Anaemia

Feeling constantly tired, short of breath, or a bit dizzy? These seemingly minor complaints could be pointing towards a widespread health condition known as anaemia. Often overlooked or dismissed as just "being a bit run down," anaemia affects millions worldwide, quietly impacting their energy levels, cognitive function, and overall well-being. But what exactly is it, and why does it make us feel so drained? 

This comprehensive guide aims to cover the details of anaemia, offering a clear and accessible overview of this prevalent blood disorder, from its various forms to the ways we can effectively manage and prevent it. We’ll also explore the signs to look out for, the steps doctors take to diagnose it, and the diverse range of treatments available, allowing you to understand your body better.

Anaemia, simply put, is a condition where your blood doesn't have enough healthy red blood cells. Red blood cells are incredibly important; they contain a protein called haemoglobin, which is responsible for carrying oxygen from your lungs to every part of your body. Think of haemoglobin as the oxygen delivery service for your cells and tissues. When you have anaemia, your body isn't getting enough oxygen, which is why you might feel weak, tired, or breathless. 

It's not a disease in itself, but rather a symptom or sign of an underlying problem. The severity can range from mild, where you might not even notice it, to severe, which can significantly impact your daily life and, in some cases, lead to serious health complications.

Anaemia is a truly global health issue. Its prevalence is notably higher in individuals aged over 65, those of Black and Asian ethnicities, and people residing in areas with higher social deprivation. Globally, the World Health Organization (WHO) estimates that 40% of all children aged 6–59 months, 37% of pregnant women, and 30% of women aged 15–49 years are affected by anaemia. These figures highlight anaemia as a significant public health concern across all income levels and age groups.

Anaemia isn't a single condition; it's a broad term encompassing various types, each with its own specific cause. Understanding these different types is crucial for accurate diagnosis and effective treatment.

Iron-Deficiency Anaemia: This is by far the most common type of anaemia. It occurs when your body doesn't have enough iron to produce haemoglobin. Iron is a key component of haemoglobin, and without sufficient iron, your red blood cells can't carry enough oxygen.

Vitamin-Deficiency Anaemia: This type arises from a lack of certain vitamins essential for red blood cell production.

• Vitamin B12 Deficiency Anaemia (Pernicious Anaemia): This often occurs due to a lack of intrinsic factor, a protein needed for vitamin B12 absorption in the gut. Without enough B12, the body produces abnormally large, immature red blood cells (megaloblastic anaemia) that don't function properly.
• Folate Deficiency Anaemia: Similar to B12 deficiency, a lack of folate (vitamin B9) can also lead to megaloblastic anaemia. Folate is crucial for DNA synthesis, which is vital for red blood cell formation.

Anaemia of Chronic Disease (Anaemia of Inflammation): This type is common in people with long-term inflammatory conditions such as cancer, kidney disease, Crohn's disease, or rheumatoid arthritis. These conditions can interfere with the body's ability to use iron effectively or produce enough red blood cells.

Aplastic Anaemia: A rare but serious type, aplastic anaemia occurs when your bone marrow, the spongy tissue inside your bones that produces blood cells, stops making enough red blood cells, white blood cells, and platelets. This can be caused by infections, certain medications, or autoimmune diseases.

Haemolytic Anaemia: In this type, red blood cells are destroyed faster than the bone marrow can produce new ones. This destruction can be due to various reasons, including inherited conditions (like sickle cell anaemia or thalassaemia), autoimmune disorders, or certain infections or medications.

Sickle Cell Anaemia: An inherited disorder where red blood cells are abnormally shaped (like a sickle or crescent moon). These rigid, sticky cells can block blood flow, causing pain crises, organ damage, and chronic anaemia.

Thalassaemia: Another inherited blood disorder where the body produces an abnormal form of haemoglobin, leading to excessive destruction of red blood cells and anaemia. The severity varies depending on the specific type of thalassaemia.

The causes of anaemia are diverse and depend heavily on the type. However, they generally fall into three main categories:

Blood Loss: This is a very common cause, as the body loses red blood cells along with blood.

• Heavy Menstrual Periods: A frequent cause of iron-deficiency anaemia in women of childbearing age.
• Gastrointestinal Bleeding: Ulcers, haemorrhoids, gastritis, or even certain cancers can cause slow, chronic blood loss that leads to anaemia.
• Injury or Surgery: Significant blood loss during trauma or surgical procedures.
• Frequent Blood Donations: In some individuals, very frequent donations can lead to temporary iron depletion.

Decreased Red Blood Cell Production: The bone marrow isn't making enough red blood cells.

• Nutritional Deficiencies: Lack of iron, vitamin B12, or folate in the diet.
• Chronic Diseases: Kidney disease, chronic inflammatory conditions, cancer, and other long-term illnesses can suppress red blood cell production.
• Bone Marrow Disorders: Conditions affecting the bone marrow, such as aplastic anaemia, leukaemia, or myelodysplastic syndromes.
• Medications: Some drugs, particularly chemotherapy agents, can suppress bone marrow function.

Increased Red Blood Cell Destruction: Red blood cells are being destroyed too quickly.

• Inherited Blood Disorders: Sickle cell anaemia, thalassaemia, and G6PD deficiency cause red blood cells to be fragile and easily destroyed.
• Autoimmune Diseases: Conditions like lupus or rheumatoid arthritis can cause the immune system to mistakenly attack and destroy red blood cells.
• Infections: Certain infections, such as malaria, can lead to haemolysis (red blood cell destruction).
• Certain Medications: Some drugs can trigger an immune response that destroys red blood cells.

The symptoms of anaemia can vary widely depending on the severity and underlying cause. Mild anaemia might not cause any noticeable symptoms, or they might be so subtle that they are dismissed. As the anaemia worsens, symptoms tend to become more pronounced. Common symptoms include:

• Fatigue and Weakness: The most common symptom, due to insufficient oxygen reaching muscles and tissues. This can range from a persistent tiredness to extreme exhaustion.
• Pale Skin: Reduced red blood cells mean less haemoglobin circulating, leading to a paler complexion, especially noticeable in the face, inside the lower eyelids, and on the nail beds.
• Shortness of Breath: Even with mild exertion, the body struggles to get enough oxygen.
• Dizziness or Light-headedness: Due to reduced oxygen supply to the brain.
• Cold Hands and Feet: Poor circulation and reduced oxygen can make extremities feel cold.
• Headaches: Often described as a dull ache, these can be a sign of reduced oxygen to the brain.
• Chest Pain (especially with exertion): In severe cases, the heart has to work harder to pump oxygen-poor blood, which can strain the cardiovascular system.
• Irregular Heartbeat (Palpitations): The heart may beat faster or irregularly to compensate for the lack of oxygen.
• Brittle Nails: Nails might become spoon-shaped (koilonychia) in severe iron deficiency.
• Sore or Swollen Tongue (Glossitis): Especially common in vitamin B12 deficiency.
• Restless Legs Syndrome: An irresistible urge to move the legs, often worse at night.
• Pica: Cravings for non-nutritive substances like ice, dirt, or clay, particularly in iron deficiency.

Diagnosing anaemia typically begins with a thorough medical history and physical examination. Your doctor will ask about your symptoms, diet, medical conditions, and family history. They will also look for physical signs of anaemia like pale skin or changes in your nails. However, the definitive diagnosis relies on blood tests.

Complete Blood Count (CBC): This is the primary test for diagnosing anaemia. It provides a comprehensive look at your blood components, including:

• Haemoglobin (Hb) and Haematocrit (Hct): These measurements indicate the amount of oxygen-carrying protein and the percentage of red blood cells in your blood, respectively. Low levels suggest anaemia.
• Red Blood Cell Count (RBC): The number of red blood cells.
• Mean Corpuscular Volume (MCV): This measures the average size of your red blood cells. It helps differentiate types of anaemia (e.g., small cells in iron deficiency, large cells in B12/folate deficiency).
• Red Cell Distribution Width (RDW): Measures the variation in the size of your red blood cells.

Peripheral Blood Smear: A microscopic examination of a blood sample to check the size, shape, and colour of red blood cells, which can offer clues about the underlying cause.

Iron Studies: If iron deficiency is suspected, further tests measure:

• Serum Ferritin: Reflects your body's iron stores. Low levels indicate iron deficiency.
• Serum Iron: Measures the amount of iron in your blood.
• Total Iron-Binding Capacity (TIBC): Measures the blood's capacity to bind to iron.

Vitamin B12 and Folate Levels: To check for deficiencies in these vitamins.

Other Tests: Depending on the suspected cause, your doctor might order additional tests, such as:

• Kidney function tests
• Inflammatory markers (e.g., C-reactive protein)
• Stool test for occult blood (to check for gastrointestinal bleeding)
• Bone marrow biopsy (in cases of suspected bone marrow disorders)

The treatment for anaemia is entirely dependent on its underlying cause. There isn't a one-size-fits-all solution, which is why accurate diagnosis is so important.

Iron-Deficiency Anaemia:

• Iron Supplements: Oral iron tablets (Brands available: Orofer XT, Feronia XT, Ferium XT) and syrups (Brands available: Cheri, Dexorange) are the most common treatment. It's crucial to take them as prescribed and to understand that it can take several months for iron stores to replenish.
• Dietary Changes: Increasing intake of iron-rich foods (red meat, poultry, fish, beans, lentils, fortified cereals, dark leafy greens).
• Addressing Blood Loss: Treating the source of blood loss, such as medication for ulcers or management of heavy menstrual bleeding.
• Intravenous Iron: For severe cases or when oral iron isn't absorbed or tolerated.

Vitamin-Deficiency Anaemia (B12 and Folate):

• Vitamin B12 Injections: For pernicious anaemia or severe malabsorption, injections are often necessary.
• Oral Vitamin B12 Supplements: For milder deficiencies or those without malabsorption issues.
• Folic Acid Supplements: For folate deficiency.
• Dietary Changes: Consuming foods rich in B12 (meat, dairy, eggs) and folate (green leafy vegetables, fruits, nuts, beans).

Anaemia of Chronic Disease:

• Treating the Underlying Condition: The primary focus is managing the chronic disease causing the anaemia.
• Erythropoiesis-Stimulating Agents (ESAs): In some cases, medications that stimulate red blood cell production may be prescribed, particularly in kidney disease.
• Iron Supplementation: Sometimes used if there is also an element of iron deficiency.

Aplastic Anaemia:

• Blood Transfusions: To provide red blood cells, platelets, and white blood cells.
• Medications: Immunosuppressants to prevent the immune system from attacking bone marrow, or medications that stimulate bone marrow function.
• Bone Marrow Transplant: A potential cure for severe cases, especially in younger patients.

Haemolytic Anaemia:

• Immunosuppressants: If caused by an autoimmune condition.
• Splenectomy: Surgical removal of the spleen, as the spleen is often involved in destroying red blood cells.
• Blood Transfusions: To replace destroyed red blood cells.

Sickle Cell Anaemia and Thalassaemia:

• Blood Transfusions: Regular transfusions are often necessary.
• Medications: Drugs to reduce pain crises, prevent complications, or improve haemoglobin production.
• Bone Marrow Transplant: A potential cure for some individuals.

• Gender: Women, especially those of childbearing age, due to menstrual blood loss.
• Pregnancy: Increased iron and folate demand for fetal development.
• Dietary Deficiencies: Lack of iron, B12, or folate in the diet.
• Chronic Diseases: Kidney disease, inflammatory bowel disease, cancer, autoimmune conditions.
• Gastrointestinal Conditions: Crohn's disease, coeliac disease, gastric bypass surgery affecting nutrient absorption.
• Vegetarian or Vegan Diets: If not carefully planned to include adequate iron and B12 sources.
• Age: Older adults are at higher risk due to dietary changes, chronic diseases, and reduced nutrient absorption.
• Genetic Factors: Family history of inherited anaemias like sickle cell disease or thalassaemia.
• Frequent Blood Donations: Can deplete iron stores over time.
• Certain Medications: Some drugs can interfere with red blood cell production or cause bleeding.

• Severe Fatigue: Significantly impacts quality of life and daily activities.
• Heart Problems: Increased workload on the heart can lead to arrhythmias or heart failure.
• Pregnancy Complications: Premature birth, low birth weight, and developmental issues for the baby.
• Growth and Development Problems in Children: Especially in iron-deficiency anaemia.
• Neurological Problems: Nerve damage in severe vitamin B12 deficiency.
• Increased Risk of Infections: Weakened immune system.
• Increased Risk During Surgery: Due to reduced oxygen-carrying capacity.
• Increased Risk of Falls in Older Adults: Due to weakness and dizziness.

Living with anaemia can be challenging, but managing your condition effectively can significantly improve your quality of life.

• Prioritise Rest: Listen to your body and allow yourself adequate rest, especially during periods of increased fatigue. Don't push yourself too hard.
• Follow Your Treatment Plan Diligently: Take all prescribed medications and supplements as directed by your doctor, even if you start feeling better. Consistency is key.
• Eat an Anaemia-Friendly Diet: Focus on iron-rich foods and foods that boost iron absorption (like those high in vitamin C). Consult a dietitian if you need help with meal planning.
• Stay Hydrated: Drinking enough water can help with overall energy levels and bodily functions.
• Pace Yourself: Break down tasks into smaller, manageable steps. Avoid overexertion and learn to recognise your energy limits.

"Anaemia is always about iron deficiency." 

While iron deficiency anaemia is the most common type, it's not the only one. Anaemia can result from deficiencies in other vitamins (like B12 or folate), chronic diseases, genetic conditions, or bone marrow problems.

"You can fix anaemia just by eating more red meat." 

While red meat is a great source of iron, dietary changes alone might not be enough to correct significant iron deficiency, especially if there's an underlying cause like blood loss or malabsorption. Supplements or other medical interventions are often necessary.

"If you're tired, you must be anaemic." 

Fatigue is a symptom of many conditions, not just anaemia. While anaemia often causes tiredness, it's crucial to get a proper diagnosis from a doctor rather than self-diagnosing based on fatigue alone.

It's important to see a doctor if you experience persistent symptoms that could indicate anaemia. Don't dismiss ongoing fatigue, shortness of breath, dizziness, or unusual paleness. Early diagnosis and treatment are crucial to prevent complications. You should particularly seek medical attention if:

• Your symptoms are worsening.
• You have new or severe symptoms.
• You have a chronic health condition that puts you at risk for anaemia.
• You are pregnant or planning a pregnancy.
• You are experiencing heavy menstrual bleeding.
• You notice blood in your stool or urine.

• What type of anaemia do I have, and what is its specific cause?
• What are my haemoglobin and ferritin levels, and what do they mean?
• What is the recommended treatment plan for my type of anaemia?
• How long will I need to take medication or supplements?
• Are there any dietary changes I should make, and do I need to see a dietitian?
• What are the potential side effects of my treatment, and what should I do if I experience them?
• When should I expect to start feeling better, and when will I need follow-up blood tests?

• Be Understanding About Fatigue: Recognise that their fatigue is real and not just "laziness." Offer to help with tasks that require energy, like errands or housework.
• Encourage Adherence to Treatment: Gently remind them to take their medications or attend appointments without nagging. Offer to help them remember if needed.
• Help with Meal Preparation: If they struggle with energy for cooking, offer to prepare iron-rich meals or bring healthy food options.
• Educate Yourself: Learn about their specific type of anaemia and its impact. This will help you offer more targeted and empathetic support.

Anaemia, though common, is a complex health condition with various forms and underlying causes. It can significantly impact daily life, leading to persistent fatigue, weakness, and a host of other symptoms. However, with accurate diagnosis and appropriate treatment tailored to the specific type of anaemia, most individuals can manage their symptoms effectively and improve their overall well-being. 

By understanding the signs, seeking timely medical advice, and actively participating in your treatment plan, you can take significant steps towards restoring your energy and living a healthier life. Remember, persistent symptoms are your body's way of telling you something is amiss – don't ignore them.