Anaemia: what is it and what problems does it cause?
Rather than anaemia, it is correct to speak of anaemia. This condition, characterised by an alteration in the morphology of red blood cells and erythrocyte indices (components of the blood count that provide information about the physical characteristics of red blood cells), takes many forms
The most frequent cause of anaemia is iron deficiency
According to the World Health Organisation, more than 700 million people worldwide do not get enough iron.
However, this is not the only cause.
Anaemia can also be caused by problems in the production of red blood cells, their breakdown, haemorrhage, genetic defects or diseases such as leukaemia and rheumatoid arthritis.
Iron deficiency anaemia is called sideropenia and affects 3% of the adult population in industrialised countries (mainly women, especially pregnant women).
The percentages rise in poorer areas of the world, up to 50% where the diet is excessively poor and intestinal bacteria common.
The most common types
A person suffers from anaemia when they have haemoglobin levels in the blood of less than 12 g/dl for women and 13 g/dl for men, or when the volume of settled red blood cells is below normal.
This condition may be temporary and indicative of a particular phase in a person’s life (menstrual cycle, pregnancy) or chronic.
The patient suffering from anaemia, regardless of the classification of the condition, sees a reduction in the erythrocyte mass and – therefore – the ability to transport oxygen from the blood to the tissues.
The most common forms of anaemia are:
- iron deficiency anaemia
- sickle-cell anaemia
- pernicious anaemia
- haemolytic anaemia
- aplastic anaemia
- Mediterranean anaemia
- Iron deficiency anaemia
Iron-deficiency anaemia occurs when a person does not get enough iron from the diet.
Or when the body does not absorb enough iron or when there is a prolonged loss of it.
Iron is mainly found in meat, liver and offal, yolk and fish.
Vegetarians and vegans, on the other hand, can get it from legumes, dried fruit and dark green leafy vegetables.
If the diet is correct, but malabsorption occurs, this may be due to a condition of chronic diarrhoea, hypochlorhydria (the stomach does not produce sufficient acid secretion), intestinal steatorrhea (the faeces contain unabsorbed fats), or following surgery such as resection of the ileum or part of the stomach.
Finally, prolonged iron loss may occur during the menstrual cycle or in the case of gastrointestinal bleeding: haemorrhoids, haemorrhagic gastritis, ulcers, diverticula, hiatal hernia, Crohn’s disease, ulcerative colitis, colon or stomach cancer. The lungs can also bleed, and so can the kidneys.
It is therefore essential to understand the cause of sideropenia and then act accordingly.
Iron deficiency anaemia is more common during pregnancy and in children.
Sickle cell anaemia
A genetic blood disorder, sickle-cell anaemia is characterised by the ‘sickle’ shape of red blood cells.
This conformation prevents them from passing properly through the blood capillaries, predisposing the patient to ischaemic tissue damage.
The increased weakness of the corpuscles also causes haemolysis.
Sickle cell anaemia cannot be cured, and therapy is aimed at containing its symptoms: analgesics and fluids during painful attacks, transfusions when the anaemia becomes very severe, antibiotics to limit the risk of infection.
It is essential to maintain a correct lifestyle, to avoid red blood cell scythes: regular exercise, little stress, sufficient hydration, diet with the right amount of folic acid.
Only in rare cases does a bone marrow transplantation take place, a complicated procedure also due to the limited availability of donors.
Pernicious anaemia
The patient suffering from pernicious anaemia suffers from vitamin B12 malabsorption: in most cases, abnormal antibodies affect and destroy the parietal cells of the stomach and the gastric mucosa is chronically inflamed (autoimmune atrophic gastritis).
However, pernicious anaemia may also have other causes: surgical resection of the ileum, chronic H.pylori infection, abuse of anti-ulcer drugs, malabsorption syndromes.
Pernicious anaemia is kept under control with intramuscular injections of vitamin B12.
Haemolytic anaemia
Haemolytic anaemia indicates a group of blood disorders that – in common – have the premature destruction of red blood cells:
- haemolytic anaemia from intraglobular causes, if the red blood cells show internal changes;
- haemolytic anaemia due to extra-globular causes, if the destruction of red blood cells depends on external causes.
Treatment depends on the cause that triggers the destruction of the corpuscles, but generally includes the administration of corticosteroids, immunosuppressants, intravenous immunoglobulins, iron, and chelating agents.
In rare cases, more invasive therapies may be required, from transfusions to removal of the spleen.
Aplastic anaemia
A disease of the bone marrow, aplastic anaemia is characterised by the numerical reduction of blood cells.
The sufferer, therefore, does not have enough red blood cells but also not enough white blood cells, platelets and – hence – stem cells.
The causes may be the most diverse
- exposure to chemicals (pesticides, benzene, etc.)
- exposure to ionising radiation
- intake of drugs (tolbutamide, phenylbutazone, chloramphenicol, etc.)
- infections (hepatitis B and hepatitis C viruses, dengue, HIV)
- autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis)
- paroxysmal nocturnal haemoglobinuria
Therapy for aplastic anaemia is aimed at symptom control and recovery of bone marrow function.
Thus, transfusions of haematology and platelet concentrates are carried out, antibiotics are administered in case of infection and immunosuppressants, up to and including bone marrow transplantation.
Mediterranean anaemia
Mediterranean anaemia, or thalassaemia, is caused by a genetic defect that leads to the destruction of red blood cells.
More widespread in Sardinia than in the rest of Italy, it has a typical symptomatology of chronic fatigue and poor growth: low haemoglobin values and poor oxygenation of tissues, organs and muscles are the cause.
Patients suffering from Mediterranean anaemia must undergo frequent blood transfusions.
Regardless of the type one suffers from, there are several typical symptoms:
- paleness
- feeling of fatigue
- weakness
- brittle, spoon-shaped nails (coilonichia)
- frequent headaches or migraines
In more severe cases, it is also possible to experience
- dyspnoea
- fatty degeneration of the liver, heart and kidneys: lipids accumulate in their cells, causing loss of function of the affected cell
- heart failure, if the fatty degeneration of the heart is important
- oliguria and anuria if the anaemia is caused by conspicuous bleeding
Diagnosis and treatment
Anaemia is diagnosed on the basis of the anamnesis and objective test, followed by a laboratory test.
The doctor will prescribe a blood count with leukocyte and platelet formula, red blood cell index and morphology, and a peripheral smear test.
On the basis of the results obtained, he will assess further investigations.
Anaemia, however, is not a diagnosis: it is an indication of an underlying problem, which may be a genetic mutation, a pathological condition or an incorrect lifestyle.
If for anaemia due to genetic causes there is no cure, and therapy is aimed at containing the symptoms, when the cause of the anaemia is a pathology, it is on its resolution that the specialist will work.
The case of sideropenic anaemia is different, which includes a change in one’s lifestyle habits.
If the patient does not take enough iron, he must include in his diet
- egg yolks
- whole shellfish and crustaceans
- meat
- offal
- dark green leafy vegetables
- legumes
- foods high in vitamin C, which facilitates the absorption of iron: lemons, oranges, grapefruit, mandarins, kiwi, parsley, peppers, lettuce, spinach, radicchio, broccoli
- foods high in vitamin B12, if there is a vitamin B12 deficiency: liver, vegetables, pulses, sweet fruit
If considered appropriate, the doctor may resort to drug therapy.
The most commonly used drugs are:
- ferrous sulphate, which generally has no side effects
- ferrous salts, which can however cause side effects such as constipation, diarrhoea, abdominal cramps
- iron dextran
- iron fumarate
- iron gluconate
- iron saccharate
- iron carbonyl
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