Anemia may not mean iron deficiency

Anemia is a sign of a disease, not a disease itself and its complexities extend far beyond sickle cell and iron deficiency. It is condition resulting from a significantly decreased number of red blood cells, which carry oxygen throughout the body. Anemia often causes fatigue, dizziness, weakness and pale nailbeds.

The word "anemia" comes from the Greek for "without blood." Blood is approximately 55 percent plasma, which is the fluid portion, and 45 percent blood cells. About 99 percent of the cells should be red blood cells. Having a low red blood cell count can usually be attributed to three basic factors: not enough cells are being made, those cells are not living their full 100 to 120 day lifespan or they are being destroyed prematurely by the immune system.

Often, the reason that the body is not producing enough red blood cells is an iron, B12 or folate deficiency. Diet is an important factor to consider, but women’s menstrual blood loss may result in iron deficiency as well. It is harder to become deficient in B12, which is abundant in meats. However, in cases of pernicious anemia, the body destroys what helps it to absorb B12. Folate deficiencies are most common in pregnant or nursing women and alcoholics.

"Actually, studies have been done to try to add folate to alcohol," Marc Kahn, senior associate dean at Tulane University’s school of medicine, said. "It changed the flavor and turned it yellow."

Because these deficiencies may not be the reason for the decreased number of red blood cells, doctors who suspect their patients may be suffering from anemia must also ensure that they are not bleeding internally. Doctors may take a stool sample and ask patients if they have noticed blood in their urine or feces. Colon polyps and gastrointestinal bleeding often cause low red blood cell counts because the body is unable to produce the cells as quickly as it is losing them.

Premature destruction of the red blood cells is often associated with AIDS, leukemia, lymphoma, myeloma or other bone marrow and immune system diseases and disorders.

Those with Krohn’s disease, cancer and kidney failure are also especially susceptible to anemia.

If patients suspect that they have an iron deficiency because they are exhibiting symptoms of anemia, they should ask a doctor to have a blood count done.

"Men should have 13.5 to 17.5 grams of hemoglobin per deciliter of blood," Ruben Mesa, associate professor of the medical division of hematology at the Mayo Clinic, said. "They would be considered anemic at 12g/dcl, but 12 to 15g/dcl is normal for women because they don’t have testosterone driving the count up."

Blood transfusions are generally necessary for patients whose hemoglobin count falls below 8g/dcl, but are only a quick fix to a problem that must be treated more extensively to find its cause, Mesa said. Maintaining a proper diet or taking supplements may help those who are vitamin deficient. However, a physician should determine what the cause of anemia is before patients make changes in their diet or begin taking supplements.

"If it’s a 24 year-old woman, it’s probably menstruation causing iron deficiency, but men and post-menopausal women who are anemic are very possibly bleeding from the intestinal tract," Mesa said. "Sickle-cell is generally diagnosed during childhood, and there are some other genetic diseases that interfere with the production of hemoglobin that may be diagnosed in children as well."

Anemia is generally a sign of more serious issues. Therefore, patients who experience trouble breathing or have black, tarry or bloody stools should contact their physician immediately as anemia can lead to jaundice, low blood pressure, enlargement of the spleen and weight loss. (Black, tarry stool is reason to seek emergency treatment.) Left untreated, anemia can cause chest pains, alter the patient’s mental state and damage the internal organs.