By: Rebecca Bicknese

 Anemia is a condition in which you don’t have enough healthy red blood cells to carry enough oxygen to your tissues.  Anemia is the most common blood condition in the United States. Around 3.5 million Americans on average are diagnosed with a type of anemia each year.

 There are more than 400 types of anemia, which are divided into 3 groups:  Anemia caused by blood loss  Anemia caused by decreased or faulty red blood cell production  Anemia caused by destruction of red blood cells

Red blood cells can be lost through bleeding. This can occur over a long period of time and can often go undetected. This kind of chronic bleeding commonly comes from:  Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis, and cancer  Use of nonsteroidal anti-inflammatory drugs such as aspirin or Motrin  Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies

The body may produce too few blood cells or the blood cells may not work properly. Red blood cells may be faulty or decreased due to abnormal red blood cells or the lack of minerals and vitamins needed for red blood cells to work properly.  Sickle cell anemia  Iron deficiency anemia  Vitamin deficiency anemia  Aplastic anemia

A disease passed down through families in which red blood cells form in an abnormal crescent shape.

Sickle Cell Symptoms Symptoms usually don’t occur until a child is over the age of 4 months. Almost all patients with sickle cell anemia have painful episodes, which can last from hours to days. Some patients have one episode every few years, while others have many episodes per year. The episodes can be severe enough to require a hospital stay. Common symptoms include:  Attacks of abdominal pain  Bone pain  Breathlessness  Delayed growth and puberty  Fatigue  Fever  Jaundice  Paleness  Rapid heart rate  Ulcers on the lower legs (in adolescents and adults) Other symptoms include:  Chest pain  Excessive thirst  Frequent urination  Painful and prolonged erection (priapism - occurs in % of men with the disease)  Poor eyesight/blindness  Strokes  Skin ulcers

 Hemoglobin is a protein inside red blood cells that carries oxygen. Sickle cell anemia is caused by an abnormal type of hemoglobin called hemoglobin S. Hemoglobin S distorts the shape of red blood cells, especially when there is low oxygen.  The distorted red blood cells are shaped like crescents. These fragile, crescent-shaped cells deliver less oxygen to the body's tissues. They also can clog more easily in small blood vessels, and break into pieces that disrupt blood flow.  Sickle cell anemia is inherited from both parents. Sickle cell disease is much more common in people of African and Mediterranean descent. It is also seen in people from South and Central America, the Caribbean, and the Middle East.  Someone who inherits the hemoglobin S gene from one parent and normal hemoglobin (A) from the other parent will have sickle cell trait. People with sickle cell trait do not have the symptoms of true sickle cell anemia.

 Patients with sickle cell disease need ongoing treatment, even when they are not having a painful episode.  The purpose of treatment is to manage and control symptoms, and to limit the frequency of episodes.  During a sickle cell episode, you may need certain treatments. Painful episodes are treated with pain medicines and by drinking plenty of fluids. It is important to treat the pain. Non-narcotic medications may be effective, but some patients will need narcotics.  Antibiotics and vaccines are given to prevent bacterial infections, which are common in children with sickle cell disease.  Blood transfusions are used to treat a sickle cell crisis. They may also be used on a regular basis to help prevent strokes.

 Dialysis or kidney transplant for kidney disease  Drug rehabilitation and counseling for psychological complications  Irrigation or surgery for persistent, painful erections  Surgery for eye problems  Wound care, zinc oxide, or surgery for leg ulcers  Bone marrow transplants can cure sickle cell anemia. However, transplants have many risks, including infection, and rejection. They are not an option for most patients. Also, sickle cell anemia patients are often unable to find suitable donors.

In the past, sickle cell patients often died from organ failure between ages 20 and 40. With advances in medicine and a better understanding of the disease today, patients can live into their 50s or beyond. Causes of death from Sickle Cell Anemia include organ failure and infection.

Iron deficiency anemia is the most common form of anemia. About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body. Iron is a key part of hemoglobin, the body normally gets iron through diet and by recycling iron from old red blood cells. The causes of iron deficiency are:  Blood loss (including from heavy menstrual bleeding)  Poor absorption of iron by the body  Too little iron in the diet

 Blue color to whites of the eyes  Brittle nails  Decreased appetite (especially in children)  Fatigue  Headache  Irritability  Pale skin color  Shortness of breath  Sore tongue  Unusual food cravings  Weakness

 Iron supplements are available.  For the best iron absorption a patient should take the supplement on an empty stomach. Some people cannot tolerate this and may have to take their supplements with food.  Patients who cannot tolerate iron by mouth can also get an iron supplement by injection.  Milk and antacids may interfere with the absorption of iron and should not be taken at the same time as iron supplements. Vitamin C can increase absorption and is essential in the production of hemoglobin.  Pregnant and breastfeeding women will need to take extra iron because their normal diet usually will not provide the required amount.

One can also help their anemia by increasing the amount of iron in their diet. Iron-rich foods include:  Eggs (yolk)  Fish  Peas and beans  Meats (liver is the highest source)  Poultry  Raisins  Whole-grain bread Most people that take iron supplements and include more iron in their diet will have their blood counts return to normal in about 2 months.

Vitamin deficiency anemia is due to having a low red blood cell count due to a lack of the vitamin B12, which is why it is also called B12 deficiency anemia. Symptoms include:  Confusion or change in mental status in severe or advanced cases  Decreased sense of vibration  Diarrhea  Fatigue  Loss of appetite  Numbness and tingling of hands and feet  Pallor  Shortness of breath  Sore mouth and tongue  Weakness

Vitamin B12 is essential for normal nervous system function and blood cell production. The main sources of vitamin B12 include meat, eggs, and dairy products. For vitamin B12 to be sufficiently absorbed by the body, it must bind to protein released by cells in the stomach. The combination of vitamin B12 bound to protein is absorbed in the final part of the small intestine.

Causes of vitamin B12 deficiency include:  Abdominal or intestinal surgery that affects the ability for vitamin B12 to bind to protein produced by the stomach or for it to be absorbed  A diet low in vitamin B12 (for example, a strict vegetarian diet that excludes all meat, fish, dairy products, and eggs)  Chronic alcoholism  Crohn's disease  Infection with the fish tape worm  Intestinal malabsorption disorders

 Treatment depends on the specific cause of B12 deficiency anemia.  Some cases of vitamin deficiency anemia requires lifelong vitamin B12 injections. People with anemia due to a lack of dietary vitamin B12 may be told to take vitamin supplements and follow a more balanced diet. Treatment may start with vitamin B12 injections.  Anemia caused by malabsorption is treated with vitamin B12 injections until the condition improves. Treatment for vitamin deficiency anemia is usually effective and is not life threatening.

Destruction of red blood cells may happen if they are to fragile to withstand the routine stress of the circulatory system. These blood cells may rupture prematurely and cause hemolytic anemia.

Hemolytic anemia is a condition in which there are not enough red blood cells in the blood, due to the premature destruction of red blood cells.

 Chills  Dark urine  Enlarged spleen  Fatigue  Pale skin color (pallor)  Rapid heart rate  Shortness of breath  Yellow skin color (jaundice)

Hemolytic anemia occurs when the bone marrow is unable to increase production to keep up with the premature destruction of red blood cells.

 Can be inherited  Stressors such as infections, drugs, snake or spider venom, or certain foods  Toxins from advanced liver or kidney disease  Inappropriate attack by the immune system  Hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman  In rare cases, an enlarged spleen can trap red blood cells and destroy them before their circulation time is up.

Treatment depends on what type and the cause of the hemolytic anemia. Folic acid, iron replacement, and corticosteroids may be used. In emergencies, a blood transfusion may be necessary. In rare cases removal of the spleen (splenectomy) may be necessary.

 Anemia - MayoClinic.com. (n.d.). Mayo Clinic medical information and tools for healthy living - MayoClinic.com. Retrieved August 9, 2010, from  MD, MPH, S. N. (n.d.). Anemia. MedicineNet.com. Retrieved August 8, 2010, from  Sarkodee-Adoo,MD, C. (n.d.). Anemia Causes, Types, Symptoms, and Treatment Information on WebMD.com. WebMD - Better information. Better health.. Retrieved August 9, 2010, from guides/understanding-anemia-basics