Wednesday, January 27, 2010

Anemia .. different types & how to treat

What is Anemia?

Anemia is a condition where there is an abnormally low number of red blood cells circulating in the body. It is the most common disorder of the red blood cells, affecting about 3.5 million Americans.

Anemia is not a disease. It is a condition that results from below-normal levels of hemoglobin in the red blood cells. Hemoglobin is the iron-containing pigment of the red blood cells that carries oxygen from the lungs to the tissues.

There are many different kinds of anemia, each with its own cause. For example, a poor diet can cause anemia. The more severe types of this condition are often inherited.
Why Does Anemia Occur?
To understand why anemia occurs, it's important to understand the function of blood itself. Blood is a mixture of plasma (the fluid part of the blood) and cells. Its red color comes from the predominant cells found in the blood, called erythrocytes.

A healthy person has about 5 million red cells in every cubic millimeter of blood. Each cell contains a protein (hemoglobin) that carries oxygen through the body.
The process of creating and recycling red blood cells is exceptionally complex. Trouble can occur at any point in this process. If the red blood cells fail to effectively transport oxygen throughout the body, anemia can result.

Facts About Anemia

The word anemia is Greek for "without blood."
Anemia is a common problem for menstruating women because their iron supplies are depleted monthly.

In young children, marrow in all the bones produces red blood cells. As a person ages, red blood cells are eventually produced only in the marrow of the spine, ribs, and pelvis.
The life span of a red blood cell is between 90 and 120 days.
Old red blood cells are removed from the blood by the liver and spleen, and the iron is returned to the bone marrow to make new cells.

A person with anemia will feel tired and weak because the body's tissues are being starved of oxygen. In fact, fatigue is the main symptom of most types of anemia. The severity of symptoms is in part related to the severity of anemia. Mild anemia can occur without symptoms and may be detected only during a medical exam that includes a blood test.

What Are The Symptoms Of Anemia?

Symptoms of anemia include:
. Fatigue
. Weakness
. Fainting
. Breathlessness
. Heart palpitations (rapid or irregular beating)
. Dizziness
. Headache
. Ringing in the ears (tinnitus)
. Difficulty sleeping
. Difficulty concentrating

Common signs include:

. Pale complexion
. The normally red lining of the mouth and eyelids fades in color
Rapid heartbeat (tachycardia)
. Abnormal menstruation (either absence of periods or increased bleeding)

. Other signs depend on the cause of the anemia. These can include spoon-shaped finger nails and toenails in iron-deficiency anemia, mild jaundice in hemolytic anemias, and leg ulcers in sickle cell anemia .

What Causes Anemia?

There are three general causes of anemia:

. Decreased red cell production by the bone marrow
. Increased red cell destruction, or hemolysis
. Blood loss from heavy menstrual periods or internal bleeding

When you're anemic, your body either produces too few healthy red blood cells, or destroys them faster than they can be replaced or loses too many of them. If your diet lacks certain vitamins and minerals, the production of hemoglobin can slow down.

Types of anemia caused by decreases in red cell production include iron deficiency anemia and vitamin deficient anemia.

If something in the body destroys or attacks red blood cells, the bone marrow tries to produce more blood. If the destruction of red blood cells is rapid, the marrow can't catch up. This problem is often inherited. The resulting anemia is called hemolytic anemia.

Hemolytic Anemia

A severe bleeding episode can result in temporary anemia until the body has had time to make up the blood that was lost. But even small, persistent losses of blood may cause anemia if you have a poor diet. A healthy person whose diet contains plenty of iron and vitamins can produce large amounts of new blood, reducing the risk of anemia

The Different Kinds Of Anemia
There are different kinds of anemia. Some forms of this condition are inherited, while others are brought on by poor nutrition.

Iron Deficiency Anemia
The body needs iron to produce the hemoglobin necessary for red blood cell production. In general, most people need just 1 milligram of iron daily. Menstruating women need double that dose.

Vitamin Deficiency Anemias
Vitamin B-12 is also essential in hemoglobin production. Normally, a chemical secreted by the stomach helps the body absorbs this vitamin. However, some people can't readily absorb B-12. The result is B-12 deficiency (pernicious anemia). Because the symptoms develop gradually this condition may not be immediately recognized. Those with thyroid disease or diabetes mellitus are at increased risk for this type of anemia. The condition occurs most often in 40- to 80-year-old northern Europeans with fair skin.

A lack of folic acid, another one of the B vitamins, can also lead to anemia. Folic acid deficiency is a particular problem for alcoholics.

Food rich in iron and vitamins

Hemolytic Anemias
Anemia caused by the premature destruction of red blood cells is known as hemolytic anemia. In this type of anemia, antibodies produced by the immune system damage red blood cells. This condition is sometimes associated with disorders such as systemic lupus, or lymphoma.

Toxic materials such as lead, copper, and benzene can also cause the destruction of red blood cells.

Blood transfusions may be necessary for some people with this kind of anemia. Hemolytic anemia can be acquired or inherited. Sickle cell disease and thalassemia are both inherited types of hemolytic anemia.

Sickle Cell Anemia

Sickle cell anemia is also known as Hemoglobin S disease. This is a serious, life-threatening inherited form of anemia. Persons with this disease have sickle-shaped red blood cells that are stiff and unable to squeeze through blood vessels.
Persons with this disease often suffer from pain in the joints and bones. Infections and heart failure can also occur.
The disease occurs in just 0.6 percent of the population, usually in African Americans.
This is a group of anemias due to the defects in the genes producing hemoglobin. It is most common in people of Mediterranean descent. There are two major forms: thalassemia minor and thalassemia major.

As its name implies, thalassemia minor is mild and those suffering from this condition go on to live a full life. Treatment is often unnecessary. Thalassemia major can be serious, but it is very rare. Transfusions or bone marrow transplants are usually required. Thalassemia major is also called Cooley's anemia, named after the doctor who first described it in 1925.
Aplastic Anemia
This is one of the deadliest and most rare forms of anemia. Only two to six people per million have this type of anemia. The condition results from an unexplained failure of the bone marrow to produce all types of blood cells. Instead, fat cells replace bone marrow.
Aplastic anemia is usually found in adolescents and young adults. Symptoms can include bleeding in the mucous membranes. Chemicals such as benzene and certain pesticides can also cause this type of anemia.

Favism, G6PD Deficiency, Fava Beans and Legumes

What is Favism?

Favism describes the susceptibility to, and clinical presentation of, acute haemolytic crises as a consequence of eating broad beans in a subgroup of patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. It can be potentially life-threatening. Broad beans are derived from the plant Vicia fava, hence the condition's name. Susceptible patients may also experience the syndrome when exposed to the plant's pollen.

Favism is associated with some severe variants of G6PD Deficiency. It is called favism because the consumption of broad beans, sometimes called fava beans, causes. oxidative stress and hemolytic anemia In some cases eating any legume causes some degree of hemolysis.
The exact relationship between Favism and G6PD Deficiency is not known. Broad Beans (Fava Beans) contain vicine, divicine, convicine and isouramil, all of which are oxidants.

The condition had been thought to occur only in the Mediterranean variety of G6PD deficiency. However, there have been reports of the condition affecting children in Hong Kong, Thailand and Iran. This reflects common ancestry among populations in different parts of the world due to migration as well as the large number of genetic polymorphisms that constitute the variable alleles causing G6PD deficiency.

G6PD is crucial in maintaining red cell homeostasis and its deficiency leads to increased susceptibility to haemolysis induced by drugs, infections and substances in food. There are a huge number of polymorphisms of the gene with variable effects on the activity of the enzyme and a wide range of phenotypic susceptibility to haemolysis.

The gene for G6PD is located on the X-chromosome hence it is an X-linked inherited disease that primarily affects men. It can have clinical effects in homozygous women and a proportion of female heterozygous carriers.It is thought that the susceptibility to favism is determined by a combination of the particular G6PD polymorphism (predominantly the Mediterranean form), and by variability in other enzymatic mechanisms, particularly in the metabolism of L-DOPA (found in abundance in broad beans), and vicine, convicine and isouramil (the so-called 'anti-nutritional factors' that are present in broad beans)


· G6PD deficiency is the commonest enzymopathy of man of clinical significance. It is thought to affect more than 400 million people worldwide.
· The highest prevalence of G6PD deficiency is found in tropical Africa, the Middle East, tropical and subtropical Asia, Papua New Guinea and various Mediterranean locations.
· Only a proportion of G6PD sufferers are prone to favism, and this proportion is variable between populations. A study in Sardinia, where there is a high prevalence of G6PD deficiency (7.5% of all males) found 508 cases of favism over a 9-year period. In a Thai study, favism was found in 3.6% of G6PD-deficient children. It therefore appears to be a relatively rare manifestation of a common genetic polymorphism.

· There may be a past history of episodes of neonatal or childhood jaundice.
· A dietary history may reveal recent ingestion of broad beans.
· Check for recent medication changes or history consistent with infection.

Favism leads to acute, massive intravascular haemolysis. Its main clinical features are:

· Acute back and/or abdominal pain
· Acute pallor due to anaemia
· Haemoglobinuria causing the passage of dark or orangey-yellow urine
· Jaundice
· Patients with G6PD deficiency are prone to gallstones and splenomegaly due to recurrent, often subclinical, episodes of haemolysis.
Differential diagnosis

· Acute haemolysis caused by an alternative precipitant in G6PD sufferer (e.g. drugs – particularly antimalarials' infection)
· Sickle cell anaemia and crisis
· Exacerbation of other haemolytic anaemias, e.g. hereditary spherocytosis, autoimmune haemolytic anaemia
Disseminated intravascular coagulation
Systemic lupus erythematosus

· Dipstick urine to reveal evidence of haemoglobinuria.
· FBC will show acute haemolytic anaemia picture with low haemoglobin.
· Reticulocyte count may be elevated (although often normal in early acute phase).
· Raised indirect bilirubin (unconjugated) indicating haemolysis.
· LFTs usually normal.
· Serum lactate dehydrogenase may be elevated, indicating haemolysis.
· Serum haptoglobins may be low, indicating haemolysis.
· Abdominal ultrasound may be used to detect gallstones and/or splenomegaly.
· Coombs' test is negative.
· G6PD activity assay in undiagnosed cases – may be normal if there is significant reticulocytosis as reticulocytes are rich in the enzyme; assay may need to be repeated in convalescent phase.

Associated diseases

· Glucose-6-phosphate dehydrogenase deficiency
· Gallstones due to chronic haemolysis
· Splenomegaly due to chronic haemolysis.


· Avoid further ingestion of broad beans
· Folic acid supplementation
· Iron supplementation if ongoing acute severe intravascular haemolysis
· Oxygen therapy
· Bed rest and transfer to a high care/intensive care setting
· Intravenous fluids to reduce chance of acute oliguric renal impairment
· Blood transfusion or exchange transfusion sometimes needed to treat severe anaemia

· Death due to acute severe haemolytic anaemia (relatively rare)
· Ophthalmological damage due to intra-ocular intravascular haemolysis
· Acute renal failure
· Susceptibility to infection


This is variable depending on the degree of susceptibility to favism, quantity of beans ingested and access to acute medical care. Most cases do well with supportive care but there is significant morbidity and some mortality associated with the disease.


· Avoidance of ingestion of broad beans in patients known to be G6PD deficient, or who have suffered previous episodes of favism.
· Genetic counselling and screening may be useful where there is a family history of G6PD deficiency, to allow diagnosis before exposure to haemolytic precipitants.
· Population screening and health education programs in areas of high prevalence of G6PD deficiency have been shown to reduce the incidence of favism in the at-risk population.

Herbs to treat G6PD Deficiency anemia
Chinese herbal doctors have reported some successful applications of using herbal combinations. During observation on patients receiving treatment with herbal remedy, all patients were judged as healing (full recovery and symptom free).

The most powerful feature of Traditional Chinese Medicine is that it allows you to easily combine multiple ingredients to form a recipe to suit the specific need of individual. The list below are to give you an idea of why you can get the herbal remedy best for you.

When you choose a herbal remedy there are two important things among your concerns: a good recipe and a correct way to cook it. A good recipe is half the good results.

Some Herbs are good for G6PD Deficiency anemia

Rhizoma Ligustici Chuanxiong
Radix Salviae Miltiorrhizae
Radix Angelicae Sinensis
Radix Codonopsis Pilosulae
How Is Anemia Diagnosed?
Anemia can be detected by a simple blood test. Most causes can be diagnosed by analysis of blood samples and by examination of the blood cells under a microscope.
A complete blood count test is always performed. The red blood cells and their iron-bearing protein, hemoglobin, are measured. The percentage of red blood cells in the blood is called a hematocrit.

A blood smear will determine the size, shape, and color of the blood cells. The shape of the red blood cells can be distorted in many blood disorders, such as sickle cell anemia.

Normal red blood cells (1) and abnormal sickle shape red blood cells (2)

Iron deficiency anemia is suspected when the red cells are low in number and unusually small. Measuring the amount of iron and its associated proteins in the blood can confirm this diagnosis.
Those with vitamin deficiency anemias have larger-than-normal red blood cells.

In some cases, a bone marrow biopsy may be necessary to confirm a diagnosis. A sample of bone marrow is removed from the back of the pelvic bone or from the breastbone. This sample allows physicians to determine the overall activity of the marrow and whether abnormal cells, such as cancer cells, are interfering with its function.

Other tests that may be needed include chemical examination of the stool for traces of blood, x-rays of the bowel to detect the presence of internal bleeding and examination of the small bowel lining to access its ability to absorb food normally.

How Is Anemia Treated?
The treatment for anemia depends on the type and cause.Iron deficiency anemia is treated with iron (ferrous sulphate) supplements, initially taken three times a day. If nausea, stomach cramps, diarrhea or constipation occur, the medication may be taken with a little bit of food.

Treatment should be continued for three to six months in order for the body to fully replenish its iron supply. As long as excessive bleeding is not present and there are no other complicating factors, the anemia will be corrected within a few weeks. However, if the iron deficiency is caused by blood loss that is not due to menstruation, the source of bleeding must be found and stopped. This may require surgery

ferrous sulphate

Pernicious anemia, or vitamin B-12 deficiency, is treated by a life-long course of intramuscular injections of B-12. Persons with this type of anemia receive a shot of B-12 several times a week when first diagnosed. The treatment may continue for life, with one shot about four times a year.
Folic acid deficiency anemia can be corrected by taking folic acid supplements once a day.

Hereditary hemolytic anemias, such as thalassemia is treated by first eliminating any existing infections and avoiding medications that suppress the body's immune system. These medications may attack red blood cells. In addition, persons with these types of anemia may require regular blood transfusions.

Sickle cell anemia patients may be given oxygen, oral and intravenous fluids and pain-killing drugs to reduce pain and prevent complications. Antibiotics are commonly prescribed as well. Sufferers will need blood transfusions when the anemia becomes severe or if misshapen hemoglobin needs to be replaced. In some cases, a bone marrow transplant may be effective. Adult patients may be treated with the cancer drug hydroxyurea (brand names Droxia, Hydrea).

Sometimes rare aplastic anemias and autoimmune hemolytic anemias will respond to steroids. Failure to respond to steroids may require removal of the spleen which can become enlarged with defective red blood cells. Aplastic anemias may require blood transfusions and medications to fight infections.

Most common symptoms of anemia

Other treatment options may be appropriate based on the cause of the anemia.
For instance, if the bone marrow has failed because of leukemia, intensive chemotherapy may be required. Bone marrow transplantation may be contemplated if a suitable donor exists.
With proper treatment, many types of anemia can be eliminated, especially those caused by iron deficiency and vitamin deficiency.

Good food for anemia

Need To Know:
Most cases of anemia are mild. Without treatment, however, serious problems can occur, since the reduction in red blood cells decreases the ability to absorb oxygen from the lungs.
Certain inherited forms of anemia, including thalassemia major, pernicious anemia, and sickle cell anemia can be life threatening.
You should never self-diagnose yourself with anemia. The symptoms of fatigue and weakness can be the result of many other diseases. If you suspect you have anemia, contact your doctor.

Typical tongue in case of vitamin B12 deficiency anemia

Putting It All Together
Here is a summary of the important facts and information related to anemia.

. Anemia affects about 400 millions around the world and making it the most common blood disorder in the U.S. where 3.5 million American already affected
. Anemia is the result of below-normal levels of hemoglobin in the red blood cells.
. There are many different kinds of anemia ranging from mild and easily treatable iron and, vitamin deficiency anemias to serious, and sometimes life-threatening aplastic and sickle cell anemias.
. Fatigue is the main symptom of most anemias.
. Anemia can be usually be detected with a simple blood test.
. Treatment of anemia is based on the cause of the disorder. Treatments range from folic acid or vitamin supplements in mild cases to bone marrow transplants in severe cases.
. You should never self-diagnose anemia. Symptoms of fatigue and weakness can be the result of many other diseases. If you suspect you have anemia, consult your doctor.

Medical laboratory is the place you can diagnose the anemia