Anemia

If you’re pale and feel weak and tired, you may be suffering from anemia, a condition related to a lack of red blood cells. Whether caused by an iron deficiency or other factors, anemia can be controlled. Find out how.

What is anemia?

Anemia refers to a decrease in the number of red blood cells or the amount of hemoglobin in the blood. In fact, red blood cells contain hemoglobin, an iron-rich protein that carries oxygen from the lungs to the organs so that they can function properly. A decrease in hemoglobin therefore decreases oxygen to the organs and prevents them from carrying out their jobs. Anemia can be  the result of a large number of health problems.

What causes anemia?

Anemia can be caused by the decreased production or a significant loss of red blood cells (among other reasons) due to:

• Dietary deficiencies (e.g., a lack of iron, folic acid or vitamin B12).
• A hereditary disorder.
• Certain chronic diseases (e.g., kidney failure, Crohn's disease).
• A bone marrow disorder.
• A hormonal deficiency (e.g., hypothyroidism).
• Significant blood loss (e.g., hemorrhage).
• Pregnancy (due to increased vitamin needs).

To diagnose the cause of your anemia, your doctor will ask you about your symptoms, when they started, and how severe they are. Your doctor will also go over your medical and family history, whether you have any known health problems, and whether you’re taking any medication. Your doctor will also no doubt conduct a full exam with lab tests (blood tests).

Main types of anemia

There are many types of anemia:

• Iron deficiency anemia. This is the most common type of anemia and is caused by an iron deficiency. Some of the most common causes of this anemia are a poor diet and poor iron absorption (e.g., due to a bowel resection or an inflammatory bowel disease like Crohn's disease). Gastrointestinal disorders that cause blood loss, such as ulcers or heavy menstruation, can also be a cause.
• Megaloblastic anemia. This type of anemia is due to a deficiency in folic acid or vitamin B12. A poor diet and poor vitamin absorption (e.g., due to a bowel resection or an inflammatory bowel disease like Crohn's disease) can be responsible for this type of anemia. Alcohol abuse can impede absorption of folic acid, and certain drugs such as pantoprazole (Pantoloc^TM) and metformin (Glucophage^TM) can interfere with vitamin B12 absorption.
• Anemia of chronic disease . A number of chronic diseases such as cancer, Crohn's disease, rheumatoid arthritis or hepatitis (and sometimes their treatment) can limit the production of red blood cells and cause anemia.
• Anemia due to excessive bleeding . This type of anemia is caused by a sudden and significant loss of blood (e.g., from an accident, surgery, childbirth) or bleeding that is less significant but persistent over time (e.g., gastric ulcer or colorectal cancer).

Anemia symptoms

A decrease in the amount of oxygen in the blood and an additional strain on the heart to compensate for the lack of oxygen are the main causes of anemia symptoms. Depending on the severity, speed of onset, and cause of the anemia, symptoms may vary and can include:

• weakness
• fatigue
• vertigo and dizziness
• paleness
• headache
• problems concentrating
• shortness of breath
• increased heart rate that may cause palpitations

If you have mild anemia, you may have few or no symptoms, particularly if you’re young and generally in good health.

Anemia treatment

Treatment depends on what is causing the anemia. Generally, the disorder improves or disappears when the cause is eliminated. This will mean correcting a food deficiency, stopping a drug, or treating the disease or infection that may be causing the condition. Talk to your pharmacist or doctor before stopping any medication.

If you have a vitamin deficiency, the recommendation will be to increase the amount of this vitamin in your diet. For mild anemia, a modification to your diet may be the only recommendation.

Foods that are good sources of iron	Foods that are good sources of vitamin B12	Foods that are good sources of folic acid
red meat and giblets clams and oysters eggs tofu and legumes (e.g., kidney beans and chick peas) green vegetables (e.g., spinach and asparagus) whole-grain breads and cereals	giblets meat and poultry fish and seafood (e.g., clams and oysters) eggs dairy products (e.g., milk, cheese and yogurt)	giblets legumes (e.g., beans, soybeans and lentils) green vegetables (e.g., spinach, asparagus and Brussels sprouts) orange juice nuts and seeds (almonds, flax seeds and sunflower seeds)

If your blood tests show low levels of vitamin B12, folic acid or iron, your doctor may also prescribe vitamin supplements to correct your deficiency and help you replenish your reserves. You need to take these supplements regularly for the prescribed duration and have your ordered blood tests done to make sure your treatment is effective.

For example, iron supplements are available in the form of tablets, capsules or liquids. Be careful with liquid iron, which can stain your teeth. You should therefore mix it in a small glass of juice or water, drink it with a straw, and then drink something else after. Most iron supplements must be taken on an empty stomach to increase their effectiveness. You can also take them with a glass of orange juice, as vitamin C increases their absorption. Iron supplements can turn your stool black and cause constipation. You will need to increase the amount of water and fibre in your diet, unless contraindicated.

Unlike iron supplements, vitamin B12 and folic acid supplements cause few to no side effects.

You may need to get vitamin injections, for example, if you aren’t absorbing oral supplements well. You may also need blood transfusions depending on the severity of your anemia and your symptoms. 

For anemia in which the bone marrow can’t produce enough red blood cells, you may need to take a medication that acts like erythropoietin (Eprex™, Aranesp™). Erythropoietin is a natural hormone produced mainly by the kidneys that contributes to the production of red blood cells in the bone marrow. These medications are used to treat chronic renal failure when the amount of erythropoietin produced by the body is insufficient.

If you suffer from anemia, you will need to rest until your condition goes away or is controlled. Don’t hesitate to talk to your pharmacist, who is here to answer your questions.