Saturday, May 3, 2008

Anemia - When Blood count goes low




Anemia is defined as a qualitative or quantitative deficiency of hemoglobin. But what is hemoglobin? It is a molecule inside red blood cells (RBCs).

Red blood cells are the most numerous blood cells in blood, present in males: 4.7 to 6.1 million cells per microliter (cells/mcL) and in females: 4.2 to 5.4 million cells/mcL.

Hemoglobin is a molecule that is in charged of carrying oxygen. As Red blood cells move around the body, oxygen in the hemoglobin molecule will go from the lungs to the tissues. Normal values of hemoglobin vary depending on age and sex:

cord blood  -  13.5-20.5 Hb g/dL
first day of life  -  15.0-23.5 Hb g/dL
child, 6mths-6yrs  -  11.0-14.5 Hb g/dL
child, 6-14yrs  -  12.0-15.5 Hb g/dL
adult males  -  13.0-17.0 Hb g/dL
adult females  -  12.0-15.5 Hb g/dL
pregnant females  -  11.0-14.0 Hb g/dL

When anemia settles, it leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.

The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).

Anemia is the most common disorder of the blood. The prevalance of anemia in the USA is 3.5 million (NHLBI) or 1.29%. The largest groups of individuals that are part of anemics involve infants, pregnant women and the elderly:

A. 7% of children aged 1-2 had anemia in the US 1999-2000 (MMWR, NCHS, CDC)
B. 12% of women aged 12-49 had anemia in the US 1999-2000 (MMWR, NCHS, CDC)
C. 174,600 nursing home residents had anemia in the US 1999 (National Nursing Home Survey, NCHS, CDC)
D. 10.7% of nursing home residents had anemia in the US 1999 (National Nursing Home Survey, NCHS, CDC)

Broad types of anemia

There are three broad causes of anemia: blood loss, compromised red blood cell production and abnormal rate of red blood cell destruction:

I. Anemia-inducing blood loss can be caused by: childbirth, injury or surgery or by more chronic situations including: gastro-intestinal ulcers (causing black and tarry stools or rectal bleeding) or cancers, hemorrhoids, menstrual bleeding, repetitive nosebleeds or tumors or the kidney or bladder.

II. Compromised red blood cell production can be caused by deficiency of dietary elements including: folic acid, iron, vitimin B12 or vitimin C or other factors such as: arthritis, bone marrow dysfunction, chemo/radio-therapy, chronic disease/infection, leukemia, lymphoma, metastatic cancer, myelodysplasia or myelofibrosis. These factor impair the ability of the bone marrow to produce blood.

III. Abnormal red blood cell destruction can also be caused by a number of conditions, including: autoimmune dysfunction, enlarged spleen, G6PD deficiency, hereditary elliptocytosis, hemoglobin C disease, hemoglobin E disease, hemoglobin S-C disease, hereditary spherocytosis, mechanical damage, paroxysmal nocturnal hemoglobinuria, sickle cell disease or thalassemia. In all these cases the red blood cells along with the hemoglobin have shapes that the spleen and liver recognize as abnormal and foreign. Therefore, the cells are destroyed.

Also, water-weight gain in pregnant women can dilute the blood sufficiently to cause anemia.

Diagnosis

Generally, clinicians request complete blood counts in the first batch of blood tests in the diagnosis of an anemia. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and is sometimes a necessity in regions of the world where automated analysis is less accessible.

There are several other studies that can come after the first test that may include: Vitamin B12, Folate levels, Reticulocite levels, TIBC, Ferritin, etc.

Signs and symptoms

Most of the times when anemia starts and progresses slowly, it may go undetected in many peopl due to its vague and unspecific symptoms. Most commonly, people with anemia report a feeling of weakness or fatigue in general or during exercise, general malaise and sometimes poor concentration. People with more severe anemia often report dyspnea (shortness of breath) on exercise. Very severe anemia prompts the body to compensate by increasing cardiac output, leading to palpitations and sweatiness, and to heart failure.

Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia.

Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced scholastic performance in children of school age. Anemia decreases the capability of individuals who are affected to perform physical activities. The lack of iron associated with anemia can cause many complications, including hypoxemia, brittle or rigid fingernails and cold intolerance.

Treatments for anemia

There are many different treatments for anemia and the treatment depends on severity and the cause of the anemia. Please bear in mind that NOT ALL ANEMIAS WILL RESPOND TO IRON SUPPLEMENTS.

In developed countries, iron deficiency from nutritional causes is rare in non-menstruating adults (men and post-menopausal women). The diagnosis of iron deficiency anemia mandates a search for potential sources of loss such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron deficiency anemia is treated by iron supplementation with ferrous sulfate or ferrous gluconate ( ferrous sulfate type causes more constipation ). Sometimes vitamin C is added to aid in the body's ability to absorb iron.

When another anemia of deficiency starts, vitamin supplements given orally (folic acid) or subcutaneously (vitamin b-12) will replace them.

In anemia of chronic disease, anemia associated with chemotherapy, or anemia associated with renal disease, some clinicians prescribe recombinant erythropoietin, epoetin alfa, to stimulate red cell production.

In severe cases of anemia, or with ongoing blood loss, a blood transfusion may be necessary. In severe, acute bleeding, transfusions of donated blood are often lifesaving. Improvements in battlefield casualty survival is attributable, at least in part, to the recent improvements in blood banking and transfusion techniques.

Transfusion of stable and hospitalized patient has been the subject of numerous clinical trials, and transfusion is emerging as a deleterious intervention as it has repetitively failed to show improvement over conservative non transfusion therapies. these new studies suggest that the threshold for transfusions should be 7 and not 10 g/dl ( Not for patients with know ongoing bleeds, unstable ICU and cardiovascular disease ).

Alternative Medicine

First let's make some common sense recommendations: Do not drink coffee, tea, beer or cola with meals as these inhibits the absorption of iron. Instead, drink citrus juices, that are rich in Vitamin C and assists in the absorption of iron. Avoid excessive consumption of alcohol. If you are a strict vegetarian, watch your diet very closely.

Quit tobacco.

Minimize your exposure to lead and other toxic metals such as aluminum, cadmium and mercury.

On the food and diet section, cosider adding the following to your diet:

1. Chive - This vegetable is rich in vitamin C and iron - eat fresh chives.
2. Quinoa - This is a grain rich in all eight essential amino acids that form a complete protein.
3. Gentian - The bitter herb gentian is popular in England for the treatment of anemia. Gentian can be brewed into a tea or you can take a commercially available extract.
4. Dandelion is also believed to help people with anemia. It is very rich in vitamins and minerals.
5. Green leafy veggetables that will provide with iron.
6. Beef,root vegetables, warm foods and soup are the traditional ( folk ) way of treating anemia.

Other herbs that are of interest to those suffering from anemia include alfalfa, bilberry, burdock root, cherry, goldenseal, grape skins, hawthorn berry, horsetail, mullein, parsley, nettle, pau d'arco, red raspberry, shepherd's purse, watercress, and yellow dock root.

For homeopathic treatments, please visit: http://www.hpathy.com/diseases/anemia-symptoms-treatment-cure.asp

Chinese Medicine has several herbs that work by nourishing blood and help circulating it. These include: Dong quai root,Millettia root & vine, Sichuan lovage rhizome, White atractylodes rhizome, Red jujube fruit, gingseng, etc. Acupucnture and acupressure can also help equilibrate the body, thus improving the functions of the organs that form blood, store it and circulate it.




Acupuncture and Anemia



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