Anemia: What is it?

Feeling tired lately? Perhaps you are short of breath or a bit pale. Even more concerning, you occasionally experience dizziness, an irregular heartbeat, or chest pain. In addition to feeling run down, you are also troubled by headaches and cold hands and feet.

Could anemia be the culprit?

“Being anemic means that your hemoglobin level is lower than normal,” says Gerald Soff, M.D. As a hematology expert with the University of Miami Health System and Sylvester Comprehensive Cancer Center, Dr. Soff specializes in diagnosing blood, bone marrow, and lymphatic system diseases. The hemoglobin he’s referring to is a protein inside red blood cells.

Hemoglobin carries oxygen from your lungs to other organs and is just one of many important components in your blood. “White blood cells fight infection. Red blood cells carry oxygen. Platelets help the blood clot,” Dr. Soff says.

How does a person become anemic?

When a person is anemic, their body does not have enough healthy red blood cells or hemoglobin. To evaluate this condition, Dr. Soff says physicians look at “three mechanisms” that could be causing the problem:

1. A decrease in the amount of red blood cells the body produces because of a nutritional deficiency or medical condition.
2. Heavy bleeding or blood loss.
3. A condition known as hemolytic anemia, where red blood cells are destroyed faster than normal and faster than the body can replace them.

Anemia can be temporary or long-term and varies from mild to severe. In some individuals, it indicates a more serious condition. Fortunately, this condition can be diagnosed easily with a complete blood count (CBC) test. If you suspect anemia, you should also discuss your family medical history with your doctor, as well as any health problems you’re experiencing.

There are many kinds and causes of anemia.

Iron deficiency is one cause – it is the number one nutritional deficiency in the world.

“Our bodies need a sufficient amount of iron in order to make hemoglobin, and iron is incorporated into red cells. Women lose blood regularly during their years of menstruation. This often results in iron deficiency anemia, particularly if the woman does not take in enough iron from her diet or supplements to maintain her body’s iron stores,” Dr. Soff says.

People commonly see a hematologist because of iron deficiency anemia, even if they take oral iron supplements. “In those cases, hematologists give the patient intravenous iron to more rapidly and effectively restore adequate iron,” Dr. Soff says.

However, Dr. Soff says it’s too simplistic to assume all cases of anemia are “iron-poor blood.” A lack of vitamin B-12 is another nutritional cause of anemia. “We get essential nutritional elements such as iron and B-12 from red meat. If a person follows a vegan or vegetarian diet, they must compensate by taking iron and vitamin B-12 supplements.”

A multivitamin with iron and vitamin B-12 supplement will usually suffice, but the nutritional status and blood counts need to be monitored. Although the highest amounts of B-12 are found in red meat, it is also present in dairy products, fortified cereal, and some soy products. The majority of iron comes from animal protein; other iron-rich foods include eggs, dark leafy greens, beans, iron-fortified cereals, and dried fruit.

Other causes of anemia are more complicated, and may include:

• Inflammatory diseases such as Crohn’s disease, ulcerative colitis, cancer, HIV/AIDS, rheumatoid arthritis, and kidney disease that prevent the body from making enough red blood cells
• Pre-cancerous polyps that create excessive bleeding
• Being pregnant without taking iron supplements
• Regular use of pain relievers such as aspirin that can cause internal bleeding

Weight loss surgery is another potential cause.

“There are lifelong consequences to having bariatric surgery. It reduces a person’s ability to absorb iron, and they are also prone to vitamin B-12 deficiency. These are easily addressed as long as the patient and their doctor are aware. If an oral iron supplement causes the patient to experience constipation and bloating, I give them a monthly intravenous dose of iron and B-12,” Dr. Soff says.

Without sufficient B-12, the body can’t produce healthy red blood cells. Some individuals who have trouble absorbing vitamin B-12 can also develop pernicious anemia. Left untreated, the condition can cause serious complications, such as damage to the stomach lining and nervous system, and in some cases, a greater risk of stomach cancer.

Some diseases, Dr. Soff says, “leave a different footprint on blood cells, making them appear bigger or smaller than normal or unusually shaped.” In sickle cell anemia, abnormal hemoglobin causes red blood cells to form a crescent or sickle shape. These mishappen cells die prematurely, causing chronic red blood cell deficiency. Newer gene therapies are showing promising results for people with this inherited disease. “By introducing artificial genes into blood, we can manipulate the DNA, form new cells, and increase the amount of normal hemoglobin,” Dr. Soff says.

Managing anemia during cancer treatment

At Sylvester, Dr. Soff sees many patients with cancer who are anemic.

“Cancer itself often suppresses production of red blood cells due to inflammation, low levels of bleeding from the digestive tract, and the cancer spreading to the bone marrow which displaces the normal blood-forming cells. Unfortunately, many types of chemotherapy and radiation therapy have an adverse effect on blood-forming cells, in addition to the intended effect of killing cancer cells,” Dr. Soff says. Determining why a cancer patient has anemia and implementing an appropriate treatment strategy is a major part of his practice.

The good news?

“Anemia is very treatable if you seek out good care, whether it’s from a hematologist or your primary care doctor,” Dr. Soff says.

Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: Anemia symptoms, Dr. Gerald Soff, Iron deficiency anemia, Sickle cell anemia, Vitamin B-12 deficiency