Anemia

Anemia (uh-NEE-me-eh) is a condition in which a person’s blood has a lower than normal number of red blood cells (RBCs), or the RBCs don’t have enough hemoglobin (HEE-muh-glow-bin). Hemoglobin—an iron-rich protein that gives the red color to blood—carries oxygen from the lungs to the rest of the body. In people with anemia, the blood does not carry enough oxygen to the rest of the body. As a result, people with anemia feel tired, along with other symptoms, because their bodies are not receiving enough oxygen. In severe or prolonged cases of anemia, the lack of oxygen in the blood can cause serious and sometimes fatal damage to the heart and other organs of the body.

RBCs also are called erythrocytes (eh-RITH-ro-sites). RBCs are disc-shaped and look like doughnuts without a hole in the center. They are produced continually in the spongy marrow inside the large bones of the body and normally last 120 days. RBCs’ main role is to carry oxygen, but they also remove carbon dioxide (a waste product) from cells and carry it to the lungs to be exhaled. White blood cells and platelets are the two other kinds of blood cells. White blood cells help fight infections. Platelets help blood to clot. In some kinds of anemia, there are low amounts of all three types of blood cells.

Causes
There are three main causes of anemia: blood loss, lower than normal levels of red blood cell (RBC) production, or higher than normal rates of RBC destruction. More than one of these factors can combine to cause anemia.

Treatment
The goal of treating anemia is to increase the oxygen-carrying capacity of the blood. This is done by increasing the red blood cell (RBC) count and/or hemoglobin level in the RBCs as close as possible to normal levels. An additional goal is to treat the underlying condition or cause of the anemia.

The treatment your doctor prescribes will depend on the type, cause, and severity of the anemia you have. Treatment may include dietary supplements, changes in diet, medicines, and/or medical procedures such as blood transfusions or surgery.

Nutrition and Dietary Supplements
Some types of anemia are caused by low levels of vitamins or iron in the body. Low levels of vitamins or iron can be due to poor diet or certain diseases and conditions. Treatment for vitamin or iron deficiency may include changing your diet or taking vitamin or iron supplements. The vitamin supplements most commonly taken are vitamin B12 and folate. Vitamin C is sometimes given to help the body absorb iron.

Iron
Your body needs iron to produce hemoglobin. Iron found in meats is more easily absorbed into your blood than the iron found in vegetables and other foods. To treat your anemia, your doctor may recommend eating more meat—especially red meat such as beef and liver—as well as chicken, turkey, pork, fish, and shellfish.

Sometimes iron is given in the form of mineral supplements. Usually these are combined with multivitamins and other minerals that help your body absorb iron. Some foods are fortified with extra iron (that is, iron is added to the foods). These foods include cereals, bread, and pasta. You can find out how much iron is in your food by reading the nutrition labels on food packaging. The amount is given as a percentage of the recommended daily requirement.

Other foods that are good sources of iron include:

• Spinach and other dark green, leafy vegetables
• Peanuts, peanut butter, and almonds
• Eggs
• Peas; lentils; and white, red, or baked beans
• Dried fruits, such as raisins, apricots, and peaches
• Prune juice

Vitamin C
Vitamin C helps the body absorb iron. Good dietary sources of vitamin C are vegetables and fruits, especially citrus fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones. Citrus fruits include oranges, grapefruits, tangerines, and similar fruit. If you are taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This citrus fruit affects the strength and effectiveness of a few medicines. Other fruits rich in vitamin C include kiwi fruit, mangos, apricots, strawberries, cantaloupes, and watermelons.

Vegetables rich in vitamin C include broccoli, peppers, tomatoes, cabbage, potatoes, and leafy green vegetables like romaine lettuce, turnip greens, and spinach.

Vitamin B12
Low levels of vitamin B12 can lead to a type of anemia called pernicious anemia. Pernicious anemia most often occurs because the body is unable to absorb vitamin B12. Pernicious anemia can often be treated with vitamin B12 supplements. Good food sources of vitamin B12 include breakfast cereals fortified with this vitamin. Animal products are particularly rich in vitamin B12. These items include meats (such as beef, liver, poultry, fish, and shellfish), eggs, and dairy products (such as milk, yogurt, and cheese).

Folate
Folate is a form of vitamin B that is found in foods. Your body needs folate to produce and maintain new cells. Folate is very important for pregnant women to help avoid anemia and ensure the healthy development of the fetus. Good sources of folic acid—in addition to bread, pasta, and rice fortified with a man-made version of folate—include:

• Spinach and other dark green, leafy vegetables (folate comes from the Latin work meaning “leaf”)
• Black-eyed peas or dried beans
• Beef liver
• Eggs
• Bananas, oranges, orange juice, and some other fruits and juices

Medicines
In addition to iron and vitamins, your doctor may prescribe other medicines to treat the underlying causes of anemia or to increase the production of RBCs. Some of these medicines include:

• Antibiotics to treat infections.
• Hormone treatment for adult and teenaged women who have heavy menstrual bleeding.
• Epoetin—a man-made version of erythropoietin, a hormone made by the kidneys that stimulates increased production of RBCs. This medicine has some risks. Based on your situation, your doctor will decide whether the benefits of the medicine outweigh the risks.
• Medicines to prevent the body’s immune system from mistakenly attacking its own RBCs.
  Chelation (ke-LAY-shun) therapy for lead poisoning (mainly in children).

Medical Procedures
Some types of serious anemia may require medical procedures. These procedures include blood transfusions and transplants of bone marrow or stem cells.

Blood Transfusions
Transfusions are given through a vein and require careful matching of donated blood with the recipient’s blood. The transfused blood must be compatible at least with the recipient’s blood type (A, AB, B, or O) and usually with other factors. People who receive blood transfusions on a regular basis must be monitored for iron overload—too much iron in the body. If too much iron accumulates, the person must have chelation therapy to reduce the excess iron that could cause damage to their organs.

Bone Marrow or Stem Cell Transplant
Serious anemia, such as aplastic anemia, that results from the failure of bone marrow to make RBCs is sometimes treated with marrow or stem cell transplants. Donor marrow is usually taken from a large bone, such as the pelvis. Marrow is given by transfusion through a vein. Stem cells for a transplant can be from matched umbilical cord blood, from bone marrow donated by a family member, or from a matched but unrelated donor. Stem cells in bone marrow develop into mature blood cells.

Surgery
Surgery may be necessary to control or stop serious or life-threatening bleeding that is causing anemia. For example, surgery may control chronic bleeding from a stomach ulcer or colon cancer.
Removal of the spleen may be necessary to stop or reduce high rates of RBC destruction. The spleen removes worn-out RBCs from the body. An enlarged or diseased spleen removes more RBCs than normal, causing anemia.