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Anemia

Introduction

What should I know about Anemia?

Back in the 1950’s, numerous television commercials were aimed at improving the dreary and exhausting life of the American housewife by eliminating anemia. The commercial made the assumption that most women had iron deficiency anemia. The before and after shots always portrayed a woman who was so exhausted that she could hardly move and then showed her later dancing with her husband, cooking dinner, playing with the children, and all the while being ever so perky. This amazing recovery was after only a couple of doses of the advertiser’s elixir. There is much more to anemia than those old commercials led us to believe, though many Americans continue to perceive it in this limited fashion even though there are a variety of causes and many different types of anemia.

The average adult body contains about 4 grams of iron, approximately two-thirds of which exists in the form of hemoglobin, a protein in the blood that carries oxygen. Another 13 percent exists as a type pigment in our muscles that carries oxygen, called myoglobin. Using iron is one of the many fascinating processes that our bodies have developed. Inorganic iron is actually quite toxic and in order for our bodies to use it they must run it through a complicated system of absorption, transport, storage, assimilation, and elimination. (1)

Anemia can be defined as a reduction in red cell mass; or rather, a decline in the number of red blood cells necessary for our blood to be able to carry oxygen to our tissues. (2) A diagnosis of anemia means that for some reason, there are not enough red blood cell being manufactured (iron deficiency anemia), there is a loss of red blood cells (anemia associated with acute bleeding), or that there is the presence of some illness in the body (anemia of chronic disease).

Iron deficiency anemia, anemia of chronic disease, and anemias associated with acute bleeding account for roughly 75 percent of all anemias. (3) Iron deficiency anemia occurs in approximately 25 percent of those diagnosed with anemia. Common causes include poor diet, poor absorption of iron from the intestines, increased iron demands (as in pregnancy, adolescence, infancy, old age, or during exercise), blood loss, and certain diseases. Dietary deficiencies most frequently result from decreased consumption of animal protein and ascorbic acid, (4) as a consequence of chronic alcoholism, food faddism, prolonged illness with anorexia, or poor nutrition.

A healthcare practitioner will want to know what type or class of anemia they are working with in a particular patient and there are several different ways that anemia is classified which relates back to the different types of anemias mentioned above. One method is to classify on the basis of the "morphology" (form) of the red blood cells. In studying the morphology of the red blood cell, one would actually be looking at the appearance of that cell in regard to it’s size and how much hemoglobin (an oxygen carrying protein pigment) it contains. Another way to classify anemia is through studying its etiology, or cause. The third classification refers to what is known as the pathophysiology, or how it actually functions.

Within these various classifications are many types of anemia. Each type has its own name and its own cause. A healthcare professional will label the diagnosis with one of these names after examining the symptoms, performing various lab tests, and determining the cause.

Statistic

Centers for Disease Control- MMWR- Recommendations to Prevent and Control Iron Deficiency in the United States April 03, 1998 / 47(RR-3);1-36

    Iron deficiency is the most common known form of nutritional deficiency. Its prevalence is highest among young children and women of childbearing age (particularly pregnant women). About 15 to 20 milligrams of iron is lost every menstrual period. Women with heavy menses and women who wear intrauterine devices (IUDs) may lose twice that much.

Centers for Disease Control, 2000.

  • Iron deficiency, the most common nutritional deficiency worldwide, has negative effects on work capacity and on motor and mental development in infants, children, and adolescents, and maternal iron deficiency anemia might cause low birthweight and preterm delivery.
  • Although iron deficiency is more common in developing countries, a significant prevalence was observed in the United States during the early 1990s among certain populations, such as toddlers and females of childbearing age.
  • Test

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

In general, the signs and symptoms a patient might present depend upon how fast the anemia has developed, how old the person is and how healthy their heart is. Depending whether or not the onset of anemia is acute (comes on quickly), or chronic (develops slowly over a longer period of time), the symptoms may range from shortness of breath and rapid heartbeat to fatigue, weakness, headache, dizziness, and loss of skin tone or color.

Of course, the different types of anemia will come along with different symptoms. When the anemia goes on for too long or is severe enough other symptoms appear. These include spooning of the nails (koilonychias), a craving for substances such as clay, ice or cornstarch (pica), inflammation of the tongue (glossitis), anorexia, dementia, and psychosis. (5)

Iron deficiency anemia

  • May be without symptoms or have vague, general signs and symptoms associated with most anemias
  • Symptoms appear with hemoglobin below 8 or 9 Gm/100ml
  • Concave, spoon shaped nails
  • Inflammation of the tongue
  • Inflammation of the mouth
  • Craving substances such as clay, ice, or cornstarch

Vitamin B12 anemia

  • may exist due to affects on the spinal cord and brain
  • Numbness and lack of muscular coordination
  • Inflammation of the tongue
  • Decreased feeling in the lower extremities
  • Muscle weakness
  • Difficulty in swallowing
  • Lack of appetite
  • Irritability

Folic acid deficiency

  • Symptoms similar to vitamin B12 deficiency without the mental confusion and psychiatric problems
  • May not have symptoms early, which often makes early diagnosis difficult

Treatment Options

Conventional

Treatment of iron deficiency anemia usually consists of dietary supplementation of iron preparations. Iron is, of course, available in the diet; however, absorption varies greatly with different foods. Iron is poorly absorbed from vegetables, grain products, dairy products, and eggs and is best absorbed from meat, fish, and poultry. Substitution of meat for eggs, milk, or cheese in a mixed meal has been reported to quadruple the absorption of iron from an entire meal. (6) Studies have determined that beverages have an effect on iron absorption. Drinking milk or tea with a meal may cut iron absorption by as much as one half, while drinking orange juice can double iron absorption.

In most cases of iron deficiency anemia, taking iron by mouth in a standard supplement form is sufficient. The preferred iron preparation is a non-enteric coated iron salt, (a tablet or capsule which is not coated with a substance that keeps it from dissolving in the stomach) ferrous salt. This preference is due to the fact that the greatest absorption of iron occurs in the first part of the small intestine known as the duodenum. The small intestine is very alkaline making absorption of the iron difficult.

Sometimes it is necessary to give a patient iron without having the iron go through the digestive tract. This is called parenteral iron therapy and it may be necessary in patients who for some reason cannot tolerate taking oral doses of iron or for who cannot absorb iron. Methods used are intravenous and intramuscular, or injection. Some researchers believe that even after reaching normal hemoglobin levels, a patient should continue iron therapy for six months in order to be certain that the new level will be maintained. (7)

If the anemia is the result of a vitamin deficiency, then the treatment depends on how serious the deficiency is and how long it has gone untreated. Sometimes treatment may involve injections or intravenous dosing and the length of time that the therapy is in place may vary as well. Anemia as it relates to various nutritional deficiencies is covered in the nutrition section below.

Nutritional Suplementation


Vitamin B6

Some hemodialysis patients with normal serum ferritin (iron that is stored in the tissues) levels developed a type of anemia known as hypochromic, microcytic anemia. It was found that these patients responded well to Vitamin B6, or pyridoxine. (8) In addition, Vitamin B6 may also be useful for patients with sickle cell anemia. Studies have indicated that supplementation with pyridoxine might help with the symptoms associated with sickle cell anemia and in general, be therapeutic. (9)


Copper

Copper deficiency anemia can occur from taking in too much zinc, (10) certain problems associated with malabsorption, (11) or long-term feeding through the intestines. (12) Copper deficiency can prevent the release of iron from storage sites, resulting in what appears to be iron-deficiency anemia. This condition does not respond to iron supplementation, and occurs even though the body has iron available. (13)


Vitamin C

Vitamin C deficiency can result in the development of several different classifications of anemia. (14) Vitamin C is also very useful in that it helps the body to absorb iron. This is done the by binding of Vitamin C with dietary iron in the acidic stomach and then the releasing of the iron when it reaches the alkaline intestine. (15)


Vitamin A

Vitamin A deficiency has also been reported as a possible factor in anemia. (16) The authors of one study state that nearly fifty percent of pregnant women in developing countries suffer from iron-deficiency anemia, which is usually treated with iron supplements such as ferrous sulfate. However, studies reveal that administering vitamin A with ferrous sulfate improves the deficiency. This is a new area of research and needs further investigation in order for us to understand exactly what the relationship is between Vitamin A and iron. (17)

Herbal Suplementation


Ashwagandha

Ashwagandha is rich in iron, which may increase hemoglobin and red blood cell count in people who are anemic. (18) This herb should be used in moderation in men with known cardiovascular risk because iron may potentially accelerate this risk.

Ashwaghandha is an adaptogen, or substance that helps protect the body against various emotional, physical, and environmental stresses. An animal study suggests that Ashwagandha may prove to be helpful in increasing hemoglobin concentrations in deficiencies caused by certain drugs. (19)


Dong Quai

Dong quai reportedly promotes circulatory activity and has blood building properties, while reducing the viscosity of the blood. (20) , (21) The root contains about 750-880ppm of elemental iron, and has been used traditional for anemia and increasing red blood cell counts. (22)

Diet & Lifestyle

Excess Zinc: Long-term consumption of pharmacologic doses of zinc can induce a severe copper deficiency, which can enable the development of sideroblastic anemia. (23)

Hydrochloric acid: Gastric secretion of hydrochloric acid influences iron absorption. Patients with hydrochloric acid deficiency are more likely to have reduced iron absorption as well as intestinal bacterial overgrowth, which can also hinder digestion and absorption of nutrients.

References

  1. Sproat TT. Anemias. In: DiPiro JT et al. eds. Pharmacotherapy, A Pathophysiologic Approach 4th ed. Stamford, CT. 1999;1531-1548.
  2. Keitt AS. Introduction to the anemias. In: Wyngaarden JB, Smith LH, eds. Cecil’s Textbook of Medicine. 17th ed. Philadelphia. WB Saunders. 1985;870-76.
  3. Bergin JJ. Evaluation of anemia. Postgrad Med J. 1985;77:253-269.
  4. English EC, Finch CA. Iron Deficiency: A systematic approach. Drug Therapy. Apr1984;19-20,25-27.
  5. View Abstract: Healton EB, Savage DG, Brust JC. Neurologic aspects of cobalamin deficiency. Medicine. 1991;70:229-245.
  6. Cok JD. Food iron absorption in human subjects—III. Comparison of the effects of animal proteins on non-heme iron absorption. Am J Clin Nutr. 1976;29:859-867.
  7. View Abstract: Brigden ML. Iron deficiency anemia. Every case is instructive. Postgrad Med. Mar1993;93(4):181-2, 185-92.
  8. View Abstract: Toriyama T, et al. Effects of high-dose vitamin B6 therapy on microcytic and hypochromic anemia in hemodialysis patients. Nippon Jinzo Gakkai Shi. Aug1993;35(8):975-80.
  9. View Abstract: Natta CL, Reynolds RD. Apparent vitamin B6 deficiency in sickle cell anemia. Am J Clin Nutr. Aug1984;40(2):235-9.
  10. View Abstract: Gyorffy FJ, Chan H. Copper deficiency and microcytic anemia resulting from prolonged ingestion of over-the-counter zinc. Am J Gastroenterol. Aug1992;87(8):1054-5.
  11. View Abstract: Hayton BA, et al. Copper deficiency-induced anemia and neutropenia secondary to intestinal malabsorption. Am J Hematol. Jan1995;48(1):45-7.
  12. View Abstract: Tamura H, et al. Anemia and neutropenia due to copper deficiency in enteral nutrition. JPEN J Parenter Enteral Nutr. Mar1994;18(2):185-9.
  13. Watts DL. The nutritional relationships of copper. J Orthomol Med. 1989;4(2):99-108.
  14. Sauberlich HE. "Ascorbic acid," in Nutrition Refiews’ Present Knowledge in Nutrition, Fifth Edition. Washington, DC: The Nutrition Foundation, Inc. 1984.
  15. View Abstract: Lynch SR. Ascorbic acid and iron nutrition. ASDC J Dent Child. Jan1981;48(1):61-3.
  16. Mejia LA. Vitamin A deficiency as a factor in nutritional anemia. Int J Vitam Nutr Res Suppl. 1985;27:75-84.
  17. View Abstract: Sajedianfard J, at al. Therapeutic values of different routes of administration of vitamin A with ferrous sulfate in treating deferoxamin-induced iron-deficiency anemia. J Nutr Sci Vitaminol. Tokyo. Jan1999;45(1):31-7.
  18. Boone K. Withania – The Indian Ginseng and Anti-aging Adaptogen Nutrition and Healing. Jun1998;5(6):5-7.
  19. View Abstract: Ziauddin M, et al. Studies on the Immunomodulatory Effects of Ashwagandha. J Ethnopharmacol. Feb1996;50(2):69-76.
  20. View Abstract: Chen YC. Experimental Studies on the Effects of Danggui Buxue Decoction on IL-2 Production of Blood-deficient Mice. Chung Kuo Chung Yao Tsa Chih. 1994;19(12):739-41.
  21. View Abstract: Chen YC, et al. Research on the Mechanism of Blood-tonifying Effect of Danggui buxue Decoction. Chung Kuo Chung Yao Tsa Chih. 1994;19(1):43-45.
  22. Boone K. Clinical Applications of Ayurvedic and Chinese Herbs. Phytotherapy Press. Queensland Australia. 1997;3-6.
  23. View Abstract: Broun ER, et al. Excessive zinc ingestion. A reversible cause of sideroblastic anemia and bone marrow depression. JAMA. Sep1990;264(11):1441-3.