Anaemia

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Overview

Anaemia is a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to the body's tissues. Having Anaemia may make you feel tired and weak.

There are many forms of Anaemia, each with its own cause. Anaemia can be temporary or long term, and it can range from mild to severe. See your doctor if you suspect you have Anaemia because it can be a warning sign of serious illness.

Treatments for Anaemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of Anaemia by eating a healthy, varied diet.

Symptoms

Anaemia signs and symptoms vary depending on the cause of your Anaemia. They may include:

• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or light-headedness
• Chest pain
• Cold hands and feet
• Headache

At first Anaemia can be so mild that it goes unnoticed, but symptoms worsen as Anaemia worsens.

When to see a doctor

Make an appointment with your doctor if you're feeling fatigued for unexplained reasons. Some Anaemias, such as iron deficiency Anaemia or vitamin B-12 deficiency, are common.

Fatigue has many causes besides Anaemia, so don't assume that if you're tired you must be anaemic.

Causes

Anaemia occurs when your blood doesn't have enough red blood cells. This can happen if:

• 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 destroys red blood cells

What red blood cells do

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

Red blood cells contain haemoglobin — an iron-rich protein that gives blood its red colour. Haemoglobin 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 spongy material found within the cavities of many of your large bones. To produce haemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Causes of Anaemia

Different types of Anaemia and their causes include:

Iron deficiency Anaemia:

This is the most common type of Anaemia worldwide. Iron deficiency Anaemia is caused by a shortage of iron in your body. Your bone marrow needs iron to make haemoglobin. Without adequate iron, your body can't produce enough haemoglobin for red blood cells.

Without iron supplementation, this type of Anaemia occurs in many pregnant women. It is also caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer and regular use of some over-the-counter pain relievers, especially aspirin.

Vitamin deficiency Anaemia:

In addition to iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production.

Additionally, some people may consume enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency Anaemia, also known as pernicious Anaemia.

Anaemia of chronic disease:

Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells.

Aplastic Anaemia:

This rare, life-threatening Anaemia occurs when your body doesn't produce enough red blood cells. Causes of aplastic Anaemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.

Anaemias associated with bone marrow disease:

A variety of diseases, such as leukaemia and myelofibrosis, can cause Anaemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from mild to life-threatening.

Haemolytic Anaemias:

This group of Anaemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a haemolytic Anaemia, or you can develop it later in life.

Sickle cell Anaemia:

This inherited and sometimes serious condition is an inherited haemolytic Anaemia. It's caused by a defective form of haemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.

Other Anaemias:

There are several other forms of Anaemia, such as thalassemia and malarial Anaemia.

Risk factors

These factors place you at increased risk of Anaemia:

A diet lacking in certain vitamins: Having a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of Anaemia.

Intestinal disorders: Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn's disease and celiac disease — puts you at risk of Anaemia.

Women, pre menopause: In general, women who haven't experienced menopause have a greater risk of iron deficiency Anaemia than do men and postmenopausal women. That's because menstruation causes the loss of red blood cells.

Poor folic acid levels during pregnancy: If you're pregnant and aren't taking a multivitamin with folic acid, you're at an increased risk of Anaemia.

Chronic conditions: If you have cancer, kidney failure or another chronic condition, you may be at risk of Anaemia of chronic disease. These conditions can lead to a shortage of red blood cells.

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

Family history: If your family has a history of an inherited Anaemia, such as sickle cell Anaemia, 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 Anaemia.

People over age 65 are at increased risk of Anaemia.

Complications

Left untreated, Anaemia can cause many health problems, such as:

Severe fatigue: When Anaemia is severe enough, you may be so tired that you can't complete everyday tasks.

Pregnancy complications: Pregnant women with folate deficiency Anaemia may be more likely to experience complications, such as premature birth.

Heart problems: Anaemia can lead to a rapid or irregular heartbeat (arrhythmia). When you're anaemic your heart must pump more blood to compensate for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure.

Life-threatening complications: Some inherited Anaemias, such as sickle cell Anaemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe Anaemia and can be fatal.

Prevention

Eat a vitamin-rich diet: Many types of Anaemia can't be prevented, but iron deficiency Anaemia and vitamin deficiency Anaemias can be avoided by having a diet that includes a variety of vitamins and nutrients, including:

Iron-rich foods: Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit.

Nutrients and folic acid: This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice.

Vitamin B-12: Foods rich in vitamin B-12 include meat, dairy products, and fortified cereal and soy products.

Vitamin C: Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. These items help increase iron absorption.

Diagnosis

To diagnose Anaemia, your doctor may ask you about your medical and family history, perform a physical exam, and run the following tests:

Full blood count (FBC):

A FBC is used to count the number of blood cells in a sample of your blood. For Anaemia your doctor will be interested in the levels of the red blood cells contained in the blood (haematocrit) and the haemoglobin in your blood.

Normal adult haematocrit values vary from one medical practice to another but are generally between 40 and 52 percent for men and 35 and 47 percent for women. Normal adult haemoglobin values are generally 14 to 18 grams per decilitre for men and 12 to 16 grams per decilitre for women.

A test to determine the size and shape of your red blood cells:

Some of your red blood cells may also be examined for unusual size, shape and colour.

Additional diagnostic tests:

If you receive a diagnosis of Anaemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency Anaemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumours or kidney problems.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose Anaemia.

Treatment

Anaemia treatment depends on the cause.

Iron deficiency Anaemia:

Treatment for this form of Anaemia usually involves taking iron supplements and making changes to your diet.

If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.

Vitamin deficiency Anaemias:

Treatment for folic acid and B-12 deficiency involves dietary supplements and increasing these nutrients in your diet.

If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may need vitamin B-12 shots. At first, you may receive the shots every other day. Eventually, you'll need shots just once a month, which may continue for life, depending on your situation.

Anaemia of chronic disease:

There's no specific treatment for this type of Anaemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.

Aplastic Anaemia:

Treatment for this Anaemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells.

Anaemias associated with bone marrow disease:

Treatment of these various diseases can include medication, chemotherapy or bone marrow transplantation.

Haemolytic Anaemias:

Managing haemolytic Anaemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Depending on the severity of your Anaemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful.

Sickle cell Anaemia:

Treatment for this Anaemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements and antibiotics.

A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea also is used to treat sickle cell Anaemia.

Thalassemia:

This Anaemia may be treated with blood transfusions, folic acid supplements, medication, removal of the spleen (splenectomy), or a blood and bone marrow stem cell transplant.

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