Anemia in Adults, Childs, and during Pregnancy
Anemia is a very common condition where the number of red blood cells or the amount of hemoglobin in red blood cells is less than normal. Iron deficiency anemia is a specific type of anemia caused by a lack of mineral iron in the body. Iron is important in the formation of hemoglobin so a reduced iron level causes a reduced hemoglobin level in the blood.
Red blood cells contain hemoglobin, which is the substance that makes blood red. Its main purpose is to carry oxygen around the body. If the body does not receive enough oxygen, various symptoms occur. These include tiredness, weakness, and lack of energy. If the anemia becomes more severe, it can become life-threatening.
What is Anemia?
If the proportion of red blood pigment and red blood cells in the organism is too low, there is anemia. The iron-containing protein hemoglobin is the most important ingredient in red blood cells and is responsible for transporting oxygen from the lungs to the body cells. From there, the hemoglobin transports carbon dioxide (CO2), which accumulates in the cells as a metabolic waste product, back into the lungs. The CO2 can now be exhaled. – If there is a hemoglobin deficiency, the body cells can no longer be supplied with sufficient oxygen.
Types of Anemia
There are different types of anemia in medicine. Depending on the shape, the appearance of the erythrocytes, and the amount of hemoglobin contained, the group to which they belong is determined:
Microcytic, hypochromic anemia: In this form, the erythrocytes are too small and contain too little hemoglobin. A typical representative is iron deficiency anemia.
Macrocytic, hyperchromic anemia: In this form of anemia, the erythrocytes are too large and contain sufficient hemoglobin. This allows enough oxygen to be transported, but it is broken down too early in the spleen. This occurs, among other things, with a deficiency in folic acid, a vitamin B12 deficiency, or what is known as pernicious anemia.
Normocytic, normochromic anemia: Heavy blood loss leads to this type of anemia. The erythrocytes are normal in size.
Causes of Anemia
The causes that lead to anemia can vary. There is the possibility that it is already congenital due to certain genetic defects or that it was acquired in the course of life, for example through an unbalanced diet. Anemia can also be a side effect of chronic diseases or occur in old age when regeneration processes slow down. Anemias are divided into groups according to their mechanism of development:
Anemia due to impaired blood formation: Iron deficiency anemia: Iron deficiency often results from chronic bleeding, such as very long and heavy menstrual bleeding or a bleeding stomach ulcer. But malnutrition with too little iron-rich food can also lead to anemia. The ability of the intestine to absorb iron can also be impaired. Anemia is also common during pregnancy and breastfeeding, as the need for iron is increased during this period.
Vitamin B12 deficiency anemia: If the absorption of vitamin B12 in the body is disturbed, this can lead to macrocytic hypochromic anemia. The vitamin plays an essential role in forming new cells and in the metabolism of various protein building blocks (amino acids). The triggers for this deficiency symptom include chronic inflammation of the gastric mucosa and celiac disease.
Folic acid deficiency anemia: An unbalanced diet or alcohol abuse can cause a deficiency of folic acid in the body and lead to macrocytic, hyperchromic anemia. The vitamin is required for cell division and blood formation.
Pernicious anemia: This special form of vitamin B12 deficiency anemia can result from damage to the gastric mucosa, partial removal of the stomach, worm infestation of the intestine, or an autoimmune disease.
Aplastic anemia: A dysfunction of the bone marrow causes a decrease in red and white blood cells and platelets. The dysfunction can be a congenital condition such as Fanconi anemia. It can also be an acquired bone marrow dysfunction, for example, due to toxins, drugs, or certain infectious diseases.
Renal anemia: Chronic kidney diseases or kidney damage can lead to a functional weakness of the organ. The kidneys then produce too few of the hormone erythropoietin. It is closely related to the formation of red blood cells. A deficiency in the hormone leads to renal anemia.
Thalassemia: A genetic defect disrupts the formation of hemoglobin and thus also that of the red blood cells. Existing erythrocytes are relatively small in size and have a shortened lifespan. This form of anemia belongs to the group of microcytic, hypochromic anemia.
Anemia, due to other diseases: Chronic diseases are one of the most common triggers of anemia. But inflammation, viral infections, cancers such as leukemia, chemotherapy or autoimmune diseases can also cause anemia.
Anemia Due to Bleeding: Bleeding anemia: External and internal injuries can lead to such high blood loss that anemia develops. For example, an accident can be the cause of blood loss, but small sources of bleeding such as hemorrhoids or undetected gastric ulcers can also trigger chronic blood loss.
Anemia Due to Increased Erythrocyte Breakdown
Hemolytic anemia: If there is an increased breakdown or breakdown of red blood cells, one speaks of hemolytic anemia. While erythrocytes usually live to be 120 days, their lifespan is reduced to less than 30 days. This can be caused by a genetic defect (corpuscular hemolytic anemia) such as sickle cell anemia or spherical cell anemia. Extracorpuscular hemolytic anemia is also an option for the shortened lifespan of the erythrocytes. The blood cells can be destroyed by mechanical action, for example by an artificial heart valve or by medication, immune reactions, infectious agents, and chemicals.
Symptoms of Anemia
If anemia occurs as an accompanying symptom of a disease, those affected can suffer from different symptoms. The following symptoms are characteristic of anemia itself: dizziness, headache, shortness of breath during exertion and possibly also at rest, reduced mental and physical performance, palpitations, ringing in the ears, pale skin, and a red, smooth tongue (“lacquer tongue”). Depending on the specific form of anemia and thus the lack of oxygen in the body, further symptoms can arise.
Anemia due to iron deficiency can lead to brittle nails and inflamed corners of the mouth and mucous membranes. Pernicious anemia, anemia due to a lack of vitamin B12, can lead to loss of appetite, memory disorders, and digestive disorders such as diarrhea or constipation, burning of the tongue, and weight loss.
Anemia due to internal bleeding shows up in black stools (tarry stools or melena) or red blood in the stool or urine. It can lead to cardiovascular collapse, low blood pressure, and a high heart rate.
Diagnosis of Anemia
If anemia is suspected, the doctor will order a blood test after a detailed discussion about current symptoms and the medical history. Among other things, parameters such as the hematocrit value (ratio of solid cells to the liquid portion of the blood), the hemoglobin value, liver, and inflammation values are determined. The blood analysis also shows the number and size of each blood cell. The iron level and iron reserves in the body are also determined.
If a bleeding stomach ulcer is suspected, a further examination can provide information about possible bleeding in the gastrointestinal tract: The so-called occult blood test checks whether there are traces of blood in the stool that cannot be seen with the naked eye. It may be useful to have a gastroscopy or colonoscopy. Any possible sources of bleeding in the digestive tract can be identified and usually stopped during the procedure.
The doctor will examine the urine to clarify any bleeding in the bladder or urinary tract. Depending on the result, further urological checks can be ordered. If necessary, additional gynecological examinations are carried out for women.
To diagnose severe anemia, it may be necessary to collect bone marrow from the patient. The procedure helps to identify diseases such as certain types of leukemia or aplastic anemia.
Treatment of Anemia
Treatment for anemia depends on the specific cause of the disease. If, for example, there is iron or folic acid deficiency anemia, the substances can initially be absorbed through medication and later supplied through an adequate change in diet. In vitamin B12 deficiency anemia, patients are usually given the vitamin by injections into the muscle. If any bleeding causing the anemia is discovered, it will be stopped. If there is a lot of blood loss, the patient may receive a blood transfusion. Patients with kidney disease with renal anemia are given erythropoietin. This compensates for the lack of the blood-forming hormone. In some particularly severe cases of hemolytic anemia, surgical removal of the spleen may be indicated. The organ is responsible for breaking down the red blood cells. Stem cell transplantation is recommended for patients with severe congenital anemia, such as sickle cell anemia.
How does Anemia Develop?
The causes of anemia are manifold. For example, anemia can be a reduced formation or an increased breakdown of red blood cells. Likewise, too little production of hemoglobin. For example, if you lose red blood cells (erythrocytes) through bleeding, this can also lead to anemia. In many cases, there is also a deficiency in important vitamins or minerals such as vitamin B12, iron, or folic acid. In addition, numerous anemias occur as an accompanying symptom of chronic diseases.
How to Prevent Anemia?
Certain forms of anemia can be prevented. It is important to have a balanced diet with sufficient folic acid, for example, from beans, asparagus, spinach, cabbage, or liver. But vitamin B12 should also play an important role in the diet. It is found in fish, dairy products, meat, and eggs. Because of blood loss through menstruation, women should ensure that they consume enough iron to prevent iron deficiency. The mineral is found, for example, in red meat, whole grain cereals, legumes, and nuts. In combination with vitamin C (for example, lemon or orange juice), iron-containing products can be absorbed even better by the intestine.
What is anaemia in pregnancy?
During pregnancy, the body’s demand for iron is greater. It is needed in pregnancy for your baby’s growth and brain development.
Your recent blood test has shown you are anemic. This is caused by a reduction of red blood cells which help to transport oxygen around the body.
To produce red blood cells, the body needs iron, vitamin B12, and folic acid. If there is a lack of one or more of these, anemia will develop. The most common type of anemia is iron deficiency anemia.
Causes of anaemia in pregnancy
It is common for women to develop iron deficiency during pregnancy because the demand for iron and other vitamins is increased. The mother must increase her production of red blood cells and, in addition, the baby needs its own supply of iron, which can only be obtained from the mother. It is normal for the levels to drop a little in pregnancy because there is far more fluid in your blood to dilute the red blood cells. This is normal for pregnancy.
Other causes of anemia may include:
- A diet low in iron
- Pregnancies close together
- Carrying twins or triplets
Treating anaemia in pregnancy
Following discussion with your midwife or doctor, they may advise the following treatment. Iron supplements are available in tablets or in liquid form. If you have been prescribed iron supplements, it is important to take them and to finish the course. You will then be offered a blood test to check the iron supplement has been beneficial. If you fail to respond to iron supplements intravenous iron may be considered, however, there can be risks with this. These will be explained to you if you require this type of treatment.
Iron supplements can often cause constipation or diarrhea and some women are unable to take them. Iron supplements are better absorbed if taken an hour before meals however, side effects on the gut, such as abdominal discomfort, constipation, diarrhea, and nausea can occur. Some of these symptoms may be resolved by taking the iron with or after food. Please talk to your doctor or midwife about this.
You should contact the Antenatal Clinic, or physician if you are experiencing any of the side effects described within this leaflet, or if you are not tolerating the supplements.
How can I avoid anaemia whilst I am pregnant?
You should look to eat the following:
Iron-rich foods include:
- Dark-green leafy vegetables, such as watercress and curly kale
- Iron-fortified cereals or bread
- Brown rice
- Pulses and beans
- Nuts and seeds
- White and red meat
- Eggs (these must be well cooked during pregnancy)
- Dried fruit, such as dried apricots, prunes, and raisins.
Your daily diet should include foods from all the major food groups to ensure it’s healthy and balanced. It is important to be aware that food and drink containing vitamin C are important as vitamin C helps your body absorb iron.
The following are good sources of vitamin C:
- Fresh fruit juice
However, consuming large amounts of some foods and drinks, as well as certain medicines, may make it harder for your body to absorb iron.
- Tea and coffee, it is suggested that you avoid these drinks at mealtimes.
- Calcium – found in dairy products, such as milk.
- Antacids and proton pump inhibitors (PPIs) – medications used to relieve indigestion.
- Wholegrain cereals – although whole grains are a good source of iron themselves, they contain phytic acid, which can stop your body from absorbing iron from other foods and pills.