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ABCMD definition of Anemia: A medical condition when your body does not have enough red blood cells (the type of cells in your body that carry oxygen to all the parts of your body).

Basics of Anemia:

Anemia is a medical condition where people have low levels of red blood cells in their body. Red blood cells are the type of cells in your blood that have the special role of carrying oxygen from your lungs to all the other parts of your body that need it. A person who has low levels of red blood cells in their body is referred to as “Anemic.”

What causes Anemia?

Anemia has many causes. Here are a few of the most common causes of Anemia:

1) Poor production. Red blood cells are made in your body within the bone marrow. Normally, red blood cells last around 3 months (120 days) before they need to be replaced with new red blood cells. This requires that you have all the building blocks needed to make new red blood cells and the appropriate signal to the bone marrow (Erythropoetin made and released by the kidneys) to make new red blood cells.

a. Conditions that lead to low levels of new red blood cell production include

i. Poor nutrition (low iron, folate, vitamin B12, etc). Anemia from low B12 has its own name in medicine and is called Pernicious Anemia.

ii. Chronic disease,

iii. Alcoholism,

iv. Leukemia,

v. Aplastic Anemia (the bone marrow that holds the red blood cells precursors fails)

vi. Kidney Disease- the kidney normally makes and releases Erythropoetin (Epo) into the blood. Erythropoetin travels in the blood to the bone marrow where it stimulates new production of red blood cells. Without this signal, red blood cell production decreases.

2) Blood loss (bleeding). This is probably the most common cause of Anemia. Your body loses red blood cells faster then it can make them.

a. Anemia from blood loss is most commonly seen in:

i. Gastrointestinal bleeding (stomach or duodenal ulcers, colon cancer, esophageal varices, etc.),

ii. Major trauma/accidents (pelvic fractures, amputations, etc.)

iii. Surgical procedures.

3) Increased destruction of red blood cells. Destruction of red blood cells is usually called “Hemolytic Anemia.”

a. Conditions that can lead to Hemolytic Anemia include transfusion reaction, Sickle Cell Disease, Hereditary Spherocytosis, heart valves, hypersplenism (your spleen destroys the red blood cells, lead poisoning, etc.

4) Chronic disease

5) Pregnancy

6) Genetic causes.

a. Sickle Cell Disease, Hereditary Spherocytosis, Thalassemias, etc.

What are the some of the signs of Anemia?

Some of the signs (things you see) and symptoms (things you feel) of Anemia may include the following:

Weakness, increased fatigue, poor exercise tolerance

Shortness of breath

Chest pain or racing heart (tachycardia, palpitations)

Malaise (just not feeling well)

Pallor (pale skin)

Pica (eating dirt, clay, etc). This is most common in iron deficiency Anemia.

Blood in stool or dark/tarry stool. This is common with ulcers, cancer, hemorrhoids, esophageal varices.

How is Anemia Diagnosed?

Anemia is diagnosed with a simple blood test. Anemia can be diagnosed by either testing Hemoglobin or Hematocrit levels in your blood. These tests can be ordered individually or in combination as part of a Complete Blood Count, or as your doctor might say, a “CBC.” The other things a Complete Blood Count or a CBC tests are white blood cell count (WBC) and platelet count. White blood cells are the types of cells in your body that fight infection, while platelets are a type of cells in your body that are involved in blood clotting (to help stop bleeding).

How is Anemia Treated?

Anemia is treated based on the cause. For example, if you are anemic due to a bleeding ulcer, your primary treatment will be treatment of the ulcer. This prevents further blood loss. Similarly, if you are anemic from poor nutrition (lack of the appropriate building blocks of red blood cells), your doctor will provide you with an appropriate diet and/or vitamins to include iron, vitamin B12, folate, etc.

If your anemia is severe enough (the level of red blood cells in your blood is low enough), your doctor may recommend a blood transfusion. A blood transfusion is when someone else’s blood (that has been cleaned and screened for disease) is given to you through an IV. Blood transfusions have the benefit of immediately increasing the number of red blood cells in your blood/body. However, blood transfusions have risks, including but not limited to, fever (elevated body temperature), hemolytic reactions (when your body’s immune system or the system that fights infection destroys the red blood cells) and transmission of Human Immunodeficiency Virus (HIV) or Hepatitis B or C. Transmission of HIV or Hepatitis B or C is very rare with blood transfusion. The Center for Disease Control (CDC) estimates 1/1-2,000,000 risk for transmission of HIV or Hepatitis C and 1/200,000 for Hepatitis B. This means if 2,000,000 people got a blood transfusion, 1 person would get HIV or Hepatitis C.

In comparison to a blood transfusion, treating your anemia with time, appropriate diet, preventing further blood loss allows your body to make its own red blood cells. This has the benefit of preventing reactions you can get with a blood transfusion (transmission of HIV, Hepatitis, etc). However making new red blood cells takes time and some times, especially in emergencies, patients do not have time and require transfusions.

Ask your doctor about the best way to treat your Anemia.

Interesting Notes:

1) Some people have religious beliefs that do not allow them to receive blood products. This is true for most Jehovah’s Witnesses. This can make medical care complicated for these people, especially when these people need large surgeries and a large amount of blood loss is expected.

2) Some people abuse one of the treatments of Anemia for competitive advantage in sports. Erythropoetin, or Epo as some call it, is a substance normally made by the kidneys. Erythropoetin, or Epo, travels in the blood to the bone marrow where causes an increase in production of red blood cells. With more red blood cells in the body, people have the ability to deliver oxygen throughout their body to the parts that need it (muscles) more efficiently. This can increase endurance (how long you can compete or work out), recovery from competition, etc. However, use of Erythropoetin has many dangerous side effects. Abuse of Erythropoetin or Epo is most commonly seen and reported in competitive cycling.