Anemia

WHAT YOU SHOULD KNOW

Anemia is the medical term for a shortage of red blood cells or the hemoglobin they contain. It is the hemoglobin that carries oxygen from the lungs to all other parts of the body. Without a sufficient supply of this substance, the body becomes starved for oxygen and loses the energy needed to function. The many forms of anemia are classified according to their cause. Among the more common types are:

• Posthemorrhagic anemia: Loss of red blood cells due to massive or prolonged bleeding
• Iron-deficiency anemia: Reduced production of red blood cells due to a shortage of iron
• Pernicious anemia: Disruption of red blood cell production due to inadequate absorption of vitamin B ₁₂
• Folic acid deficiency: A shortage of red blood cells due to lack of folic acid in the diet
• Aplastic anemia: Decreased production of blood cells due to declining function in the bone marrow, where the cells are manufactured
• Hemolytic anemia: Premature destruction of red blood cells

Causes

Excessive bleeding is the leading cause of anemia. When blood is lost, the body pulls water from tissues outside of the bloodstream to keep the circulatory system filled with fluid. However, new blood cells can't be manufactured as quickly, and in the diluted blood the count begins to decline. This can happen after sudden bleeding due to an accident, surgery, childbirth, or a ruptured blood vessel. It can also develop more gradually as a result of chronic nosebleeds, heavy menstrual cycles, hemorrhoids, stomach or small intestinal ulcers, kidney or bladder tumors, or gastrointestinal cancer. A variety of mechanisms underlie the other major types of anemia.

• Iron-deficiency anemia: Depletion of the body's stores of iron is usually a result of chronic, hidden bleeding.
• Pernicious anemia: The lack of a chemical called intrinsic factor renders the body unable to absorb the vitamin B ₁₂ needed to produce red blood cells. Intrinsic factor is manufactured in the lining of the stomach. Supplies can be disrupted by certain parasites, inflammatory bowel disease, and diseases of the small intestine. Disorders such as thyroiditis and diabetes can also be at fault.
• Folic acid deficiency: This problem often accompanies pregnancy, when the body needs eight times more folic acid than usual. A deficiency can also be brought on by inadequate intake of foods high in folic acid content---such as meat, poultry, fish, cheese, eggs, cereals, green leafy vegetables, yeast, and mushrooms---and by overcooking food, which destroys folic acid. Alcoholism is another potential culprit.
• Aplastic anemia: Anything that harms bone marrow can lead to a decline in blood cell production. Immunosuppressive drugs, anticancer drugs, and other toxic chemicals bring on many cases in this category.
• Hemolytic anemia: Destruction of red blood cells can follow the use of certain drugs, mismatched blood transfusions that cause antibodies to attack red blood cells, or a drug allergy. Some cases of this disorder are inherited.

Signs/Symptoms

Fatigue, weakness, light-headedness and a poor resistance to infection accompany all forms of anemia. Other symptoms vary according to the underlying cause.

• Iron-deficiency anemia: Cracked lips, inflamed tongue, spoon-shaped nails, difficulty swallowing, and cravings for dirt, paint, or ice.
• Pernicious anemia: Weakness in the arms and legs, inflamed tongue, nausea, loss of appetite and weight, impaired sense of smell, numbness and tingling in the hands and feet, difficulty maintaining proper balance, shortness of breath, depression, confusion, headache, and poor memory.
• Folic acid deficiency: Inflamed tongue, paleness, shortness of breath, nausea, vomiting, and occasionally diarrhea.
• Aplastic anemia: Paleness, chills, rapid heartbeat, shortness of breath, yellow skin and eyes, dark urine, red spots indicating bleeding under the skin, and spontaneous bleeding from the nose, mouth, rectum, vagina, or gums.
• Hemolytic anemia: Shortness of breath, irregular heartbeat, yellow skin and eyes, dark urine, and enlarged spleen.

Care

There are several methods of treatment for anemia, depending upon the severity of the condition and how rapidly blood is being lost. Not all cases are curable. If the condition is severe, a blood transfusion is the only treatment available. However, in less severe cases, the problem can be remedied by other means. Typical treatments for specific forms of anemia are as follows.

• Iron-deficiency anemia: Treatment to halt any underlying hidden bleeding, plus iron supplements, usually taken orally between meals.
• Pernicious anemia: Regular injections of vitamin B ₁₂ . (Injections are needed because of the body's inability to absorb the vitamin through the digestive tract.)
• Folic acid deficiency: Folic acid supplements.
• Aplastic anemia: The ideal treatment is a bone marrow transplant to replace poorly functioning bone marrow cells with healthy ones. (However, the transplant must match your own marrow exactly. It may be taken from a relative or a donor found through the National Bone Marrow Program.)
• Hemolytic anemia: In most cases, elimination of the cause; in some, surgery to remove an enlarged spleen.

Risks

Severe anemia, left untreated, can lead to a stroke or heart attack. It's important to seek a remedy for the problem.

WHAT YOU SHOULD DO

• Take prescribed medications and supplements exactly as directed. If you are taking an iron supplement and miss a dose, skip it and take the next one on time. Do not double your dosages.
• If medications such as oral contraceptives and immunosuppressive drugs are causing the anemia, you'll need to find replacements. Talk to your doctor about alternative medications or therapies.

Call Your Doctor If...

• Any of your symptoms get worse.
• You develop any of the following conditions during treatment:
• • fever
  • cough
  • swollen joints
  • muscle aches
  • sore throat
  • blood in your urine
• You experience any side effects from iron supplements such as:
• • fever
  • tight chest
  • difficulty breathing
  • skin irritations including a rash, redness, or itching

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

If you need a bone marrow transplant to remedy aplastic anemia, you'll be kept in a special nursing unit of the hospital to limit your exposure to infection. You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• Oxygen: Your body may need extra oxygen. It will be given by either a mask or nasal prongs.
• Pulse Oximeter: This is a clip placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• IV: A tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it. An IV is also used to transport the bone marrow into your body.
• Blood: Samples will be taken from a vein in your hand or the bend in your elbow to be used for testing.
• ECG: Also known as a heart monitor, an electrocardiograph or an EKG. Patches placed on your chest are hooked up to a TV-type screen that shows a tracing of each heartbeat.
• Anesthesia: General anesthesia is administered by injection or inhalation with an airway tube placed in your windpipe.
• Surgery: The transplant marrow is first removed from the top of the donor's hip, then filtered and treated. It can be administered to you immediately or frozen and stored for later use. The transplant is given via an IV line. New marrow entering the bloodstream will eventually find its way into the bone cavities and grow to replace the old bone marrow.

After You Leave

• You will need to rest in bed for several days and avoid situations that could potentially expose you to any viruses or infections.

Call Your Doctor If...

• You experience the following:
• • fever
  • swelling anywhere in the body
  • skin rash
  • joint pain
  • yellow skin or eyes
  • puffy feet and ankles
  • urinary discomfort or decreased urine after one day

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