Anemia

SUPPLEMENTAL KNOWLEDGE
Jhunie B. Wahayna

If you feel- tired, fatigue easily, appear pale, develop palpitations (feeling of heart racing), become short of breath, hair loss, malaise (general sense of feeling unwell), and worsening of heart problems. You might be experiencing anemia.

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used.

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow. Anemia is caused essentially through two basic pathways. Anemia is either caused by a decrease in production of red blood cell or hemoglobin, or by a loss or destruction of blood.

As more common classifications of anemia (low hemoglobin) is based on the MCV (mean corpuscular volume), or the volume of individual red blood cells. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume). If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume). If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as what may be the most common reason for anemia.
Some patients with anemia have no symptoms. Others with anemia may feel- tired, fatigue easily, appear pale, develop palpitations (feeling of heart racing), and become short of breath. Additional symptoms may include- hair loss, malaise (general sense of feeling unwell), and worsening of heart problems.

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Anemia is usually detected or at least confirmed by a complete blood cell (CBC) count. CBC test may be ordered by a physician as a part of routine general check-up and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

A CBC is a test for counting and examining the different types of cells in the blood. Traditionally, CBC analysis was performed by a physician or a laboratory technician by viewing a glass slide prepared from a blood sample under a microscope. Today, much of this work is often automated and done by machines. Six component measurements make up a CBC test: the Red Blood Cell (RBC) count, Hematocrit, Hemoglobin, White Blood Cell (WBC) count, Differential blood count (the "diff"), and Platelet count.

Only the first three of these tests: the red blood cell (RBC) count, the hematocrit, and the hemoglobin, are relevant to the diagnosis of anemia. Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which basically measures the average volume of red blood cells in a blood sample. This is important in distinguishing the causes of anemia. Units of MCV are reported in femtoliters, a fraction of one millionth of a liter. Other useful clues to causes of anemia that are reported in a CBC are the size, shape, and color of red blood cells.

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.

The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body.

The hematocrit is specifically a measure of how much of the blood is made of red cells. The hematocrit is a very convenient way to determine whether the red blood cell count is too high, too low, or normal. The hematocrit is a measure of the proportion of blood that is composed of the red blood cells. The RBCs in the sample of blood are packed down by spinning the tube in a centrifuge under prescribed conditions. The proportion of the tube that consists of RBCs is then measured. Let's say that it is 45%. The hematocrit is 45.

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.

Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.

In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.

If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor. As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If hemoglobin level is too low, this process may be impaired, resulting in body having low oxygen level (hypoxia).

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health condition of the patient.