Basic Facts About Anemia, Causes &Prevention

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Anemia is a process, not a disease, and is the most common disorder of the blood. Anemia occurs when the amount of red blood cells or hemoglobin (oxygen-carrying protein in the blood) in the blood becomes low, causing the tissues of the body to be deprived of oxygen-rich blood. It is characterized by a reduction in size, number, or color of red blood cells (RBC), which results in reduced oxygen-carrying capacity of the blood. The blood of an anemic person has trouble carrying oxygen to tissues and organs, in a sense, become "starved" of oxygen and without oxygen, the tissues cannot produce energy to function. In order for the body to stay healthy, organs and tissues need a steady supply of oxygen.

There are several kinds of anemia produced by a variety of underlying causes, but the most common and most severe type of anemia, iron-deficiency anemia (IDA). Just as the name implies, this form of anemia is due to insufficient iron. In the United States, 20% of all women of childbearing age have iron-deficiency anemia, compared with only 2% of adult men. The principal cause of iron-deficiency anemia in premenopausal women is blood lost during menses.

During their reproductive years, women are at an increased risk for iron deficiency because they lose 20-40 mg or iron per month during the menstrual cycle. Inadequate iron needs to be replenished through a well balanced diet. Iron balance is maintained through the absorption mechanism of the gastrointestinal tract.

Other common causes of anemia include: eating inadequate amounts of iron-rich foods, a deficiency of Vitamin B-12, a deficiency of folic acid, or poor iron absorption by the body.

When the body has sufficient iron to meet its needs (functional iron), the remainder is stored for later use in the bone marrow, liver, and spleen. Iron-deficiency ranges from iron depletion, which yields no physiological damage, to iron-deficiency anemia, which can affect the function of numerous organ systems. Iron-depletion causes the amount of stored iron to be reduced, but has no affect on the functional iron. However, a person with no stored iron has no reserves to use if the body requires more iron. In essence, the amount of iron absorbed by the body is not adequate for growth and development or to replace the amount lost. Iron-deficiency anemia is the final stage of iron deficiency.

What is the role of iron in the body?

Iron is responsible for the transport and storage of oxygen within working muscle cells including the heart. Within each red blood cell are proteins called hemoglobin and embedded in each hemoglobin protein are four iron particles. These iron particles give the red blood cell the ability to transport oxygen. Iron binds to oxygen in the lungs and then circulates the oxygen-rich blood to the tissues of the body. Inadequate iron availability results in reduced production of red blood cells. Consequently, the red blood cells that do form are small, with less hemoglobin and a decreased oxygen-carrying capacity. The total amount of iron in the body is dependent on intake, loss, and storage of the mineral.

How much iron does a woman need?

The body recycles iron, so when a cell dies the iron is used to produce new cells. Due to the body's efficient reuse of iron, iron has a relatively small Recommended Daily Allowance (RDA). The RDA of iron for postmenopausal women is 10 milligrams; women of childbearing age (11-50 years) as well as nursing mothers require 15 milligrams, and pregnant women 30 milligrams. A multitude of national nutrition surveys report that as many as 90% of women do not consume enough iron.

Red blood cells are formed in the bone marrow where iron-rich hemoglobin is accumulated.

Typically, the heart pumps oxygen-depleted blood to the lungs, where hemoglobin of the red blood cells binds to oxygen and this oxygen-rich blood circulates through the body to the tissues and organs. The blood also brings carbon dioxide, the waste product of the energy production process, back to the lungs where it is exhaled from the body.

Red blood cells have a lifetime of 120 days and must constantly be replaced. Since hemoglobin is the main component of red blood cells and the carrier for oxygen molecules, anemia occurs when the hemoglobin supply is inadequate or if the hemoglobin is dysfunctional.

The initial stages of anemia normally present no symptoms. As the body's store of iron becomes exhausted or depleted, so does the body's iron supply to the bone marrow diminishes. A decrease in iron to the marrow hampers its ability to produce healthy red blood cells which require iron. If iron stores do not become replenished, full-blown iron-deficiency anemia develops. It can take months or even years to develop symptoms of iron-deficiency anemia, symptoms include- weakness, paleness, shortness of breath, poor appetite, and increased susceptibility to infection is evident. If iron stores are "re-built", symptoms will disappear.

Who is at risk for developing anemia?

An iron deficit is not necessarily due to poor eating habits, an otherwise balanced diet may not supply ample iron to women in one of the following groups- menstruating, dieting, pregnant, vegetarian and women who do not eat red-meat, as well as women who have trouble absorbing iron from their foods.

Menstruation: The monthly blood loss that occurs during menstruation causes the body to need increased iron. Women who experience heavy bleeding should pay special attention to their iron intake.

Dieting: Since the average American women's diet does not reach the RDA for iron, dieting and decreasing food intake will make it even more difficult to reach the recommended RDA for iron.

Pregnancy: Pregnant women are at an increased risk for developing anemia, because the iron stores are placed at an increased demand caused by the higher blood volume and demands of the fetus and placenta.

Vegetarians: Vegetarians and people who do not consume red meat are more apt to be iron deficient. Meat sources of iron, also called heme-iron, such pork, beef and lamb are among the richest sources of iron. Heme-sources of iron are best absorbed and utilized by the body. Non-heme sources such as the iron in beans, grains and vegetables is not nearly as well absorbed by the body.

Absorption: The capacity of the body to absorb iron from the diet is a crucial factor for developing iron stores and maintaining functional iron. When the body has trouble absorbing iron from foods or when iron is lost through cellular break down, iron deficiency anemia is likely to occur.

How is anemia diagnosed?

Anemia is diagnosed by a blood test, either by a finger stick in a physician's office, or by a blood test done in a laboratory.

What are the consequences of being anemic?

Mild anemia does not have any significant long-term consequences. However, as the anemia becomes more severe, there are medical problems, which may arise. The most serious of these involve the heart. Severe anemia may cause a condition called high-output heart failure, where the heart must work harder to provide enough oxygen to the brain and other internal organs. The heart beats faster and increases the amount of blood that is delivered per minute.

When this condition occurs in individuals that have existing heart disease, the heart may be unable to keep up with this increased demand, and symptoms of heart failure such as difficulty breathing and leg swelling may occur. Individuals who have coronary artery disease, or narrowing of the blood vessels supplying blood to the heart, may develop symptoms of angina, the pain associated with an insufficient blood flow to the heart muscle.

Depending on the age of the woman and the degree of coronary artery disease, angina may develop with even mild anemia. In severe cases, the heart muscle may be permanently injured, and the woman will be at increased risk for a heart attack.

How can developing anemia be prevented?

Iron-deficiency anemia can be prevented by control of bleeding and restoration of adequate iron supplies by iron supplements. Bleeding caused by uterine abnormalities such as fibroids is often controlled with the use of non-steroidal anti-inflammatory agents (such as ibuprofen or naproxyn) or oral contraceptives. Mild bleeding from the gastrointestinal tract is controlled either by acid-blocking agents which allow ulcers to heal, or, if the bleeding is from polyps in the colon, by removal of the polyps.

If a person is treated for anemia, what are the chances it will reoccur?

The answer to this question depends on the cause of the anemia. If stopping the source of the blood loss treats iron-deficiency anemia, the anemia should resolve once the iron stores are repleted, and should not reoccur unless another site of bleeding arises. Pernicious anemia, caused by B12 deficiency, generally must be treated life-long with B12 injections, and will reoccur if the B12 treatment is stopped. Inherited anemias, such as thalassemia, are lifelong conditions as well.

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