The first thing you notice when you have anemia is fatigue accompanied by loss of muscle strength. In other words, everyday tasks require more effort and it is much more difficult to climb stairs or make small efforts than before. In a word, one is not at 100% of one’s physical potential.
In general, we do not usually give too much importance to the fact that we are tired, and therefore we do not report it to our family doctor until after a period of time (generally more than three months) when the symptoms do not disappear or increase. Therefore, an important aspect to take into account in all anemia is that it usually results in long-lasting or progressive fatigue, except in those cases in which the patient adapts very well to anemia.
Can anemia be accompanied by other diseases?
Anemia is not a disease, but the symptom or clinical manifestation of a disease. It is like fever, and, therefore, anemia may be the first sign of a disease whose importance depends on its cause. The study of anemia is part of hematology and may be a simple iron deficiency or a more serious disorder that must be investigated and correctly diagnosed. In some diseases, anemia is an inherent part of their pathology such as, for example, anemias of genetic or hereditary origin (rare anemias) while in others it is an accompanying phenomenon (secondary anemias).
Unfortunately, there is a false belief that all anemia is due to a poor diet or a lack of iron, and iron tablets are often prescribed before a diagnosis is made in the hope of seeing their effect. In view of this unethical attitude, it must be said that, although in 90% of cases anemia is due to a lack of iron (iron deficiency anemia), there are many other causes in which the administration of iron can be highly harmful (iron overload).
What other causes can indicate anemia in the body?
The most important, because of their frequency, are hemorrhages or blood loss. Iron, which forms a structural part of hemoglobin, the red pigment that gives color to red blood cells (see photograph), is lost when blood, i.e. hemoglobin, is lost. Hemorrhages can be external and very visible, easy to diagnose, or internal by losses of small amounts of blood over long periods of time, which go unnoticed but leave the body’s iron deposits exhausted. Internal causes, generally clinically imperceptible, include gastric ulcer, aspirin intake, intestinal polyps and colon cancer, among other more or less serious forms of expression.
In clinical practice, the most frequent cause of iron deficiency anemia is menstruation, typical of young or pre-menopausal women, where it is very important to accurately assess the level of iron deposits in the body in order to administer the amount of iron needed in each case to restore the deposits adequately. This administration of iron should not be interrupted until the deposits are completely replenished, for which it is essential to follow the hematologist’s guidelines. In general, treatment of severe iron deficiency anemia usually requires 2 to 3 months.
How should anemia be treated?
In the case of anemia, treatment should be directed towards the cause of the anemia, i.e., the underlying disease or situation. For this, the first thing to do is to make a correct diagnosis and, if the anemia is due to a lack of iron, a pharmacological preparation with a high iron content should be administered, whenever possible orally, and, if it is due to another cause, first establish the diagnosis and do not administer iron until a lack of iron is demonstrated by the pertinent analyses. The correct approach to iron deficiency is to diagnose and treat the underlying disease that causes it.
Is it true that some foods can help in cases of anemia?
In a certain way yes, from a scientific point of view. The problem is that very little iron is absorbed through food because iron, in excess (iron overload), is highly toxic and can damage vital tissues such as the heart, pancreas, liver and others. Therefore, the body has a protective system against iron overload that drastically limits its absorption. Thus, a normal diet absorbs about 1.5 mg/day of iron, which is sufficient to supply the daily formation of red blood cells, but has little margin against an increase in iron loss (chronic hemorrhage), an excess of consumption (growing children and young people) or a defect in absorption (celiac disease or aging). Thanks to this physiological brake on iron absorption, which involves a very important protein called hepcidin, its overload and thus its possible oxidizing and lethal effect on the various tissues of the body mentioned above is avoided. There is a hereditary disease, with loss of control of iron absorption, called hemochromatosis, in which iron, in excess, accumulates in the deposits, but also in many other tissues of the organism and can even cause the death of the patient, if it is not diagnosed in time.
On the other hand, it should be mentioned that when we speak of normal diet, two types of food are included: vegetable and animal. Vegetable foods, although they may contain a lot of iron, as is the case of legumes, this is absorbed very little and most of it is eliminated through the feces. In animal foods, i.e. meat, iron forms a structural part of hemoglobin within the group called “heme” which, as if it were a pill, is absorbed very quickly and much better than in plant foods. That is why eating meat provides more iron than eating vegetables because its degree of absorption is greater than any other type of food. However, in the face of a real lack of iron, the ingestion of meat can never replace the administration of a pharmacological iron preparation, that is to say, the patient will never be cured by eating meat.
Are patients who have already suffered from anemia more likely to suffer from it again?
It all depends on the cause of the anemia. For example, in the case of iron deficiency anemia due to menstruation (young women) and recovered with the administration of iron, it reappears when the administration of iron ceases, since the monthly loss of iron persists. This is what happens in young women with poorly controlled iron deficiency and where it is common to hear the patient say that she has been anemic “forever”. In this case, with a correct administration of iron and its periodic control by the hematologist, the anemia disappears and the patient shows a favorable turnaround in her quality of life.
When the anemia is not due to a lack of iron, it will not be cured until the cause disappears. Finding out this cause is often a long and costly process that requires extensive knowledge of internal medicine. It has therefore been said that, in some cases, the diagnosis of anemia is a real clinical challenge.
The way hematologists diagnose and manage the treatment of anemia is not based on whether the patient is more or less tired, but by requesting a series of laboratory tests, including blood hemoglobin concentration (Hb), red blood cell size or mean corpuscular volume (MCV) and reticulocyte count.
The World Health Organization (WHO) has defined the existence or not of anemia on the basis of Hb. Thus, a woman is anemic when her Hb is less than 120 g/l, a man when his Hb is less than 130 g/l, and a child, when his Hb is less than 110g/l. Nowadays, to express hemoglobin concentration we no longer use the classic “percentages” (%) and we only speak of Hb concentration per liter of blood (l). The MCV is as important as the Hb concentration because it is used to classify anemia into three types:
- Microcytic (MCV
- Macrocytic (MCV> 98fl).
- Normocytic (MCV between 82 and 98 fl).
Microcytic anemias are generally due to a lack of iron (iron deficiency anemias) and macrocytic anemias to a lack of vitamin B12 (megaloblastic anemias). When the MCV is normal (normocytic anemias) it is more difficult to make a diagnostic orientation and should always be complemented with a reticulocyte count, which allows us to know the degree of response of the bone marrow (the blood factory) to anemia. If the reticulocyte concentration is high (reticulocytosis) the anemia is generally due to a destruction of red blood cells in the blood (hemolytic anemia) and, if it is low, the anemia is due to an inability of the bone marrow to produce red blood cells (dyserythropoietic anemia or bone marrow aplasia).
Ultimately, however, it is the hemoglobin concentration that allows the hematologist to monitor the course of anemia once the diagnosis has been made.