ANEMIA

Common types of anemia and their causes include:

• Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of the element iron in your body. This type of anemia is often caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer, a polyp somewhere in your digestive system, and prolonged use of aspirin or drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs).
• Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production.
• Anemia of chronic disease. Certain chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn’s disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can cause anemia.
• Aplastic anemia. This very rare life-threatening anemia is caused by a decrease in the bone marrow’s ability to produce red blood cells. Causes of aplastic anemia include infections, drugs and autoimmune diseases.
• Anemias associated with bone marrow disease. A variety of diseases, such as leukemia, myelodysplasia or myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete life-threatening shutdown of the blood-making process.
• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction.
• Sickle cell anemia. This inherited and sometimes serious anemia is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.
• Other anemias. There are several other rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.

Anemia symptoms vary depending on the cause of your anemia but may include:

• Fatigue
• Weakness
• Pale skin
• A fast or irregular heartbeat
• Shortness of breath
• Chest pain
• Dizziness
• Cognitive problems
• Cold hands and feet
• Headache

DIAGNOSIS

To diagnose anemia, your doctor will likely ask you about your medical history, perform a physical exam, and order blood tests.

There are basically three different causes of anemia: blood loss, decreased or faulty red blood cell production, or destruction of red blood cells.

Blood tests will not only confirm the diagnosis of anemia, but also help point to the underlying condition. Tests might include:

• Complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of red blood cells
• Blood iron level and your serum ferritin level, the best indicators of your body’s total iron stores
• Levels of vitamin B12 and folate, vitamins necessary for red blood cell production
• Special blood tests to detect rare causes of anemia, such as an immune attack on your red blood cells, red blood cell fragility, and defects of enzymes, hemoglobin, and clotting
• Reticulocyte count, bilirubin, and other blood and urine tests to determine how quickly your blood cells are being made or if you have a hemolytic anemia, where your red blood cells have a shortened life span

RECOMMENDED MEDICATIONS

Anemia treatment depends on the cause.

• Iron deficiency anemia. This form of anemia is treated with changes in your diet and iron supplements.
If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.
• Vitamin deficiency anemias. Folic acid and vitamin C deficiency anemias are treated with dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.
• Anemia of chronic disease. There’s no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.
• Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can’t make healthy blood cells.
• Anemias associated with bone marrow disease. Treatment of these various diseases can include simple medication, chemotherapy or bone marrow transplantation.
• Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells.
Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful.
• Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements and antibiotics.
A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.
• Thalassemia. This anemia may be treated with blood transfusions, folic acid supplements, removal of the spleen (splenectomy), a bone marrow transplant or a another drug.