As the most common diagnosed blood disorder globally, anemia occurs when there is a decrease in the number of circulating red blood cells in the body. It is estimated to affect 1.62 billion people globally and more than 3 million Americans – this equates to more than 24% of the world’s population.
Let’s begin with red blood cell basics.
Your body needs red blood cells to survive.
Your red blood cells resemble a donut, without a hole.
They are round with a somewhat flat, indented center.
These red blood cells have two very important roles:
They carry oxygen from your lungs to the rest of your body and they transport carbon dioxide from your body back to the lungs to be exhaled.
These cells begin in the bone marrow as stem cells which will then develop into platelets, red blood cells or white blood cells. The average life of a red blood cell in an adult is approximately 100-120 days.
Symptoms may range, depending on the type and severity of anemia.
However, common symptoms may include; weakness, dizziness, fatigue, chest pain, irregular or weak heartbeat, headache, cold hands or feet and pale or yellowed skin.
While there is no single cause of anemia, here is an overview of some of the most common causes.
Blood Loss – When the body loses blood, it’s reaction includes pulling water from body tissues in order to keep the blood vessels filled. The result of this is diluted blood and a lower red blood cell count.
This blood loss may be rapid and caused by events such as surgery, trauma or childbirth. Or, it may be chronic caused by conditions such as a stomach ulcer or cancer. Other causes of blood loss related anemia may include menstrual bleeding or overuse of NSAIDs (such as aspirin and ibuprofen.)
It is worth noting that the most common type of anemia called iron-deficiency anemia is often included in this category.
Decreased or Flawed Red Blood Cell Production – There are many conditions and diseases that may cause an issue with bone marrow production of red blood cells. These may include:
- Vitamin deficiency anemia – Your body needs both vitamin B-12 and folate to produce red blood cells. In the event that these are deficient, the production of red blood cells will be decreased. The most common examples of this are megaloblastic anemia and pernicious anemia.
- Bone Marrow or Stem Cell Complications – There are a few examples of types of anemia in this category. One is known as aplastic anemia which occurs when there are not enough stem cells present. Another example is thalassemia which occurs when red blood cells are prevented from growing and maturing properly.
- Iron-deficiency anemia – Caused by several factors which may include menstruation, poor diet, endurance training or frequent blood donation; this type of anemia occurs when the deficiency of iron in the body causes a decrease in the production of red blood cells.
- Sickle cell anemia – In this hereditary condition, red blood cells are misshapen into a crescent shape. These can get lodged in smaller blood vessels which causes pain.
- Leukemia – This cancer of the bone marrow typically causes over production of white blood cells, which in turn reduces the number of red blood cells.
Destruction of Red Blood Cells – As mentioned previously, typically your red blood cells live 100-120 days in your blood stream. One specific type of this anemia is called autoimmune hemolytic anemia in which the body’s immune system attacks its own red blood cells, mistaking them as a foreign substance. The breakdown of the red blood cells can also be caused by some of the following:
- Clotting disorders
- Severe hypertension
- Toxins from kidney or liver disease
- Certain drugs including some antibiotics
There are many ways to diagnose anemia – with the most common being a complete blood count.
This blood test is used to measure the number of blood components which includes hemoglobin and hematocrit levels – or the ratio of the volume of red blood cells to the total volume of blood. This test is used for a variety of reasons and is a way to indicate overall health as well as the possibility of conditions such as leukemia or kidney disease. However, it is worth noting that it is possible to be outside the normal range and still considered healthy. Speak to your doctor about your results.
Treatment options range, with one common goal – to increase the red blood cell count.
Depending on the underlying cause of the anemia, treatment may vary. Your doctor will know what is best for your specific condition and symptoms. Some treatments may include:
- Vitamin deficient anemia – dietary supplements and/or B12 injections
- Iron deficiency anemia – Iron supplements or dietary changes. (If this is being caused by blood loss, that must also be treated.)
- Sickle cell anemia – Treatment ranges from intravenous fluids, oxygen therapy and pain relief to supplements, blood transfusions and even some cancer medications.
- Hemolytic anemia – In some cases, blood filtering may be necessary. Other treatment may include immunosuppressant medications and avoiding medications that make the condition worse.
- Thalassemia – Typically, folic acid supplementation may be accompanied by removal of the spleen, with possible bone marrow transplants or blood transfusions.
- Aplastic anemia – Treatment will include bone marrow transplants and blood transfusions.
The role of the hematologist.
A hematologist is a doctor that specializes in the diagnosis, treatment and the prevention of blood diseases. This specialty includes both cancerous and non-cancerous disorders affecting the blood components, including white blood cells, red blood cells and platelets. They also treat conditions related to the organs that produce these blood components such as the bone marrow and spleen. Often, due to the specialized and extended training of the hematologist, patients are given referrals for specialized treatment.