ANEMIA

Possible Cause

• Your body doesn't make enough red blood cells.
• Bleeding causes you to lose red blood cells more quickly than they can be replaced.
• Your body is destroying red blood cells.

What do red blood cells do?

Your body makes three types of blood cells — white blood cells to fight infection, platelets to help with the formation of blood clots and red blood cells to carry oxygen throughout your body.

Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Common types of anemia and their causes include:

• Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of iron in your body. Your bone marrow needs iron to make hemoglobin. This type of anemia is often caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer, a polyp somewhere in your digestive system, and prolonged use of aspirin or drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs).
• Vitamin deficiency anemias. A diet lacking folate and vitamin B-12, that are responsible to produce healthy red blood cells, can cause anemia. Additionally, some people may consume enough B-12, but their bodies aren't able to absorb the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia.
• Anemia of chronic disease. Certain chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can cause anemia.
• Aplastic anemia. This very rare life-threatening anemia is caused by a decrease in the bone marrow's ability to produce red blood cells. Causes of aplastic anemia include infections, drugs and autoimmune diseases.
• Anemias associated with bone marrow disease. A variety of diseases, such as leukemia, myelodysplasia or myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete life-threatening shutdown of the process.

Other cancers of the blood or bone marrow — such as multiple myeloma, myeloproliferative disorders and lymphoma — also can cause anemia.

• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life.
• Sickle cell anemia. This is inherited and is caused by a defective form of hemoglobin in which red blood cells have an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.
• Other anemias. There are several other rare forms of anemia, such as thalassemia and the ones that are caused by defective hemoglobin.

Risk Factors

These factors place you at increased risk of anemia:

• A diet lacking in certain vitamins. Choosing a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of anemia.
• Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients— such as Crohn's disease and celiac disease — puts you at risk of anemia. Surgical removal of the parts of your small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.
• Menstruation. In general, women who haven't had menopause at the right age have a greater risk of iron deficiency anemia than do men and postmenopausal women. That's because menstruation causes the loss of red blood cells.
• Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to cope with your increased blood demands as well as be a source of hemoglobin for your baby.
• Chronic conditions. For example, if you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of anemia. These conditions can lead to a shortage of red blood cells.

Slow, chronic blood loss from an ulcer or any other source within your body can deplete your body's store of iron, leading to iron deficiency anemia.

• Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk of the condition.
• Other factors. A history of certain infections, blood diseases and autoimmune disorders, alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

Complications

Left untreated, anemia can cause numerous complications, such as:

• Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. You may be too exhausted to work or play.
• Heart problems. Anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure.
• Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

Care and Treatment

Choose a vitamin-rich diet.Many types of anemia can't be prevented. However, you can help avoid iron deficiency anemia and vitamin deficiency anemias by choosing a diet that includes a variety of vitamins and nutrients, including:

• Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit..
• Folate. This nutrient, and its synthetic form folic acid, can be found in citrus fruits and juices, bananas, dark green leafy vegetables, legumes, and fortified breads, cereals and pasta.
• Vitamin B-12. This vitamin is found naturally in meat and dairy products. It's also added to some cereals and soy products, such as soy milk.
• Vitamin C. Foods containing vitamin C — such as citrus fruits, melons and berries — help increase iron absorption.

Consider genetic counseling if you have a family history of anemia. If you have a family history of an inherited anemia, such as sickle cell anemia or thalassemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.

When to Call the Doctor

Make an appointment with your doctor if you're feeling fatigued for unexplained reasons. Some anemias, such as iron deficiency anemia or vitamin B-12 deficiency, are common. Fatigue has many causes besides anemia, so don't assume that if you're tired you must be anemic. Some people discover they are anemic and have low hemoglobin levels when they go for blood donation. Low hemoglobin may be a temporary problem and one can redeem it by eating more iron-rich foods or taking a multivitamin containing iron. It may also be a warning sign if your condition does not improve with the above remedies.

If you're told that you can't donate blood because of low hemoglobin, make an appointment with your doctor.