General Health: Anemia

Anemia is defined as a condition of deficiency of hemoglobin, leading not enough red blood cells in the body. The functions of hemoglobin is to carry oxygen from the lung to the body' s cells.

Causes of Anemia
There are many causes of anemia, including
1. Poor nutrition
In some parts of the world, anemia is caused by iron deficiency due to less meat in the diet. People who are vegetarian may want to supplement their iron in plant with intake of vitamin C to enhance the absorption of Non heme iron.
2. Poor absorption
Poor absorption of iron, vitamin B12 and folate increases the risk anemia.
3. Blood loss during surgery
In some cases, temporarily anemic condition may occur as a result of large blood during surgery.
4. Bleeding
Internal bleeding due to diseases or cancers increase the risk of anemia. Some women with heavy menstruation may be at risk of anemia.
5. Cancer treatment
Cancer treatment such as chemotherapy can cause anemia because of medicine used prevent the body in production of red blood cells.
6. Drugs use to treat HIV/AID
Certain medicine used to treat HIV/AID are considered another cause of anemia.
7. Kidney disease
Kidney disease interferes with production of hormone erythropoietin, which is necessary for the production of red blood cells
8. Heredity
Certain types of anemia are caused by genetic passing through from parents such as thalassemia, sickle cell anemia.
9. Etc.

Symptoms
1. Fatigue and loss of energy
2. Unusually rapid heart beat, particularly with exercise
3. Dizziness
4. Weak and tired easily
5. Shortness of breath
6. Difficulty concentrating
7. Pale skin
8. Insomnia
9. Irritability
10. Etc.

Diagnosis
Family history is always important for diagnosis of any disease, including anemia
Complete blood count is one of most efficient test to checks your hemoglobin and hematocrit levels. Low levels of hemoglobin (Normal range in men 140 -180g/L, in women 120-160g/L) or mematocrit ( the percentage of blood volume that is occupied by red blood cells. It is normally about 45% for men and 40% for women) is a sign of anemia.

Treatments
Treatment of anemia depending to its causes, it can be supplement prescribed by the doctor, blood transfusion, change of diet, bone marrow transplant, etc.

Effects of anemia
1. Symptoms of dizziness, lack of concentration, irritability may interfere with job efficiency, sport activity, etc. for adults, mental growth and psychomotor development for children with the risk of that may be irreversible and school work and activity for children and teen.
2. Anemia and kidney disease increase the risk of heart failure as a result of the heart have to work over a prolong period of time to pump blood to the body cells need.
3. Levels of hemoglobin
Researcher found that levels of hemoglobin have a direct effect in reducing the risk of cancer recurring.
4. In general, anemia has a negative effect on quality of life and cognitive function, as well as many other aspects of patient function.

A. Anemia and surgery
People with anemia are at risk during and after surgery due to not enough of red blood cells and sometime it can cause perioperative anemia as a result of losing too much blood, leading to insufficient hemoglobin to carry oxygen and nutrients for our body's organs and cells need.

Benefit of treating Anemia before surgery
If you are required surgery for whatever reasons, there are something you should consider to prevent complication during and after surgery.
Increase your red blood cells count or raise level of hemoglobin will reduce the need for blood transfusion during surgery, especial surgery that result in heavy blood loss.
a. Intake of foods with rich of folate, vitamin B12 and iron such as peas, lentil, soybeans and chickpeas, etc.
b. Vitamin C
Vitamin C is vital for the absorption of iron by increasing intake of vitamin C rich vegetables and fruits such as kiwi fruit, strawberries, and cantaloupes.
To increase to red blood cells, your doctor may prescribe
c. Erythropoiesis-stimulating Agents
ESAs are given by injection or intravenously (through an IV) to stimulate the bone marrow to produce more red blood cells, thus raising the level of hemoglobin.
d. Contraceptive pill
Women who take the pill have reduced bleeding during period.
e. Etc.

It is important that you increase your red red blood cells well before the surgery to avoid the needs of blood transfusion, stay in hospital longer and your incision heal faster.


Types of blood transfusion if necessary
You surgeon will suggest some of the best options for blood transfusion if necessary during surgery, please make sure you well understood and make your choice
1. Autologous transfusion
This may be a good choice, it is a blood transfusion that uses you own blood that has been previous stored, donated before the surgery, during an operation or post-operation.
2. Allogeneic transfusion
The type of blood transfusion with the use of donated blood
3. Collect and return
With the use of a special medical machine to collect your blood during or before surgery, then return them to your body following surgery.
4. Etc.

Blood loss minimization
Minimizing blood loss is always be considered for the best of the patient, especially for patience with anemia.
1. Lower blood pressure
Lower blood pressure helps to slower the blood flow, thus reducing the blood loss during surgery.
2. Position you body to reduce the blood flow, thus reducing the blood loss during surgery.
3. Using special medical instruments to minimize incision and control blood loss.
Etc.

B. Anemia and Cancer
Cancer is defined as condition of malignant tumors during abnormal cells growth as a result of alternation of cells DNA.

Under normal condition, if you blood cell is low, you kidney responds to the condition by stimulating the production of hormone erythropoietin to signal bone marrow to increase production of more red blood cells.

Causes of anemia in cancer patient
1. Organ deficiency
In case of cancer patient the process of above may be less effective due to organs insufficiency.
2. Chemotherapy
One of the side effect of chemotherapy is the preventing of your body in production of red blood cells.
3. Bone marrow deficiency
Due to cancer cells have spread to the bone marrow by certain types of cancers, such as leukemias, lymphomas, myelomas and breast cancer can reduce the bone marrow function in red blood cells production.
4. Nutrients deficiency
Poor absorptions in cancer patient is one of the causes of anemia due to deficiency of folate, vitamin B12 and iron.
5. Bleeding
Cancers in the gastrointestinal and genitourinary tracts can cause bleeding of the surrounding tissues.
6. Etc.

After thought
Researchers found that increases the levels of hemoglobin and red blood count responds better in cancer treatments. High levels of red blood cells count and hemoglobin reduce the risk of recurring cancer.


C. Anemia and Immunodeficiency syndrome AIDS
Immunodeficiency syndrome AIDS is caused by Human immunodeficiency virus HIV, a lentivirus. It is defined as a health condition in which in which severe failure of the immune system in protecting our body from infection and irregular cell growth, leading to life-threatening infections and cancers.

Anemia is a very common with people with HIV positive and the rate increases as the progression of the disease progression. Study found that approximately 30% of HIV positive people have anemia and 90% will have anemia at some point during their life time.

Anemia and HIV infection
1. HIV infection reduces the production of erthroprotein in stimaulating the production of red blood cells.
2. HIV infection affects the bone marrow function in production of red blood cells
3. Medicine use to treat HIV-infection may reduce the bone marrow function in red blood cells production.
4. HIV infection patient may be at risk of lymphoma, a cancer which may spread to the bone marrow.
5. Infection
Infection may suppress the bone marrow in production of red blood cells.
6. Nutrients
HIV infection prevent the digestive system in absorbing folate, vitamin B12 and iron, causing anemia.
7. Etc.

Research found that increasing levels of hemoglobin has a direct affect in the increasing survival of a person with HIV infection.

D. Anemia and Hepatitis C
Hepatitis C is a health condition of infectious disease affecting the liver that may cause inflammation of the liver. Approximate 1.5% of the U.S. population is infected with HCV. Once establish, the chronic infection may progress slowly, after many years it can lead to scares in the liver, causing fibrosis, cirrhosis and liver failure.

Causes of anemia in hepatitis C patient
1. Medication
Medication used to treat hepatitis C, such as Ribaverin often cause mild anemia with no treatment required. In other treatment, use of interferon can suppress the bone marrow function in production of red blood cells.
2. Cirrhosis
Cirrhosis is advanced scarring of the liver caused by hepatitic C virus. it can reduce the spleen function in production of reb blood cells or cause spleen to remove too many blood cells.
3. Bleeding
Cirrhosis can also promote bleeding of the gastrointestinal tract.
4. Etc.

After thought
Since approximate 67% of patients will develop anemia when ribavirin and/or interferon is/are used to treat HCV,
1. Increasing red blood cells count is always important for the effectiveness of full dose of ribavirin and/or interferon in treating the diseases. Study showed that medicine used to stimulate red blood cell production are effective in treating anemia in people with hepatitis C.

2. If anemia left untreated, treatment of HCV with lower doses of ribavirin and/or interferon may reduce the effectiveness of the medicine or you doctor may discontinue treatment altogether.

E. Iron deficiency and anemia
Iron is defined simply as too little iron in the body for the production of hemoglobin. Anemia occurs when there isn't enough hemoglobin to transport oxygen to the body cells and organs need, leading to symptoms of irritability, fatigue, shortness of breath, low blood pressure, etc.. Approximate 2 out of 1000 people in Canada are considered iron deficiency. If your body delete the stored iron, it can cause no hemoglobin is produced, leading to iron deficiency anemia.

Causes of iron deficiency
1. Heavy menstruation
It may lead to iron deficiency if your body stored iron is depleted and your diet is considered low in iron.
2. Chronic internal bleeding usually caused by ulcers, polyps, or tumors can lead to low levels of iron stored in the body, leading to low levels of hemoglobin.
3. Nutrient deficiency
Diet low in folate, vitamin B12 and iron can increase the risk of iron deficiency.
4. Poor iron absorption due to inflammation.
5. Etc.
Iron deficiency can be detected with a blood test.

Foods contain high amount of iron
there are 2 types of iron in the foods
1. Heme iron
This type of iron is easily absorbed by our body and Foods contain high amount of heme iron are found in meat of all sources, including liver, beef, turkey, chicken, etc.
2. Non heme iron
This type of iron is not easily absorbed. Foods contain high amount of non heme iron are found in brocoli. spinach, soybean, kidney bean, etc.

Iron supplement such as ferrous sulfate, ferrous furmarate, etc. should only be taken with doctor subscription. Overdose of iron can be toxic to the body and has some side effects, such darken stool, constipation, stomach upset, etc.

How to reduce the risk of iron deficiency
1. Vitamin C
Vitamin C can enhance the digestive system in iron absorption. Foods contain high levels of vitamin C include broccoli, spinach, kiwi fruits, strawberry, etc.
2. Adding Heme iron in your diet
In take of meat, poultry, fish will increase the levels of iron due to its easily absorption nature
3. Coffee, tea and cocoa can reduce the iron abortion significantly.
4. Calcium and magnesium can reduce you body in iron absorption. If you are required to take them, take them at different time.
5. Etc.

F. Anemia In Teen and Children
In anemia, symptoms of early stage may be invisible to parents until it is progression state. If you notice any above symptoms of above with a pale face, taking your childern or teen to the doctor office and a blood test will review with correct interpretation.

Causes of anemia in Children and Teen
1. Infection
Chronic inflammation and infected virus will reduced the body in production of hemoglobin which is necessary in oxygen transportation.
2. Heredity
If you children and/or teen are diagnosis with certain chronic anemia such as Thalassemia, Sickle cell anemia due to inherited or genetic defects, intake of high amount of iron rich vegetables, fruits and some lean meat over a period of can help, or taking some supplements prescribed by your doctor.
3. Early infancy from 0 to 6 months
Most children born with 6 months of iron stored in their body without inherited anemia. After six months, if you are feeding your baby with breast milk, please make sure there is enough iron for the body needs, talk to your doctor will help to solve the problem. Infants born premature may be required intake of iron supplements or iron fortified formula depending of bottle feeding or breast feeding.
4. Teenager
Teenager under go growth spurt and teenage girl starts to menstruate will require intake of higher amount of iron either through diet ot iron supplements to avoid iron deficiency cause of anemia.
5. Nutrient deficiency
Deficiency of folate, vitamin B12 and iron increases the risk of anemia. Intake vitamin C will enhance the absorption of above.
6. Etc

Some general treatments
1. Diet
Diet with foods containing high amount of iron is always good to reduce the risk of anemia.
2. Low fat diet
Low fat diet is good for children, but starting low fat diet to your children too early in their life, it can increase the risk of anemia due to iron deficiency
3. Avoid giving cow's milk up to 12 months
Digestive system is not strong enough to digest them, thus reducing the nutrients absorption, including iron.
4. Cereal and iron fortified formula
Cereal contains high amount of iron, it is specially for women who breast feeding their infants. While feeding children with iron fortified formula after six months provides necessary iron which had been used up.
5. vitamin C
taking vitamin C with your diet will enhace the absorption of vital nutrients, including iron.
6. Iron supplements
Iron supplement should be only taken with your doctor prescription. Overdose of iron supplements is toxic to your body.
7. Blood transfusion
If necessary and you doctor will advice you about
8. Etc.

G. Anemia can be classified into acute and chronic anemia
Anemia due to chronic disease is a types of blood disorder as a result effected by one or more chronic medical condition(s), causing reduced red blood cells production.
Acute anemia denotes as short term drops of red blood red cells production. Most of the times, it is caused heavy internal bleeding or blood loss due to injure. It is a serious problem, in most cases, it requires medical attention immediately.
Diagnosis
Anemia can be classified 3 different categories due to its causes of decreased red blood cell production, increased red blood cells destruction, and blood loss.
In chronic anemia, a simple blood test will review the underlie of the causes
1. Chronic anemia with iron deficiency
In this case, the levels of ferritin found in the test is normal or high but the cells are not releasing their iron because in iron deficiency anemia, the levels of ferritin is lower than normal.
2. Chronic anemia with iron deficiency
The levels of total iron-binding capacity (TIBC) should be lower in chronic anemia with iron deficiency, as it reflects the inability the body to produce more transferrin, making bind up of iron not necessary.

Types of chronic diseases that cause chronic anemia
If you are in medical treatments of any chronic disease, you may be given all kinds of information related to its affects, including anemia. Sometimes prescription is given ahead of time to prevent anemia before it can happen, other time, you may require to take some types of supplements or drugs, depending to your situation. There are many types of chronic diseases associated with anemia
1. Autoimmune Gastritis
Gastritis inflammatory condition of the stomach as a result of injured respond of white blood cells in the stomach. If the disease is left untreated, it can lead tochronic condition, causing pernicious anemia.
2. Peptic ulcer
Peptic ulcer is defined as a condition of erosion of the lining of the stomach or the first part of the small intestine. It can lead to internal bleeding, causing chronic anemia, if left untreated.
3. Liver disease
Liver disease as a result of alcohol drinking can cause Macrocytosis, a condition of enlargement of red blood cells with near-constant hemoglobin concentration, leading to pernicious anemia. Other liver disease caused by hepatitis virus, can lead to decrease red blood cell count (hemoglobin), causing chronic anemia.
4. Kidney disease
kidney disease can affect the production of hormone erythropoietin, leading to reduced signal to bone marrow for increase production of more red blood cells.
5. Hypothyroidism
Hypothyroidism is defined as condition of deficiency of thyroid hormone. the main cause is due to Iodine deficiency, leading to iron-deficiency cause of chronic anemia, if left untreated. (insufficient iron)6. Sickle cell disease
It is an genetic blood disorder disease passing from generation to generation with a abnormal red blood cells shapes as a result of a mutation in the haemoglobin gene.
7. Hypermenorrhea
Hypermenorrhea or ecessive heavy menstruation can be caused either by (uterine bleeding) hormonal disorders associted with absolute or relative hyperestrogenism due deficiency of progesterone or fibroid tumors (uterine leiomyomata), polyps and cancer
8. Thrombocytopenia
Thrombocytopenia is a disorder of abnormally low amount of platelets, leading to with abnormal bleeding.
9. Cancer
More information here
10. Poor diet
More information here
11. Iron deficiency
More information here
12. Etc.

Types of chronic anemia
1. Microcytic, hypochromic anemia
Microcytic, hypochromic anemia is defined as a chronoc anemia caused by many conditions including iron deficiency, Beta-Thalassemia trait, lead poisoning, chronic illness or inflammation, and sideroblastic anemia (Korones & Cohen, 1997; Wu et al., 2002)

2. Macrocytic anemia
Macrocytic anemia is defined as a condition of not having enough healthy red blood cells in body to transport oxygen and nutrients to the body tissue and organ as a result of insufficiency of vitamin B12.

3. Normocytic anemia
Normocytic anemia is a common disease, occurring to men and women over 85 years old as a result of low red blood cell volume as result of a decreased production of normal-sized red blood cells, an increased destruction or loss of red blood cells, deficiency of vitamin B6, B12, etc.

4. Hemolytic anemia
Hemolytic anemia is defined as a condition of not enough red blood cells in the blood, as a result of the premature destruction due to abnormal breaking down of red blood cells (hemolysis) either in the blood vessels or elsewhere in the body.

5. Etc.