Anemia: an overview

Anemia is the most common blood disease which is characterized by lack of red blood cells and its inability to perform its normal function to carry oxygen to our body cells and CO2 to our lungs to be exhaled. Red blood cells are produced from the bone marrow and contain hemoglobin protein which helps red blood cells to function properly. Also Iron, vitamin B12, folic acid and other nutrients play an important role in hemoglobin and red blood cells production.

Symptoms of Anemia:

As a result of anemia, oxygen isn’t carried to our body cells properly and this may cause a lot of symptoms which include:

• Weakness
• Headache
• Fatigue
• Dizziness
• Shortness of breath
• Pale skin
• Irregular heart beats
• Cold hands or feet
• Chest pain

Causes and Types:

There are three main causes of anemia:

1. Blood loss
2. Deficiency of red blood cells
3. Destruction of red blood cells

According to these causes, the most common types of anemia include:

• Iron deficiency anemia:

  Iron is an essential element for hemoglobin synthesis and red blood cells production, so its deficiency is one of the most common causes of anemia which affects many pregnant women and may result also from heavy menstruation or stomach and gastrointestinal ulcers. Moreover, it may result from blood loss due to taking regular pain relievers which cause inflammation in the lining of the stomach.

• Vitamin deficiency anemia:

  Vitamin b12 and folic acid are crucial for production of healthy red blood cells, therefore lacking these vitamins and other nutrients in our diet may cause anemia. In addition,  malabsorption of vitamin B12 may lead pernicious anemia.

• Anemia of chronic diseases:

  Some diseases affect our body’s ability to produce red blood cells as kidney diseases, because our kidney is responsible for erythropoietin secretion which stimulates the bone marrow to synthesize red blood cells. In addition to rheumatoid arthritis, hypothyroidism, and some other diseases which cause chronic or acute inflammation.

• Sickle cell anemia:

  An inherited condition which results from defective form of hemoglobin and production of abnormal sickle-shaped red blood cells. This type of red blood cells has a rigid wall and a lifetime of only from 10 to 20 days rather than 120 days in normal red blood cells. Moreover, these cells may stick to the blood vessels and clog the circulation resulting in pain crises.

• Hemolytic anemia:

  This type results from destruction of red blood cells and failure of the bone marrow to compensate them. The most common causes of hemolytic anemia include: splenomegaly, some autoimmune diseases, some infections like malaria or viral infections such as HIV. Also some inherited disorders such as thalassemia, which is characterized by DNA mutations in the hemoglobin, and G6PD deficiency can cause hemolytic anemia. 

• Aplastic anemia:

  A rare and life threatening condition characterized by failure of the bone marrow to make red blood cells due to autoimmune disorders in which the immune system attacks bone marrow stem cells causing its destruction. It can also happen due to some medications, viral infections, and exposure to radiation and toxic chemicals.

Risk factors: 

Some factors increase the risk which include:

• Diet lacking vitamin B12, folic acid, and some minerals.
• Age: people over 65 years old are at higher risk. 
• Menstruation and Pregnancy in women.
• Intestinal disorders: as it affects absorption of vitamins and minerals from the small intestine.
• Chronic diseases: such as: kidney diseases, liver diseases, hypothyroidism, autoimmune disorders, and cancers.
• Family History: some types of anemia are inherited as sickle cell anemia.

Complications:

Severe anemia can cause many complications like:

• Extreme weakness and inability to perform daily tasks.
• Heart problem: as a result of anemia, low oxygen is carried to our cells and heart beats increase to compensate for the lack of oxygen. This may cause cardiomegaly or heart failure.
• Depression: it may happen due to nerve destruction as a result of anemia
• Restless leg syndrome: Neurological disorder characterized by sudden move of the legs usually felt in the night and evening.
• Pregnancy problems: if anemia isn’t well managed during pregnancy, it may cause preterm birth or low birth-weight baby. 
• Immune system weakness: anemia may cause frequent infections and decrease the ability of the immune system to fight infections.
• Memory problems
• Impaired development: anemia may cause impaired mental and motor development in children and infants.

Diagnosis:

1. Complete Blood Picture (CBC): it measures the count and size of red blood cells and the count of white blood cells and platelets.
2. Reticulocytes count: reticulocytes are immature red blood cells. Reticulocytes count measures our bone marrow’s ability to produce enough new red blood cells.
3. Serum iron: measures iron levels in blood and used to diagnose iron deficiency anemia.
4. Serum Ferritin: measure iron stores in our body.
5. Vitamin B12 test: measures vitamin b12 levels in our blood.
6. Folic acid test: measures folic acid levels in our blood.
7. Coomb’s test: looks for autoantibodies that target and destroy red blood cells.
8. Occult blood in stool: looks for blood hidden in stool which comes from the gastrointestinal tract as a result of ulcers or cancer in the gastrointestinal system.
9. Bone marrow tests: bone marrow aspirate and biopsy used to evaluate the function of the bone marrow. They also diagnose leukemia, lymphoma, multiple myeloma and aplastic anemia.

Prevention:

1. Diet rich in iron such as broccoli, red meat, fish, eggs, soy products, green leafy vegetables and dried fruits
2. Diet rich in vitamin B12 such as beef liver and clams 
3. Diet rich in Folic acid such as peanuts, beef, kidney beans, spinach, black-eyed peas, rice and lettuce
4. Diet rich in vitamin C as it aids in iron absorption.
5. Avoid smoking, tea and caffeine drinking
6. Check up regularly to detect anemia and avoid its complications

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