:

• Complete Blood Count (CBC)—a test that measures levels of hemoglobin and RBCs
• Other blood tests
• Blood smear
• Stool sample
• Bone marrow aspiration or biopsy

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Nutrition

Your doctor may recommended making changes to your diet or taking vitamin or iron supplements. Changes to your diet may include eating more iron-rich foods, as well as foods that are good sources of vitamin C, vitamin B12, and folate.

Medications

Depending on the cause of your anemia, your doctor may prescribe antibiotics, hormone treatment, epoetin, medications that act on the immune system, or chelation therapy (for lead poisoning) to help treat your anemia or symptoms.

Blood Transfusions

In some cases, a blood transfusion may be necessary.

Bone Marrow or Stem Cell Transplant

Serious cases of anemia, such as aplastic anemia, may need to be treated with marrow or stem cell transplants.

Surgery

Life-threatening bleeding may need to be treated with surgery. In addition, in cases of abnormally high RBC destruction, your spleen may need to be surgically removed.

Prevention

Most inherited forms of anemia cannot be prevented. But the following steps may be taken to prevent certain types of anemia:

• Eat a diet rich in iron and vitamins.
• Take iron or vitamin supplements, as recommended by your doctor.
• Treat underlying causes of anemia.
• Report signs and symptoms, especially chronic fatigue, to your doctor.

RESOURCES:

Iron Disorders Institute
http://www.irondisorders.org

National Anemia Action Council
http://www.anemia.org

CANADIAN RESOURCES:

Anemia Institute
http://www.anemiainstitute.org

Chronic Disease Management, Government of British Columbia Ministry of Health
http://www.health.gov.bc.ca/cdm.index.html

References:

Anemia. PatientUK website. Available at: http://www.patient.co.uk/showdoc.asp?doc=23068888. Accessed June 25, 2007.

Anemia. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html. Accessed June 25, 2007.

Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104:2263-2268.

Nissenson AR, Goodnough LT, Dubois RW. Anemia: not just an innocent bystander? Arch Intern Med. 2003;163:1400-1404.

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