Anemia is a condition in which the body lacks enough healthy red blood cells to carry the required amount of oxygen to the body’s tissue and organs. Anemia leads to the patient feeling weak and tired.

The role of the red blood cells is to carry oxygen from the lungs to the body’s organs and tissues and transport carbon dioxide from the body’s organs and tissues to the lungs to be exhaled. They contain hemoglobin, which is an iron-rich protein that gives the red cells their color and helps with the transportation of oxygen.

Majority of the blood cells are produced in the bone marrow, and to produce the red cells and hemoglobin, the body needs vitamin B-12, iron, folate, and other nutrients.

The levels of healthy red blood cells can be low due to a number of reasons, such as:

• Lack of enough hemoglobin in the body
• The produced hemoglobin does not work correctly
• The red blood cells are broken down too quickly
• The body fails to make enough red blood cells

Causes of Anemia

Causes of anemia depend on the type of anemia a patient has but the major cause is lack of enough red blood cells in the body. The causes can be divided into two; factors that decrease red blood cell production and factors that increase red blood cells destruction.

Factors that decrease red blood cell production include:

• Inadequate dietary intake of vitamin B-12, iron, or folate
• Hypothyroidism
• Inadequate stimulation of the production of red blood cells by the erythropoietin hormone which is produced in the kidneys

Hemorrhaging is the major factor that causes the increase of red blood cells destruction and it can be due to:

• Genetic disorders such as sickle cell anemia, thalassemia, or glucose-6 phosphate dehydrogenase (G6PD) deficiency
• Endometriosis
• Childbirth
• Menstruation
• Trauma
• Surgery
• Excessive uterine bleeding
• Cirrhosis
• Gastrointestinal lesions
• Fibrosis within the bone marrow
• Hemolysis
• Disorders of the spleen and liver

Types of Anemia

Aplastic Anemia

This condition occurs when the immune system attacks the stem cells in the bone marrow which is where the red and white cells together with the platelets are produced. The stem cells produce the blood cells. This results in the bone marrow containing a few red cells – hypoplastic – or empty – aplastic.

Other factors that can cause injury to the bone marrow and slow down blood cell production include viral infection, use of certain drugs, exposure to toxic chemicals, autoimmune disorders, chemotherapy and radiation treatment, pregnancy, and other unknown factors.

Aplastic anemia can be mild to severe and can occur suddenly or slowly and worsen over time.

Sickle Cell Anemia

Sickle cell anemia belongs to a group of conditions known as sickle cell disease. It is a genetic red blood cell disorder that is caused by a gene mutation in the body. The mutated gene causes abnormal hemoglobin which leads the red blood cells to be rigid, sticky, and misshapen. These abnormal cells can get stuck in the small blood vessels slowing or blocking the blood flow therefore preventing oxygen from reaching the body’s tissues and organs.

Iron Deficiency Anemia

This type of anemia is caused by insufficient iron in the body leading to less production of hemoglobin in the body. This results in less oxygen being carried to the body tissues and organs. Factors that can lead to iron deficiency anemia include lack of iron in the diet, blood loss, pregnancy, and inability to absorb iron.

Thalassemia

This type of anemia is a genetic disorder that causes the body to have less hemoglobin than normal. It is caused by DNA mutations of cells that produce hemoglobin leading to less oxygen being carried around the body.

Vitamin Deficiency Anemia

Vitamin deficiency anemia occurs due to lack of healthy red blood cells resulting from inadequate amounts of certain vitamins. These vitamins include vitamin B-12, vitamin C, and folate. It is cause by not eating enough foods containing these vitamins and or if the body has trouble absorbing or processing them.

Symptoms of Anemia

Individuals who suffer from anemia often complain of being tired, in pain, and feeling cold. They may also present the following symptoms:

• Constipation
• Unusual cravings such as wanting to eating dirt, ice, or clay
• Dizziness
• Trouble concentrating
• Inflammation of the tongue
• Shortness of breath
• Brittle nails
• Chest pains

Risk Factors

Factors that can increase the risk of anemia include:

• Genetics
• Age, those above the age of 65 are at a greater risk of developing anemia
• Pregnancy: Pregnant women who are not taking iron or multivitamins with folic acid are at an increased risk of anemia
• Menstruation as it can cause loss of red blood cells
• Chronic conditions such as kidney failure, cancer, and diabetes can lead to a shortage of red blood cells and this can result in anemia
• Intestinal disorders that affect the absorption of nutrients in the small intestine puts an individual at risk of anemia
• A diet lacking in certain minerals and vitamins such as vitamin B-12 and iron increases the risk of anemia

Diagnosis of Anemia

Diagnosing anemia involves a physical exam, your health history, and your family’s health history. Your physician will ask you if you’ve been exposed to toxic agents and will perform some tests on you such as:

• Complete blood count (CBC): This shows the size and number of the red blood cells in the body. It also shows the levels of the other blood cells and platelets
• Folic acid test to show the level of the folic acid in the body
• Serum iron levels test to determine if the cause of anemia is iron deficiency
• Ferritin test to analyze iron stores
• School test for occult blood: This test involves putting a certain type of chemical on the patient’s stool to see if there are traces of blood in it. If it’s positive it means that blood is being lost somewhere along the gastrointestinal tract.
• Chest x-ray
• Upper GI
• Barium enema
• CT scan for the abdomen

Treatment of Anemia

Treatment for anemia usually depends on its cause and it can include:

• Oral iron supplements
• Iron given through IV
• Change of diet to include foods high in iron and which help the body to absorb iron
• Red blood cells transfusions
• Erythropoietin injection
• Surgery
• Bone marrow transplant

Anemia can lead to cancer and it is important to seek medical attention once you suspect that you have it.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service. From initial consultation through to final diagnosis, treatment and beyond. Our multidisciplinary team of expert doctors and nurses, and technologists led by Dr Hassan Ghazal – an American triple board-certified Consultant Medical Oncologist and a Consultant Clinical Hematologist with more than 3 decades of clinical experience, are here to offer tailored management and treatment of your condition, and to answer any questions that you may have throughout your time with us. Whatever you need us for, we’re only a phone-call away.