Introduction To Anemia
You breathe as long as oxygen circulates through and nourishes the tissues of your body. Just as a postman delivers letters from home to home, your blood supplies oxygen to each and every cell of your body. The blood has plasma and cells. One of these cells is the red blood cell which contains a protein called hemoglobin. To be accurate, this hemoglobin is the “postman” providing oxygen to your tissues. Anemia results when red blood cells and/or hemoglobin are deficient and sparingly available. It is a serious blood disorder that exerts its impact upon almost every system of the body.
Anemia is a versatile blood disorder in the sense that it varies from individual to individual in its nature, intensity, and manifestation. It may result from a variety of causes ranging from genetic abnormality to bone marrow dysfunction. By definition, it is a shortage of RBCs and hence of hemoglobin in the body. Here, we shed a light on the many causes and clinical scenarios presented in anemia cases.
It has devastating effects and is potentially fatal. In this article, we shine light over the many causes and harbingers of anemia.
- Incidence of Anemia
- Causes of Anemia
Incidence Of Anemia
Globally, 24.8% of the population has anemia. It can affect the kids, the elderly and the expecting women. But its prevalence is highest among preschool kids and lowest among men. A large number of non-pregnant women also suffer from anemia. Although there are certain types of anemia that target a specific population ( e.g. sickle cell anemia is highly common in West Africans and Native Americans ), the bottom line is that it can affect people from all races and geographical backgrounds.
Causes Of Anemia
The primary marker of anemia is a lack of adequate number of RBCs to oxygenate the cells. Vital functions are impaired and structures damaged resulting in a crisis situation. Cases of anemia show a broad spectrum intensity. Some patients have a mild case of anemia that can be cured by short-term treatment. However, others undergo prolonged treatment for chronic anemia. Sometimes the situation escalates and there is a grim ending. (Think Heaven and Hell)
There is a wide variety of scenarios that can lead up to anemia. Here we list some common causes of anemia:
- You already have Iron Deficiency.
- You have an inherited blood disorder.
- You have encountered a serious accident, fall or hemorrhage.
- You have undergone chemotherapy sessions for quite some time now.
- You eat a diet poor in folic acid and Vitamin B 12.
- You already suffer from pernicious anemia.
- You have a malfunctioning bone marrow.
- You are pregnant or a nonpregnant woman with the heavy menstrual flow.
- You have intestinal troubles.
- You have a family history of anemia.
You Already Have Iron Deficiency
Not only is Iron important for the formation of other essential elements in the body(e.g., myoglobin, cytochromes, cytochrome oxidase, peroxidase, and catalase), it is crucial for the synthesis of hemoglobin. It is the central atom around which the pyrrole rings assemble during the production of hemoglobin. Henceforth, it is important for the production of erythroblasts in the bone marrow. Dried fruit, green vegetables, nuts, and lentils are some of the diets rich in iron.
If you have a diet plan low on either of these, then you are susceptible to iron deficiency anemia. But fret not, iron supplements can enhance your iron stores and help you get back on track.
You Have An Inherited Blood Disorder
From a genetic point of view, there are many anomalies that interfere with normal synthesis and functioning of blood cells. For example, in inherited spherocytosis, the RBCs formed are spherical and small-sized that easily rapture within the blood vessels. Other genetic disorders that cause hemolysis of RBCs are sickle-cell anemia and erythroblastosis fetalis.
Sickle Cell Anemia
Hemoglobin is a globular protein. It is made of polypeptide chains that are coiled and folded around one another. Haemoglobin A, which is the hemoglobin present in adults, is a combination of four polypeptide chains – two alpha chains and two beta (ß) chains. In each of the two ß chains, the sixth position is occupied by glutamic acid. In comparison, sickle-cell patients have valine in place of glutamic acid in the sixth place. This minor substitution occurs because of a genetic defect. The defective gene causes improper and faulty synthesis of hemoglobin (designated as HbS).
At low oxygen tension, the HbS molecule is crystallized within the RBC. The red cell becomes sickle-shaped and is readily raptured while passing through the capillaries. Keep in mind that the normal RBC is a biconcave disc that has a bag-like, flexible membrane. But the sickle-cell RBC can’t move through tight vascular beds owing to its fragile membrane.
The patient’s systems experience a shortage of oxygen and hence more sickling and subsequent RBC destruction. Therefore, a Sickle Cell Disease “crisis” may ensue. Once the process starts, it progresses rapidly, eventuating in a serious decrease in RBCs within a few hours and, in some cases, death.
In addition to the usual ABO blood group system, there is another blood group system that depends on the presence and absence of Rh antigens on the RBC. This is designated as the Rh – blood group system. Now when an Rh – -ve woman married to an Rh – +ve man conceives an Rh – +ve fetus, it is likely that the fetus will have erythroblastosis fetalis.
The maternal Rh – -ve antibodies cross the placental barrier and attack the Rh – +ve blood cells of the baby. These antibodies weaken the RBCs, making them so fragile that they suffer a breakdown. The spleen of the fetus enlarges and it may have congenital jaundice. Also, the child is born with a serious case of anemia. However, this type of anemia rarely causes death. An easy cure is replacing the baby’s blood with Rh – -ve blood.
You Have Encountered A Serious Accident, Fall Or Haemorrhage
During accidents and other physical mishaps, you lose a lot of blood. Naturally, there is a shortfall of red blood cells in the body. The oxygen supplied to your tissues is lesser than normal. Even after a hemorrhage, your body faces a deficit of hemoglobin. Luckily, it takes only 3-6 weeks for the body to replenish its RBC production. But only if you didn’t have a second hemorrhage. The plasma portion of blood takes only three days to return to its normal concentration. But the production of blood cells in the bone marrow is a time-taking process. And that is exactly why it takes over a month to make up for the lost RBCs.
You Have Undergone Chemotherapy Sessions For Quite Some time Now
Your stem cells may also be damaged when you are exposed to high-dose radiation or you are being treated for cancer. This radiation can damage the stem cells from which all blood cells arise. When the stem cells malfunction, the blood cells formed have strange and irregular shapes and amount of pigment. For instance, if the RBCs have a low quantity of hemoglobin and are reduced in size then this is a case of microcytic, hypochromic anemia.
You Eat A Diet Poor In Vitamin B 12 And Folic Acid
Maturation of RBCs requires Vitamin B 12, folic acid and an intrinsic factor of the stomach mucosa. Except the IF produced by parietal cells in your stomach, both the folic acid and vitamin compounds are taken up from your diet. So if you follow a diet plan that is deficient in meat, poultry, and lentils, you may develop “Vitamin Deficiency Anemia“.
The best sources of Vit B 12 are eggs, cheese, milk, shellfish, poultry, meat and other fish. Similarly, foods rich in folic acid are lentils, dried beans, peas, nuts, avocados, citrus fruit, and most importantly, green vegetables. So if you avoid healthy eating and consumption of veggies and meat, you may suffer from “megaloblastic anemia.”
Your bone marrow forms abnormal RBCs that are irregularly-shaped and large. These RBCs are termed as megaloblasts and the resulting disease “Megaloblastic Anemia.” The erythroblasts fail to develop and proliferate properly, hence causing breakdown of red cells early on.
You Already Suffer From Pernicious Anemia
By pernicious anemia, we refer to a disease in which the stomach mucosa degenerates and fails to produce an intrinsic factor that takes up Vitamin B12 in the GIT. This atrophy of the stomach lining depresses the amount of Vitamin B12 absorbed hence leading to abnormal maturation of RBCs. In a nutshell, the Vitamin B12 Deficit causes anemia. In addition to atrophy of the stomach lining, it may also occur after the loss of the entire stomach(gastrectomy).
You Have A Malfunctioning Bone Marrow
The bone marrow is the spongy tissue present in the interior of the bone. In sternum and the short bones like the ribs and vertebrae, the bone marrow is responsible for all three lines of blood cells – RBCs, WBCs, and platelets. In “Aplastic anemia” the patient endures a malfunctioning bone marrow. Bone marrow aplasia means lack of functioning bone marrow. For instance, chemotherapy for cancer and exposure to high-dose radiation can damage hematopoietic stem cells of the bone marrow, followed in a few weeks by anemia.
Likewise, high doses of certain toxic substances such as insecticides or benzene in gasoline may cause the same effect. In autoimmune disorders, such as Lupus erythematosus, the body’s own defense system begins attacking healthy stem cells. Consequently, the patient has bone marrow dysfunction and aplastic anemia.
In about half of aplastic anemia cases, the cause is unknown, a condition termed as “Idiopathic Aplastic Anemia.”
This rare bone marrow abnormality is fatal unless patients are treated with a bone marrow transplant. However, the cure rate of bone marrow transplant is not very high. And only suitable recipients can undergo this procedure. Nevertheless, all patients receive regular blood transfusions to normalize their RBC count.
You Are Pregnant Or A Nonpregnant Woman With Heavy Menstrual Flow
Basically, when you are pregnant, your body undergoes various mega changes. Your cardiac output increases, your glands release higher quantities of different hormones, and your body needs more blood and more oxygen. In order to fulfill this requirement, the stem cells try to synthesize higher quantities of RBCs.
However, the deficiency of iron in women is very common and widespread. It is not surprising for a pregnant woman to suffer from iron deficiency anemia. Instead, it is very likely. If you are pregnant, your body needs more blood for the formation and maintenance of placenta as well as the growing needs of your fetus.
Moreover, the body prepares for childbirth by reserving a major volume of blood. Clinicians claim that during pregnancy, the daily requirement of iron increases from 18mg per day to 27 mg per day. This is probably why iron and folic acid tablets are part of regular prenatal course prescribed to all pregnant ladies.
Anemia In Nonpregnant Women
On the other hand, when you are not pregnant and are just going through the normal phases of a woman’s life, then highly abnormal discharge of blood during menstruation is a bad sign. If too much blood is released so much so that your body faces a shortage of RBCs, then you need to see a gynecologist. Because you might be on the verge of iron deficiency anemia if not already suffering from it. Due to high blood flow through the vagina, a large aggregate of RBCs is lost and gone, rendering the body cells poor in oxygen.
You Have Intestinal Troubles
Other than pernicious anemia, there are other causes of megaloblastic anemia. One of these is “intestinal sprue.” In this condition, the gastrointestinal tract fails to absorb folic acid, vitamin B 12 and other vitamin compounds. As the erythroblasts can’t proliferate rapidly enough to form a normal and adequate number of RBCs, the red cells formed are mostly oversized, have bizarre shapes, and have fragile membranes. Such RBCs are defective and wreak havoc in the circulatory system.
You Have A Family History Of Anemia
Some people inherit defective genes that cause complications in the composition of their blood. Many blood disorders like spherocytosis, erythroblastosis fetalis, thalassemia and sickle cell disease are genetic in nature i.e. they can be transmitted from one generation to another. They usually follow a sex-linked mode of inheritance. Due to the formation of abnormal blood cells, these diseases can easily have anemia as an outcome.
You surely owe a huge Thank You to your blood cells for proper functioning. They are crucial to respiration, digestion, reproduction, and almost all other systems of the human body. Actually, when you are anemic, the viscosity of your blood decreases. On the other hand, its velocity increases. The vessels in the peripheral tissues of the body dilate to enhance its perfusion. This is a curative measure to fight low amount of oxygen.
But in the long run, it proves to be fatal as it increases the cardiac output drastically. This results in cardiac failure and ultimate death. So have your iron levels checked regularly and examine the water line above your lower eyelashes (pale mucous membranes of the eyes indicate early onset of anemia). If you are hale and hearty, thank your lucky stars and crack a smile.
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