Types of anemia

>> Saturday, August 6, 2022


Victor Romulo Gallardo Dumaguing, MD

A person does not have to race or run a mile to have easy fatigability; or she does not have to see a ghost or be surprised by her mother-in-law for her face to turn paper-white, if the person is anemic.
    As strongly emphasized in the previous article, a person with low blood pressure-lower than 90/60 mmHg-is NOT anemic. From a clinical perspective, the symptoms or complaints of the anemic patient- he/she gets tired easily, dizziness, palpitations, chest pains; and the signs or the findings of the examining physician- pallor or paleness of the conjunctiva of the eyes, lips, nail beds, little or no creases on the palms, tachycardia/fast heart rate, tachypnea/fast shallow breathing; are due to LOW HEMOGLOBIN which is the pigment which imparts the red color to erythrocytes or red blood cells. 
    Hemoglobin is the carrier of Oxygen to the different cells of the body; a variant, myoglobin transports O2 to the muscles , particularly skeletal muscles-muscles attached to bones- Hemoglobin is composed of a protein globin and a heme, which is mostly iron and with some copper elements.
    IRON-DEFICIENCY ANEMIA is the most common type of anemia; primary if there is a nutritional deficiency of its rich-sources; examples are leaves and fruits of bitter gourd/ampalaya and livers especially chickens’ Secondary iron-deficiency occurs in persons with bleeding issues like peptic ulcer, hemorrhoids, profuse and excessive frequent menstrual  flow-metrorrhagia/menorrhagia; cancers especially of the colon. In children and adolescents, helminthiasis or parasitic infestation is a common cause of iron-deficiency particularly Hookworms. Necator americanus and Ancylostoma duodenale are two species of worms which suck blood in the small intestines of patients.
    Recommended daily allowance for elemental iron for adults is 55-65 mg per day, with a higher dose for pregnant women and lactating mothers. Popular iron supplements are ferrous sulfate and ferrous fumarate, which could be potentially irritating to the stomach, thus the tablets/capsules should be taken after meals.
MEGALOBLASTIC ANEMIA is due to a structural abnormality of the red blood cells, which in its normal adult configuration should look like a dumbbell or biconcave disc with 7.2 microns in size. Like all cellular components of the blood- platelets/thrombocytes, white blood cells/leukocytes, red blood cells/erythrocytes start their growth process within the bone marrow of flat bones-pelvis, ribs, breast bone/strernum
    The fundamental defect in megaloblastic anemia is “ an arrest in the growth, maturation of red blood cell” so that big round red blood cells called NORMOBLASTare released into the blood stream, which in fairness, can carry already oxygen because it has already hemoglobin in its cell membrane. However, because of its huge humongous size, as the blood passes through the sinuses of the spleen-so-called the graveyard of red blood cells- the frictional forces exerted on its outer membranes lead to is easy hemolysis/breakage earlier than the usual 120 days normal life span of healthy adult red blood cells.
    Folic acid or vitamin B9 deficiency is a cause of megaloblastic anemia. Folic acid, together with iodine and iron, is one of the important nutrients, strictly and highly recommended in the diet of pregnant women in their first trimester to prevent neurologic structural abnormalities in the brain and spinal cord of the baby. Also called pteroyl glutamic acid, folic acid or folinic acid richest sources are related to its name-foliage- yes indeed, green leafy veggies, which we have in abundance in the Cordilleras.
    PERNICIOUS ANEMIA is similar to megaloblastic anemia in terms of the release of large round red cells called NORMOBLAST info the peripheral circulation or bloodstream, in other words, there is an arrest in the maturation of red blood cell into its adult form, which is also due to deficiency of vitamin B12. Cobalamin which comes in hydroxy,nitrito, cyano forms is the biggest vitamin which is derived only from animal sources, an important fact emphasized among strict vegans-those whose source of proteins are just vegetables or plant-based nutrients. Pernicious anemia is more serious than megaloblastic anemia because of neurologic signs and symptoms traced to abnormalities of spinal cord functions especially in the transmission of sensory impulses to the brain.
    Other forms of anemia are sickle cell anemia common among folks of subSaharan Africans and hemolytic anemia seen among patients belonging to the yellow race, a form of hypersensitivity to some medicines like anti-malarials and sulfonamides.
    It is the modest and sincere hope of the columnist that when our readers have their blood pressure taken, they now know how different anemia is from low blood pressure.
Next Week: What Foods Women Should Eat for Healthy Heart


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