Dr Tariq Jagnarine
Fam Medicine, Endocrinology and Diabetes
Anaemia happens when the number of healthy red blood cells in our body is too low. Red blood cells carry oxygen to all of the body’s tissues, so a low red blood cell count indicates that the amount of oxygen in our blood is lower than it should be. Many of the symptoms of anaemia are caused by decreased oxygen delivery to the body’s vital tissues and organs. Anaemia is measured according to the amount of haemoglobin — the protein within red blood cells that carries oxygen from the lungs to the body’s tissues – in our body. Anaemia affects more than 1.6 billion people around the world. Women and people with chronic diseases such as cancer have the highest risk of developing anaemia.
Risk factors for low blood count
The things that typically decrease red blood cell production, causing anaemia, include:
* Inadequate stimulation of red blood cell production by the hormone erythropoietin, which is produced by the kidneys
* Inadequate dietary intake of iron, vitamin B-12, or folate
* Hypothyroidism
On the other hand, any disorder that destroys red blood cells at a rate faster than they’re made can cause anaemia. This typically occurs due to haemorrhaging, which can happen because of:
* Endometriosis
* Accidents with severe trauma and bleeding
* Gastrointestinal lesions
* Menstruation
* Childbirth
* Excessive uterine bleeding
* Surgery
* Cirrhosis, which involves scarring of the liver
* Fibrosis (scar tissue) within the bone marrow
* Haemolysis, a rupture of red blood cells that can occur with some medications or Rh incompatibility
* Disorders of the liver and spleen
* Genetic disorders such as:
* Glucose-6-phosphate dehydrogenase (G6PD) deficiency
* Thalassemia
* Sickle cell anaemia
Overall, however, iron deficiency is the most common cause of anaemia. It accounts for nearly half of all anaemia cases, and is a major nutritional disorder worldwide.
Causes of anaemia
Dietary iron, vitamin B-12, and folate are essential for red blood cells to mature in the body. Normally, 0.8 to 1 percent of the body’s red blood cells are replaced every day, and the average lifespan for red cells is 100 to 120 days. Any process that has a negative effect on this balance between red blood cells’ production and destruction can cause anaemia. Causes of anaemia are generally divided into those that decrease red blood cells’ production and those that increase red blood cells’ destruction.
Daily nutritional requirements
and anaemia
Women need more iron and folate than men, because of iron losses during their menstrual cycle and foetal development during pregnancy and breastfeeding.
Iron
According to the National Institutes of Health, the recommended daily iron intake for adults aged 19 to 50 are as follows:
Men: 8mg, Women: 18mg, Pregnancy: 27mg, Breast feeding: 9mg
Men and women over age 50 require only 8 milligrams (mg) of iron daily. A supplement may be needed if adequate iron levels can’t be acquired through diet alone.
Good sources of dietary iron include:
* Chicken and beef liver
* Dark red meat
* Red meats such as beef
* Seafood
* Fortified cereals
* Oatmeal
* Lentils
* Beans
* Spinach
Folate
Folate is the form of folic acid that occurs naturally in the body. Males and females over the age of 14 require 400 micrograms of dietary folate equivalents (mcg/DFE) per day. For women who are pregnant or breastfeeding, the recommended intake increases to 600 mcg/DFE and 500 mcg/DFE per day respectively.
Examples of foods rich in folate are:
* Beef liver
* Lentils
* Spinach
* Great northern beans
* Asparagus
* Eggs
Vitamin B-12
The daily adult recommendation for vitamin B-12 is 2.4. Women and teens who are pregnant need 2.6 mcg per day, and those who are breastfeeding require 2.8 mcg daily.
Beef liver and clams are two of the best sources of vitamin B-12. Other good sources include:
* Fish
* Meat
* Poultry
* Eggs
* Other dairy products
Vitamin B-12 is also available as a supplement for those who don’t get enough from their diet alone.
SYMPTOMS OF LOW BLOOD COUNT
People with anaemia appear pale, and may often complain of being cold. They may also experience:
* Light-headedness or dizziness, especially when active or standing up
* Unusual cravings, such as wanting to eat ice, clay, or dirt
* Trouble concentrating, or tiredness
* Constipation
Some types of anaemia can cause inflammation of the tongue, resulting in a smooth, glossy, red, and often painful tongue. If anaemia is severe, fainting may occur. Other symptoms include:
* Brittle nails
* Shortness of breath
* Chest pains
Blood oxygen levels can be so low that a person with severe anaemia can have a heart attack.
A physical exam of someone with anaemia may show:
* High or low blood pressure
* Pale skin
* Jaundice
* An increased heart rate
* Heart murmurs
* Enlarged lymph nodes
* An enlarged spleen or liver
* Atrophic glossitis of tongue
People with signs or symptoms of anaemia should seek medical attention, especially if fainting or chest pains occur.
DIAGNOSIS
A diagnosis of anaemia begins with both a health history and a family health history, along with a physical exam.
A family history of certain types of anaemia, such as sickle cell anaemia, can be helpful. A history of exposure to toxic agents in the home or workplace might point to an environmental cause.
Laboratory tests are often what’s used to help doctors find out the cause of the anaemia.
Tests to diagnose anaemia include:
* Complete blood count (CBC). The CBC blood test shows the number and size of the red blood cells. It also shows if levels of other blood cells, like white blood cells and platelets, are normal.
* Serum iron levels. This blood test shows if iron deficiency is the cause of anaemia.
* Ferritin test. This blood test analyses iron stores.
* Vitamin B-12 test. This blood test shows vitamin B-12 levels, and helps your doctor determine if they’re too low.
* Folic acid test. This blood test reveals if serum folate levels are low.
* Stool test for occult blood. This test applies a chemical to a stool specimen to see if blood is present. If the test is positive, it means that blood is being lost somewhere in the gastrointestinal tract, from the mouth to the rectum. Problems like stomach ulcers, ulcerative colitis, and colon cancer can cause blood in stool.
TREATMENT
Treating anaemia depends on what’s causing it.
Anaemia caused by inadequate amounts of dietary iron, vitamin B-12, and folate is treated with nutritional supplements. In some cases, injections of B-12 are needed, as it isn’t absorbed properly from the digestive tract.
A nutritionist can prescribe a diet that contains the proper amounts of vitamins, minerals and other nutrients. A proper diet can help prevent this kind of anaemia from recurring.
In some cases, if the anaemia is severe, the use of erythropoietin injections to increase red blood cell production in the bone marrow is applied. If bleeding occurs, or the haemoglobin level is very low, a blood transfusion may be necessary.
PROGNOSIS
The long-term outlook for anaemia depends on the cause and the response to treatment. Anaemia is very treatable, but it can be dangerous if it’s left untreated.
Invest in a multivitamin to ensure that the body is getting the recommended daily amount of iron.
Talk to a doctor if you are experiencing any symptoms of anaemia, especially if there is a family history of low blood count. An iron deficiency may also be a sign of more serious medical conditions, so it’s important to pay attention to one’s body. In most cases, just tweaking our diet or taking an iron supplement can solve anaemia.
