Definition:

Anemia describes the condition in which the number of red blood cells in the blood is low.

Having the correct number of red blood cells and prevention of anemia requires cooperation among the kidneys, the bone marrow, and nutrients within the body. If the kidneys or bone marrow are not functioning, or the body is poorly nourished, then normal red blood cell count and function may be difficult to maintain.

Classification:

• Acute anemia- occurs quickly. Symptoms can be abrupt and more distressing.
• Chronic anemia- occurs over a long period of time. Symptoms typically begin slowly and progress gradually

In general, there are three major types of anemia, classified according to the size of the red blood cells:

Microcytic anemia:

If the red blood cells are smaller than normal.The major causes of this type are iron deficiency (low level iron) anemia and thalassemia (inherited disorders of hemoglobin).

Normocytic anemia:

If the red blood cells size are normal in size (but low in number), such as anemia that accompanies chronic disease or anemia related to kidney disease.

Macrocytic anemia:

If red blood cells are larger than normal. Major causes of this type are pernicious anemia and anemia related to alcoholism.

Causes:

Common causes of anemia include the following:

Anemia from active bleeding:

Loss of blood through heavy menstrual bleeding or, wounds can cause anemia. Gastrointestinal ulcers or cancers such as cancer of the colon may slowly ooze blood and can also cause anemia.

Iron deficiency anemia:

The bone marrow needs iron to make red blood cells. Iron plays an important role in the proper structure of the hemoglobin molecule. If iron intake is limited or inadequate due to poor dietary intake, anemia may occur as a result. This is called iron deficiency anemia. Iron deficiency anemia can also occur when there are stomach ulcers or other sources of slow, chronic bleeding (colon cancer, uterine cancer, intestinal polyps, hemorrhoids, etc).

Anemia of chronic disease:

Any long-term medical condition can lead to anemia. The exact mechanism of this process in unknown, but any long-standing and ongoing medical condition such as a chronic infection or a cancer may cause this type of anemia.

Anemia related to kidney disease:

The kidneys release a hormone called the erythropoietin that helps the bone marrow make red blood cells. In people with chronic (long-standing) kidney disease, the production of this hormone is diminished, and this in turn diminishes the production of red blood cells, causing anemia. This is called anemia related to chronic kidney disease.

Anemia related to pregnancy:

Water weight gain during pregnancy dilutes the blood, which may be reflected as anemia.

Anemia related to poor nutrition:

Vitamins and minerals are required to make red blood cells. In addition to iron, vitamin B12 and folate are required for the proper production of hemoglobin. Deficiency in any of these may cause anemia because of inadequate production of red blood cells. Poor dietary intake is an important cause of low folate and low vitamin B12 levels. Strict vegetarians who do not take sufficient vitamins are at risk to develop vitamin B12 deficiency.

Pernicious Anemia:

There also may be a problem in the stomach or the intestines leading to poor absorption of vitamin B12. This may lead to anemia because of vitamin B12 deficiency known as pernicious anemia.

Sickle cell anemia:

In some individuals, the problem may be related to production of abnormal hemoglobin molecules. In this condition the hemoglobin problem is qualitative, or functional. Abnormal hemoglobin molecules may cause problems in the integrity of the red blood cell structure and they may become crescent-shaped (sickle cells). There are different types of sickle call anemia with different severity levels. This is typically hereditary.

Thalassemia:

This is another group of hemoglobin-related causes of anemia. There are many types of thalassemia, which vary in severity from mild (thalassemia minor) to severe (thalassemia major). These are also hereditary, but they cause quantitative hemoglobin abnormalities, meaning an insufficient amount of the correct hemoglobin type molecules is made.

Alcoholism:

Poor nutrition and deficiencies of vitamins and minerals are associated with alcoholism. Alcohol itself may also be toxic to the bone marrow and may slow down the red blood cell production. The combination of these factors may lead to anemia in alcoholics.

Bone marrow-related anemia:

Anemia may be related to diseases involving the bone marrow. Some blood cancers such as leukemia or lymphomas can alter the production of red blood cells and result in anemia. Other processes may be related to a cancer from another organ spreading to the bone marrow.

Aplastic anemia:

some viral infections may severely affect the bone marrow and significantly diminish production of all blood cells. Chemotherapy (cancer medications) and some other medications may pose the same problems.

Hemolytic anemia:

The normal red blood cell shape is important for its function. Hemolytic anemia is a type of anemia in which the red blood cells rupture (known as hemolysis) and become dysfunctional. This could happen due to a variety of reasons. Some forms of hemolytic anemia can be hereditary with constant destruction and rapid reproduction of red blood cells (for example, as in hereditary spherocytosis, hereditary elliptocytosis, and glucose-6-phosphate dehydrogenase or G6GD deficiency) . This type of destruction may also happen to normal red blood cells in certain conditions, for example, with abnormal heart valves damaging the blood cells or certain medications that disrupt the red blood cell structure.

Anemia related to medications:

Many common medications can occasionally cause anemia as a side effect in some individuals. The mechanisms by which medications can cause anemia are numerous (hemolysis, bone marrow toxicity) and are specific to the medication. Medications that most frequently cause anemia are chemotherapy drugs used to treat cancers. Other common medications that can cause anemia include some seizure medications, transplant medications, HIV medications, some malaria medications, some antibiotics (penicillin, chloramphenicol), antifungal medications, and antihistamines.

Other less common causes of anemia:

• Thyroid problems.
• Cancers.
• Liver disease.
• Autoimmune diseases (lupus).
• Paroxysmal nocturnal hemoglobinuria (PNH).
• Lead poisoning.
• Aids.
• Malaria.
• Viral hepatitis.
• Mononucleosis.
• Parasitic infections (hookworm).
• Bleeding disorders.
• Insecticide exposure.

Symptoms:

• Fatigue.
• Decreased energy.
• Weakness.
• Shortness of breath.
• Lightheadedness.
• Palpitations (feeling of the heart racing or beating irregularly).
• Looking pale.

Symptoms of severe anemia may include:

• Chest pain, angina, or heart attack.
• Dizziness.
• Fainting or passing out.
• Rapid heart rate.

Some of the signs that may indicate anemia in an individual may include:

• Change in stool color, including black and tarry stools (sticky and foul smelling), maroon-colored, or visibly bloody stools if the anemia is due to blood loss through the gastrointestinal tract.
• Rapid heart rate.
• Low blood pressure.
• Rapid breathing.
• Pale or cold skin.
• Yellow skin called jaundice if anemia is due to red blood cell breakdown.
• Heart murmur.
• Enlargement of the spleen with certain causes of anemia.

Diagnosis:

• Complete blood count (CBC):Determines the severity and type of anemia.
• Stool hemoglobin test: Tests for blood in stool which may detect bleeding from the stomach or the intestines (stool Guaiac test or stool occult blood test).
• Peripheral blood smear: Looks at the red blood cells under a microscope to determine the size, shape, number, and color as well as evaluate other cells in the blood.
• Iron level: An iron level may tell the doctor whether anemia may be related to iron deficiency or not. This test is usually accompanied by other tests that measure the body’s iron storage capacity, such as transferrin level and ferritin level.
• Transferrin level: Evaluates a protein that carries iron around the body.
• Ferritin: Evaluates at the total iron available in the body.
• Folate: A vitamin needed to produce red blood cells, which is low in people with poor eating habits.
• Vitamin B12: A vitamin needed to produce red blood cells, low in people with poor eating habits or in pernicious anemia.
• Bilirubin: Useful to determine if the red blood cells are being destroyed within the body which may be a sign of hemolytic anemia.
• Lead level: Lead toxicity used to be one of the more common causes of anemia in children.
• Hemoglobin electrophoresis: Sometimes used when a person has a family history of anemia; this test provides information on sickle cell anemia or thalassemia.
• Reticulocyte count: A measure of new red blood cells produced by the bone marrow.
• Liver function tests: A common test to determine how the liver is working, which may give a clue to other underlying disease causing anemia.
• Kidney function test: A test that is very routine and can help determine whether any kidney dysfunction exists.
• Bone marrow biopsy: Evaluates production of red blood cells and may be done when a bone marrow problem is suspected.

Medications:

Medications and treatments that correct the common underlying causes of anemia include the following:

• Iron may be taken during pregnancy and when iron levels are low. It is important to determine the cause of iron deficiency and treat it properly.
• Vitamin supplements may replace folate and vitamin B12 in people with poor eating habits. In people with pernicious anemia who are unable to absorb sufficient amounts of vitamin B12, monthly injections of vitamin B12 are commonly used to replete the vitamin B 12 levels and correct the anemia.
• Stopping a medication that may be the cause of anemia may also reverse anemia after consultation with a physician.
• If alcohol is the cause of anemia, then in addition to taking vitamins and maintaining adequate nutrition, alcohol consumption needs to be stopped.

Diet:

• Eat Foods rich in IRON (dried beans, liver, read meat, dried fruits, nuts and shell fish)
• Folic Acid (Citrus Fruits, Asparagus, Spinach, mushroom, soybeans and wheat germ)
• Vitamin B12 (Shell Fish, Lamb, Beef Cheese, Fish and Eggs)

Suggestion about homoeopathic Treatment:

Homeopathic remedies could be a ray of hope in such patients. While conventional treatment advocates the supplementation of the deficient nutrients artificially, Homeopathy recommends natural sources instead, namely eating fruits like apples, dates, and amla, and vegetables like brinjal, beetroot, broccoli, and spinach. Homeopathic remedies work towards removing or reducing the tendency to anaemia and tackling the causative factors, rather than just temporarily treating the condition or offering symptomatic relief.