ANEMIA

HOW DOES BLOOD WORK?

Blood is the vehicle by which vital compounds are transported to and from tissues throughout the body (1).  Blood picks up nutrients from the gastrointestinal tract, hormones from various organs, and gases from all over the body.  Oxygen and carbon dioxide are among the gases that are transported by the blood.  Oxygen fuels the creation of energy from the food we eat whereas carbon dioxide is the waste product of metabolism.  Blood picks up oxygen from the lungs and then delivers it to all of the tissues involved in metabolism.  It then picks up carbon dioxide from these same tissues and delivers it to the lungs where it can be removed from the body via exhalation.  The process of pick up, transportation, and release of these gases is accomplished via a special iron-based protein within red blood cells known as hemoglobin (2).

Hemoglobin and other cellular components of the blood are produced in the bone marrow.  The production of many of these components, however, is heavily regulated by kidney hormones.  When oxygen levels in the kidneys are low they secrete large amounts of a hormone called EPO.  EPO acts to stimulate the production of red blood cells in the bone marrow.  High kidney oxygen levels, on the other hand, result in reduced EPO secretion and consequential down-regulation of red blood cell production (3).

In normally functioning bodies, red blood cells live for about four months.  When these cells die, their components are recycled by the spleen, liver, or lymph nodes.  The spleen also destroys and removes any malformed, old, or otherwise defective red blood cells that may be circulating in the body.  The recycled components of these dead or destroyed red blood cells are then transported to the bone marrow where they can be used for the formation of new blood cells.

ANEMIA

Anemia is defined as a deficiency of total red blood cell oxygen capacity.  Blood with this deficiency is impaired in its ability to deliver adequate oxygen to the body’s tissues (4).  Many common anemias are the result of a reduction in red blood cell size, a decrease in the production of new red blood cells, or an increase in the destruction of existing red blood cells.  Microcytic anemia, or anemia due to smaller sized red blood cells, is caused by conditions that impair hemoglobin production.  Iron deficiency is the most common cause of such an impairment (5).  Decreased production of new red blood cells, and consequential low red blood cell numbers, is usually related to problems with the bone marrow.  Among other things, these problems can be caused by deficiencies in B vitamins, viral infections, autoimmune disorders, or abnormally low EPO hormone levels.  Hemolytic anemia, or excessive destruction of red blood cells, can be caused by autoimmune attack against red blood cells, infections, or physical damage to red blood cells.  Overactive spleen activity can also lead to this kind of anemia.

RISK FACTORS FOR ANEMIA

• Insufficient intake of iron or copper
• Insufficient intake of B9 (folate) or B12
• Infections e.g.: HIV, parvovirus B19, malaria
• Lead exposure, especially as a child
• Liver disease
• Alcoholism
• Cancer
• Inherited disorders e.g.: Sickle-cell anemia, G6PD deficiency, alpha or beta thalassemia, orotic aciduria, fanconi anemia, diamond- blackfan anemia
• Chemotherapeutic drugs
• Pregnancy
• Blood loss
• Any chronic disease or inflammatory state (6)

SYMPTOMS OF ANEMIA

While there is a slew of conditions which can lead to anemia, shared symptoms of anemia result from the reduced ability of oxygen to reach the tissues.  Because oxygen is the major source of energy production in the body, anemia usually leads to fatigue and or weakness.  Such fatigue in the brain can result in neurological symptoms (7).

Shared Symptoms of Anemia

• Lack of concentration
• Fatigue or weakness
• Cold hands or feet
• Headache
• Chest pain
• Pale looking skin
• Shortness of breath (7)

Specific Symptoms of Some Anemias

• Behavioral disturbances (8)
• Dark or brown colored urine, especially in the morning (7)
• Enlarged abdomen
• Jaundice or yellow coloring of the skin and especially eyes (7)

Because iron deficiency is the most common cause of anemia, its associated symptoms deserve special treatment (9).  In addition to experiencing the shared symptoms of all anemias, people with iron deficiency anemia will often also have pica, trouble swallowing, and inverted fingernails (10).  Of these additional symptoms, pica is probably the most indicative of iron deficiency.  Pica is manifest as a desire to eat or chew nonfood items such as dirt, paper, wax, grass or hair.  It is hypothesized that this kind of behavior is driven by a subconscious search for sources of iron in anything that the body can ingest.  Trouble swallowing may be explained by anomalies in the esophagus and an increased tongue size.

Because anemic symptoms are shared with many other conditions, it is imperative to seek the attention of your health care practitioner if you experience any of the above symptoms. For more information on anemia and diagnosis: 1. Talk to you physician 2. Visit the American Society of Hematology website 3. Visit the National Heart, Lung, and Blood Institute website

ANEMIA FACTS AND STATISTICS

Among blood disorders, anemia is the most common, affecting nearly one-third of the world’s population (11).  Iron deficiency anemia is the most common kind of anemia affecting a staggering 1 billion people worldwide (9).  Due to high fetal iron demand during pregnancy, iron deficiency anemia affects approximately 50% of pregnancies worldwide.  Pregnancy-related anemia can result in harm to both mother and baby (13).

According to the WHO, anemia is most prevalent among preschool-aged children (12).

WHAT IS THE FASTEST WAY TO CURE ANEMIA?

The treatment of anemia depends on the specific anemia that a person is experiencing; however, a common treatment modality with severe anemia includes transfusion of new blood to increase oxygen carrying capacity.  To avert anemia in pregnancy, iron vitamins are often administered orally in the first trimester of pregnancy and intravenously in the second trimester (13).

Other anemic diseases require a more tailor-made approach for treatment beyond supplements for anemia.  To treat hereditary spherocytosis and pyruvate kinase deficiency, removal of the spleen is recommended.  The genetic form of sideroblastic anemia is commonly treated with B6 supplementation (14). Because chronic diseases, chronic inflammation, and cancer result in low iron in the blood, treatments targeting the underlying cause of disease often increase iron and resolves the anemia.

HOW TO TREAT ANEMIA NATURALLY

Practices to Support Blood Health:

• Frequently wash hands to help prevent infection.
• Maintain a healthy diet and weight to reduce the chance of chronic disease.
• Avoid direct contact with blood or bodily fluids to prevent exposure to HIV.
• Eat foods containing iron such as spinach, lentils, pumpkin seeds, dark chocolate, eggs, and beef (15).
• Know how much iron per day is needed to recover from anemia quickly.

Natural Supplements That Support Blood Health:

• Iron (13) (Iron supplement dosage is commonly overdosed, resulting in severe health risks. Intake should be monitored)
• Vitamin B6 (16)
• Vitamin B9 (folate) (17)
• Vitamin B12 (18)
• Copper (19)

REFERENCES

1. Your living blood – It’s alive. The Franklin Institute Inc. https://www.fi.edu/heart/its-alive. Accessed April 11, 2018.
2. How does oxygen get into the bloodstream? British Lung Foundation. https://www.blf.org.uk/support-for-you/how-your-lungs-work/oxygen-and-blood. Accessed March 24, 2018.
3. Blood basics. American Society of Hematology. http://www.hematology.org/Patients/Basics/. Accessed March 24, 2018.
4. Anemia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360. Accessed March 24, 2018.
5. Massey AC. Microcytic anemia differential diagnosis and management of iron deficiency anemia. The Medical Clinics of North America. 1992;76(3):549-566.
6. Nabili SN. Anemia. WebMD emedicinehealth. https://www.emedicinehealth.com/anemia/article_em.htm#anemia_causes. Accessed March 24, 2018.
7. Anemia. American Society of Hematology. January 08, 2018. http://www.hematology.org/Patients/Anemia/. Accessed March 24, 2018.
8. Lozoff B. Behavioral alterations in iron deficiency. Adv Pediatr. 1988;35:331-359.
9. Vos T, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2163–2196. doi:10.1016/S0140-6736(12)61729-2.
10. Iron deficiency anemia. Healthline. https://www.healthline.com/health/iron-deficiency-anemia. Accessed March 26, 2018.
11. Janz TG, Johnson RL, Rubenstein SD. Anemia in the emergency department: evaluation and treatment. Emergency Medicine Practice. 2013;15(11):1–15.
12. Global anaemia prevalence and number of individual affected. World Health Organization. http://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/. Accessed March 24, 2018.
13. Achebe MM and Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood Journal. 2017;129:940-949. doi:10.1182/blood-2016-08-672246.
14. Mir MA and Besa EC. Sideroblastic anemias treatment & management. Medscape. https://emedicine.medscape.com/article/1389794-treatment. Accessed March 24, 2018.
15. Top 10 iron-rich foods. Dr. Axe. https://draxe.com/top-10-iron-rich-foods/. Accessed March 24, 2018.
16. Vitamin B-6. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-vitamin-b6/art-20363468. Accessed March 27, 2018.
17. Vitamin B9 (folic acid). Online Holistic Health. https://www.onlineholistichealth.com/vitamins-2/vitamin-b9-folic-acid.html. Accessed March 27, 2018.
18. Nordqvist C. Everything you need to know about vitamin B12. MedicalNewsToday. https://www.medicalnewstoday.com/articles/219822.php. Accessed March 27, 2018.
19. Lazarchick J. Update on anemia and neutropenia in copper deficiency. Curr Opin Hematol. 2012;19(1):58-60. doi: 10.1097/MOH.0b013e32834da9d2.