Tuesday, December 13, 2011

Address Anemia Now


  Generally and simply put, anemia is a condition in which the person discussed has insufficient circulating healthy red blood cells with which to carry oxygenated blood to all organs and all cells.  Of course, this disorder is a continuum, and is multifactorial.   Some cases might be relatively mild and fairly easily resolved while others are chronic and much more resistant to treatment or to resolution. Make no mistake though, anemia is a co-factor in deaths for a number of other disorders, and it's much more common than is realized. People with anemia lack the stamina they need in a survival situation. They may be short of breath on exertion. They may be more fatigued than normal. If they have fair skin, they may present with pallor, but in darker skinned individuals, this may be missed.They may not think as clearly as they should in an emergency.
       The anemia that most of us are most comfortable thinking about is the type women get, which is simply from menstrual losses. Women need 18 mg. of iron daily when they are of menstrual age, and even more when they are pregnant or lactating. This can be hard to do dietarily alone, and so a good prenatal vitamin is a good idea when planning a pregnancy, pregnant or when lactating.  When anemia occurs for this population of women, it is usually relatively easily corrected and it is due to a deficiency disorder.  Still, it is very important to address this.
        Sometimes people become anemic because they have a deficiency disorder of another type. Vitamin B-12 deficiency, folic acid deficiency, and even Vitamin C deficiency impede the absorption of iron and can lead to anemia. Some people do not absorb these vitamins as well as they should, and as a result, don't absorb iron adequately, when when they do ingest what would normally be an adequate amount. Sometimes, their physician must readjust not only their vitamins, but their iron dose upwards as well.
         People who use proton pump inhibitors, like omeprazole for legitimate gastro-esophageal reflux disease, can also develop some serious anemias. Iron depends upon an acid rich environment within the stomach in order for absorption to occur. When these drugs are ordered longer term, bloodwork should be checked periodically to look for anemia. Very few physicians seem to know this, but in clinic, I have seen this a fair bit. If you must take these medications in the longer term, ask your physician to check a hemoglobin and hematocrit periodically.
         People who take certain medications, such as aspirin, NSAIDs, like ibuprofen, and some other drugs for example, may lose small amounts of gastrointestinal blood, and small amounts add up over time, and may lead to anemia.
         Some patients with ulcerative colitis or Crohn's disease have chronic anemia for multiple reasons. They find it difficult to ingest sufficient iron rich food because they have adjusted their diets in some manner. They also may be bleeding periodically from their gastrointestinal tracts losing RBCs (red blood cells) AND they have impeded absorption abilities from a gastrointestinal tract which is experiencing a disease process.  They may also have difficulties because ANYONE with a chronic inflammatory disorder of any type may well have difficulties making adequate RBCs on the marrow level.
           My last comment was designed to help you appreciate that ANYONE with any inflammatory disorder may have difficulty manufacturing RBCs and may develop anemia. This would include people in the Lupus continuum, those with rheumatoid arthritis, and even those with autoimmune thyroiditis, as in Hashimoto's thyroiditis.  Those with hypothyroidism may also have difficulty keeping up with RBC production.   Some patients, especially those with a known inflammatory disorder may also destroy more RBCs than they should, faster than a healthy body would normally recycle them. People with cancer or kidney disease may also be anemic, sometimes from the necessary treatment to both of those disorders.
            Some older patients may experience a dminished ability to manufacture RBCs even with an excellent diet.
            These are some of the causes of general anemia. There are more.  I experienced a severe case of anemia a few years ago when I was bitten on the back of the leg by a brown recluse spider.  The bite itself was mild, and healed well.  I did not equate the fatigue and shortness of breath that followed with a possible longer term reaction to the bite.  I saw my doctor and was being treated for asthma when it was noticed that I had a severe and critical anemia. At first, my internist thought I might have a bone marrow failure. When he questioned me, I finally remembered the spider bite which had been a couple of months before.  Eventually, they settled on a diagnosis of a hemolytic anemia secondary to a brown recluse bite.  The anemia resolved eventually using a prescription dose of iron, called Repliva.  (Excellent drug, buffered to be well tolerated by many patients.  Anemic patients often report gastrointestinal discomfort of many types, and often don't take kindly to iron replacement.)
              Certain heavy metal poisonings and improperly managed vegetarianism can also result in anemia.
            To review, the causes of anemia are multifactorial. Anemia is an important contributor to death in many disorders. People with heart rhythm disturbances are more likely to die if they also have anemia, for example. Assessment of potential anemia should be ongoing in any patient with a chronic illness, especially those with an autoimmune disorder, not simply those with obvious bleeding.   Alcoholics should also be regularly assessed for anemia as well. Women and particularly mothers are anemia prone.  Children should also be assessed. 
            Many of us are entering a time in which our health care, our finances, and our comfort in general with the world feels less secure than it once did. It would certainly be beneficial to be thinking clearly and dealing with a full complement of red blood cells, without anemia.  Please have this checked now, if anything I have mentioned concerns you.    Most cases of anemia are managed relatively easily once they are diagnosed.  You need not know enough about all anemias to treat them all, but you do need to have an operational knowledge of the potential causations of anemias sufficient to seek treatment prior to a major disaster, as a person interested in preparedness.  Consider the possibility of anemia in yourself and your family members today, and ask your physician for a simple blood test for this, well in advance of a crisis of another kind.


william roy said...

good blog :) here's more info on anemia if required http://www.whatisanemia.info/

JaneofVirginia said...

Thanks for your visit, your commentary and link, William.