Anemia and iron deficiency

Anemia and iron deficiency

Anemia and iron deficiency are almost aligned. Although iron deficiency is the most common cause of anemia (anemia), there are other causes.

Anemia (anemia) is actually a deficiency of red blood color (hemoglobin) in the bloodstream. The hemoglobin absorbs oxygen in the lungs and transports it through the bloodstream to the tissues and organs.

In the case of anemia, less oxygen can be transported and the tissues and organs do not function properly. The amount of hemoglobin in the blood can be measured in a blood sample (finger prick or tube of blood from an arm vein).

We speak of anemia if the result is lower than 8.6 (mmol / l) for men and lower than 7.4 (mmol / l) for women. Children have a lower hemoglobin level until puberty, a value of 7.0 (mmol / l) is normal for them, and even 6.5 (mmol / l) for infants.

Symptoms anemia

It is often thought that if someone looks pale, the person could have anemia. However, practice shows that this is rarely the case.

Only when someone has an extreme form of anemia where the amount of red blood dye (the hemoglobin) has fallen to 60% of normal, does one get a pale appearance of anemia? Unless one loses an acute amount of blood (for example in the event of an accident or a heavy stomach bleed), one will always go through a period in which other complaints occur.

Characteristic symptoms of anemia are:

  • weakness
  • fatigue
  • palpitations
  • shortness of breath (mainly during exercise)
  • dizziness
  • perspire quickly
  • ringing in the ears
  • headache

Jaundice (a yellowish discoloration of the whites of the eyes and/or the skin) may indicate anemia.) Older people may experience symptoms that fit with heart problems (chest pain) or impaired mental functioning, leading to confusion.

How does anemia develop?

The many causes of anemia can be divided into two large groups.

  • The loss of blood goes faster than the production (for example with a stomach bleed or heavy menstruation)
  • Too little blood is produced, such as a lack of iron in the diet or impaired function of the blood-forming organs

Sometimes it is a combination of both reasons.

Blood consists of:

  • red blood cells contain the red blood color (hemoglobin)
  • white blood cells contain antibodies against bacteria and viruses
  • platelets help with blood clotting
  • blood plasma the fluid in which all blood cells float

The kidney retains fluid as a reaction to blood loss, whether it is much or suddenly sudden or chronic. As a result, the amount of fluid in the blood is quickly restored, but this blood is actually diluted because the production of new blood cells is much less rapid. Subsequently, the bone marrow starts producing more blood cells at an increased rate and after a while, the blood loss is replenished.

Anemia occurs when:

  • if there are insufficient nutrients for the blood
  • if the blood production is disturbed for other reasons
  • if the blood loss goes faster than the production

This is usually a stealthy process. There are various causes that make the production lagging behind with loss or breakdown of blood. The cause of the anemia naturally determines how serious it is and what you can expect.

Causes anemia:

1. Iron deficiency The most common cause of anemia is iron deficiency. Iron is one of the building materials of the red blood dye (hemoglobin). Iron is absorbed from the diet. The recording takes place in the first part of the intestine. For this, the diet must firstly contain enough iron and, secondly, the stomach and duodenum must function properly.

Iron deficiency can occur:

  • with regular excessive blood loss (heavy menstruation, birth, illness or tumor in the gut)
  • with increased iron needs (growth period, pregnancy)
  • with the reduced iron intake (stomach or bowel abnormality), iron deficiency can occur

Eventually, the iron supply becomes exhausted, the production of hemoglobin ceases, and anemia develops. Due to the iron deficiency, other abnormalities also occur, such as on the skin and mucous membranes: a sore tongue, cracks at the corners of the mouth, swallowing complaints, crumbly, flat nails, which in the case of serious iron deficiency get a kind of spoon form.

2. Vitamin deficiency Two vitamins in the diet are necessary for the production of the blood dye, namely: vitamin B12 and folic acid.

  • Vitamin B12occurs only in animal foods such as meat, fish and dairy products. Intake in the gut requires a protein that is secreted by the stomach, after which the vitamin B12 protein complex is absorbed in the last part of the small intestine. Very little vitamin B12 is needed per day so that a dietary deficiency (strict vegetarian diet) or a reduced intake (gastric mucosa disorder, often based on an autoimmune disease or small intestinal disease, such as Crohn’s disease) can last for years take time before the supply in the body is exhausted and anemia occurs. This form of anemia is associated with mild jaundice, sore tongue and oral mucosa, and intestinal complaints. Because vitamin B12 is also needed for the function of the nervous system, especially the long nerves,

  • Folic acid is found in vegetables and fruits. Its absorption takes place in the first part of the small intestine. The supply of folic acid is rather small, so that if a deficiency in the diet (abnormal eating habits, seriousness) or a disturbed resorption (diarrhea, disease of the small intestine) a disturbance in the blood production already occurs after a few weeks, thus anemia, may reason due to folic acid deficiency. The use of antiepileptic agents and some sleeping agents (barbiturates) can also give all the symptoms of a folic acid deficiency.

3. Congenital, hereditary forms of anemia

  • G6PD deficiency. In the case of the G6PD deficiency, there is a hereditary deficiency of a certain enzyme (G6PD) in the red blood cells, which is needed to protect it against damage. The result is that the red blood cells have a shorter survival time and are very vulnerable to the use of some medicines. There are different forms of this enzyme deficiency, but in all cases, these people have mild anemia, which can be aggravated acutely when using the aforementioned medicines. Approximately 7.5% of the world population is predisposed to G6PD deficiency. The disease is mainly found in people of the Negro or Arabian races and people from around the Mediterranean. With immigration, the occurrence of G6PD deficiency in the Netherlands is also increasing.

  • ThalassemiaThalassemia is a hereditary form of anemia due to a disorder in the production of abnormal hemoglobin. The condition affects (descendants of) the population of Sardinia (18%), Cyprus (7%), Greece (5%), Southeast Asia (20%), China (5%), Saudi Arabia, West Coast of Africa, Thailand, Pakistan, India. Of the immigrant Dutch population, 10% is hereditary with this disorder. With blood tests, thalassemia initially resembles iron deficiency anemia. When more tests are done, there are differences. With iron deficiency, the red blood cells are too small and different in size, but with thalassemia, the red cells are all just as small. Also with thalassemia, the iron levels in the blood plasma appear to be normal. Iron administration, therefore, has no effect, in fact, it can lead to iron accumulation (a type of iron poisoning). The other forms of anemia are mentioned here for completeness, but they are very rare:

4. Increased blood degradation The red blood colorant (hemoglobin) is a protein that is vulnerable to damage. Therefore, it does not circulate freely in the blood but is trapped in red blood cells that are made in the bone marrow. When the erythrocytes produced as a result of an infection (malaria), mechanical reason (artificial heart valve), chemical (bacterial poison) or immunological damage are accelerated to ruin, anemia develops. The increased degradation of hemoglobin is almost always accompanied by a (slight) jaundice.

5. Bone marrow disorder In cases where the anemia is due to a bone marrow disease, it is always a malignant derailment of blood production, in which a type of blood cell grows disproportionately and takes the place of normal blood cell production (acute and chronic forms of leukemia).

In rare cases, the bone marrow is practically completely empty (aplastic anemia) or there is an ineffective blood production (dyshematopoiesis, preleukemia). In these cases, the production of the white blood cells and platelets is also often more or less disturbed, which can lead to an increased susceptibility to infections and an increased tendency to bleed.

6. Underlying disease Sometimes the cause of the anemia lies in a disturbing blood production as a result of the chronic underlying disease. This occurs with chronic infections, chronic liver disease, autoimmune diseases (chronic rheumatism), kidney poisoning, insufficient thyroid function, malignant diseases, disease of the bone marrow (the production site of the blood).

Is it serious and what can you expect?

The cause of the anemia determines how serious it is and what you can expect. Both anemias due to iron deficiency and vitamin deficiency mean that they are generally easy to treat. However, you must bear in mind that it may take several weeks before you notice the effect of the treatment. In addition to replenishing the iron or vitamin deficiency, it is of course also necessary to consider why the anemia arose. Anemia, which occurs in women around forty years of age due to an iron deficiency, can almost always be explained by iron loss during childbirth or excessive menstrual bleeding.

In iron-deficiency anemia, especially in patients aged 45-50 years and older, one should be wary of blood loss from the gut, for example, due to abnormalities in the stomach or gut wall. In the case of anemia due to vitamin deficiency, extensive research is needed to determine the cause, but that is also usually treatable.

With congenital, hereditary forms of anemia, the matter is somewhat more serious. It is something you have to take into account throughout your life. Sometimes there are periods when the anemia is so severe that only a blood transfusion can offer a solution. It is therefore common for people who are diagnosed with a hereditary form of anemia to remain under the control of a blood specialist (hematologist). The same also applies to people for whom an increased blood breakdown, a bone marrow disorder or an underlying disease is the cause of their anemia.

When to the doctor?

If you have symptoms that suggest that you might have anemia, it is always wise to contact your doctor. In the case of one or more misunderstood complaints about weakness, rapid fatigue, heart palpitations, shortness of breath, dizziness, perspiration, ringing in the ears, headaches, and jaundice, the possibility of anemia should be considered.

A fairly simple blood test can determine whether or not you have a shortage of red blood dye (hemoglobin). If this proves to be too low, then your doctor will have further tests performed to find out the cause of your anemia.

What can you do about it yourself?

Anemia is a disease that you can hardly start with without the help of your (family) doctor. First of all, your doctor will have to determine the anemia and try to find out the cause, and then anemia almost always requires medical treatment in the form of medicines or, in extreme cases, even a blood transfusion.

General advice and precautions

Unfortunately, the advice and precautions to prevent anemia are limited. A varied diet with sufficient minerals and vitamins will reduce the risk of anemia due to iron deficiency and vitamin deficiency. In some cases, such as during a heavy menstrual period or with problems with the absorption of vitamins in the gut, the help of the doctor or doctor will always be necessary.

With some forms of hereditary anemia, it is very important to know which medicines can lead to an increased blood breakdown and thus anemia.

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