Diagnosing and Treating Anemia
By Julie Campbell, MD
Human blood is made up of red blood
cells, white blood cells, and plasma. Each of these components plays important,
specific roles. The primary role of red
blood cells is to deliver nutrients and oxygen throughout the body. Anemia is a
condition that occurs when there is a decrease in the number of circulating red
blood cells and it is the most common hematologic problem internal medicine
specialists and family physicians encounter. Because sufficient, healthy red
blood cells are so crucial to our wellbeing, it is important to detect and
treat the underlying cause of anemia when it occurs.
What causes anemia?
Anemia is the manifestation of
other physical problems and the degree of anemia is often an indicator of the
degree of underlying illness. The key to treating anemia is to determine the
fundamental cause and then treat that condition.
There are many causes of anemia.
One of the most common causes is iron deficiency. This can develop as a result
of the loss of blood, which can be indicated by dark stools, heavy menstrual
flow, or blood in the urine. It can also be due to poor absorption of iron. People
with celiac disease, strict vegans, and people who have undergone gastric
bypass surgery are at increased risk for iron deficiency.
Other common causes of anemia
include decreased production of red blood cells due to vitamin deficiency,
infection, drugs, or chronic illness, such as kidney disease, inflammatory
arthritis, or cancer. People with autoimmune illness are also at higher risk
for anemia due to increased destruction of red blood cells, a process called hemolysis.
What are the most typical symptoms
While symptoms can vary, they often
include fatigue, shortness of breath, fast heart rate, and even heart failure.
Other symptoms include spooning of the fingernails, a smooth, glossy tongue
that is painful, and the urge to eat ice or dirt (pica), and neurological
problems such as confusion, memory loss, and gait instability.
How is anemia treated?
Because the causes vary, the
treatments also vary. The challenge is to diagnose the cause. For example, if
you have iron deficiency due to celiac disease (intolerance to gluten), you
will start to feel better once you are on a diet that excludes grains such as
wheat, barley, rye, and possibly oats. If your iron deficiency is due to heavy
menstrual flow or blood in your stool, your doctor will recommend ways to minimize
blood loss. If your anemia stems from a diet low in iron, you may need to
change your diet and undertake iron replacement therapy. Correcting anemia can
take two to three months and you may need an additional six months of iron
therapy to fully replenish your system.
Can anemia be caused by
insufficient vitamin B12?
Yes, vitamin B12 deficiency is a
very common cause of anemia, particularly in the older population. An estimated
5 percent of people between the ages of 65-74 have anemia caused by vitamin B12
deficiency and the percentage increases to 10 percent of the population over
the age of 75.
Are the symptoms of vitamin B12
Yes, these symptoms can be
different from other types of anemia. The symptoms include neurological
problems, such as numbness in the hands and feet, loss of balance, personality
changes, fatigue, and reversible dementia. These symptoms are even more
troubling because they can show up before the anemia is detectable by blood
testing. Anywhere between 180-914 pg/mL (picograms per milliliter) is considered a normal level of
vitamin B12. However, symptoms can develop if your B12 blood levels are under
The good news is that it is
possible to resolve B12 deficiency anemia in eight weeks with an intensive
course of B12. It takes about eight weeks for neurological symptoms to resolve,
with full recovery within a year’s time.
Campbell is on the medical staff of Cayuga Medical Center and is in practice
with Cayuga Hematology Oncology Associates, where she can be reached at (607)
272-5414. Dr. Campbell treats all types of cancer and blood disorders. During
her fellowship training at Columbia, she was recognized as Physician of the
Year and Fellow of the Year.