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Anaemia

Introduction

Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin (a protein which facilitates the transport of oxygen from the lungs to the rest of the body) in them is below normal. When a person is anaemic, there is a diminished supply of oxygen to the rest of the body as a result of the reduction in the number of red blood cells and the haemoglobin in them. The symptoms of anaemia such as fatigue, light-headedness, and weakness can be directly linked to the inadequate oxygen supply. Severe anaemia can result in a stroke or a heart attack. Anaemia can be diagnosed by doing some simple blood tests. A complete blood count will reveal the percentage of red blood cells in the total volume of the blood as well as the amount of haemoglobin in the blood sample. 
 

Causes of anaemia

The causes of anaemia can be divided into three categories:

  • Excessive bleeding
  • Decreased red blood cell production
  • Increased red blood cell destruction


Excessive bleeding

This is the most common cause of anaemia. A person may lose a large volume of blood suddenly as a result of an accident, surgery, childbirth or a ruptured blood vessel. However, more commonly, the loss of blood is the result of chronic conditions like nosebleeds, hemorrhoids, intestinal ulcers, kidney or bladder tumours, heavy menstrual bleeding, etc. 

When a person loses blood, the body tries to compensate by drawing water from tissue outside the blood stream to fill the blood vessels. Consequently, the blood becomes diluted and the number of red blood cells is reduced. Under normal circumstances, the body automatically corrects the imbalance by increasing the production of red blood cells. Loss of blood results in a fall in blood pressure and a drop in the body’s oxygen supply. In certain cases, it could lead to a heart attack or a stroke or could even be fatal. 

Some people who develop anaemia as a result of blood loss show no symptoms at all while others may experience dizziness, faintness, shortness of breath, thirst, excessive perspiration, and a weak and rapid pulse. The mildness or severity of the symptoms will depend on how rapid the blood loss is. The more rapid the blood loss, the more severe the symptoms. 

The first step in the treatment of anaemia caused by excessive bleeding would be to stop the flow of blood. If a large volume of blood has been lost rapidly, blood transfusions would have to be considered.
 

Decreased red blood cell production

There are several nutrients (primarily iron, vitamin B12 and folic acid) and hormones that work in conjunction to produce red blood cells. A lack of any of these substances could result in inadequate production of red blood cells or deformed cells. 

Iron deficiency anaemia
Iron deficiency is probably the most common cause for anaemia. Normally, when red blood cells die, the iron is recycled by the bone marrow and used in the production of fresh red blood cells. Iron deficiency in adults is usually the consequence of blood loss. Menstrual bleeding in premenopausal women and bleeding in the gastrointestinal tract in men and postmenopausal women are linked to iron deficiency. In the case of small infants and children iron deficiency may arise, as their diet may be low in iron. 

The symptoms of iron deficiency include: a craving for inedible substances like ice, dirt, or pure starch, tongue irritation, and cracks at the sides of the mouth and in the fingernails.

The treatment of this condition involves taking iron supplements in the form of tablets. Periodic blood tests must be done to ensure that the iron level in the blood has been normalized and is being maintained. A person can also increase their dietary intake of iron by eating meat and spinach. Vitamin C aids the absorption of iron. 
 

Vitamin deficiency
Megaloblastic anaemia is caused by vitamin B12 or folic acid deficiency. In this condition, the bone marrow produces large, abnormal red blood cells called megaloblasts. White blood cells and platelets may also be abnormal. 

There are several probable causes for vitamin B12 deficiency. However, the deficiency is usually linked to the failure of the stomach to produce the protein that facilitates the absorption of the vitamin into the bloodstream. Consequently, vitamin B12 is not absorbed and this, in turn, leads to the development of anaemia. Symptoms of vitamin B12 deficiency are: tingling sensation or loss of sensation in the hands and feet, spastic movements, a sore or burning tongue, weight loss, confusion, depression, etc. People with vitamin B12 deficiency are administered the vitamin by injection as they usually cannot absorb the vitamin when they take it orally. They will have to take vitamin B12 supplements for life. 

Raw vegetables, fresh fruit, and meat are a good source of folic acid. There are several factors that could lead to folic acid deficiency. A diet lacking in raw, leafy vegetables is one such factor. Pregnant and lactating women develop this deficiency because their body’s demands for folic acid increases. Excessive consumption of alcohol also interferes with the absorption of folic acid. People who are found to have folic acid deficiency are required to take folic acid supplements daily. 

Chronic disease
When people have infections, inflammation or cancer, these conditions suppress the production of red blood cells in the bone marrow. However, these conditions only result in the development of anaemia if they are severe or long lasting. 
 

Increased red blood cell destruction

In the normal course of events, red blood cells have a life of about 120 days. As they come towards the end of their lives, scavenger cells from the bone marrow, spleen and liver destroy them. Hemolytic anaemia refers to a condition when the rate at which red blood cells are being destroyed exceeds their rate of production. 

There are several possible causes for the development of hemolytic anaemia. Obstacles in the blood stream may break up red blood cells. Certain drugs like sulfa destroy red blood cells. They may also be destroyed as a result of an autoimmune reaction when the immune system malfunctions and turns on its own cells mistaking them for foreign substances. In addition, conditions like the enlargement of the spleen and the presence of lymphomas can lead to the destruction of red blood cells. 

Chills, fever, back and stomach pain, light-headedness and a significant fall in blood pressure characterize a hemolytic crisis. Hemolysis can also result in jaundice and dark urine. 


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