ANEMIA: Segment Three

This is the continuation of a three segment article about Anemia.

Anemia is a lack of red blood pigment and/or red blood cells Simply put; the proportion of blood cells in the body is too low.

Anemia is a complex subject and requires an understanding on various levels. In Segment One and Segment Two we discussed the symptoms, causes and classifications of Anemia.

In this segment we will discuss the composition of blood to give you a framework of the different components that make up our blood and why they are of importance when diagnosing Anemia.

We will also discuss ‘Diagnosis and why it is so important to get it right. The importance of Blood Composition, the procedures for the examination of the blood and how that will affect ‘Laboratory Testing. In addition there will be a discussion about the conclusions of the diagnostic process and the clarification of additional factors with the patient. The article summery will be a discussion about the various treatment options and therapies for Anemia.

This is how the blood is composed

Over half of the our blood is made up of blood plasma. Numerous substances are dissolved in it. This includes hormones and other messenger substances like nutrients (proteins, salts and sugar). These substances reach all regions of the body with the blood supplying organs and tissues throughout the body.

The other half of the blood is made up of cells. This proportion is measured by the hematocrit value. These cells are divided into three large groups: the white blood cells (leukocytes) which are part of the body’s defense system and protect the body from infection. Then there is the blood platelets (thrombocytes) which are involved in stopping bleeding and finally the red blood cells (erythrocytes) which transport oxygen in the body.

The vast majority of cells in the blood are made up of red blood cells. They take on one of the most important tasks of the blood system: transporting oxygen and carbon dioxide. A molecule called hemoglobin, which is located in the erythrocytes and is responsible for the red color of the blood, is essential for this task.

The oxygen that enters the blood in the lungs binds to certain regions of this molecule. The hemoglobin transports it through the body and finally releases it into the organs and tissues where it is needed. In exchange, the metabolite carbon dioxide (CO2) binds to the hemoglobin. Carbon dioxide is transported back to the lungs and exhaled.

If there are not enough erythrocytes or too little hemoglobin in the body, the organs are receiving too little oxygen. This can cause discomfort – however, those affected feel the symptoms differently weak or strong. All symptoms do not always have to be present.

Diagnosis

Physical symptoms such as dizziness and fatigue may lead the patient to see a doctor. Anemia can also occur as a side effect of other diseases or as a side effect of medication. It is therefore important if you suspect anemia to inform your naturopath in detail about medicines that you regularly take and about any existing symptoms.

As we have previously discussed the first indications of anemia is unusual pale skin or mucous membrane ailments, such as the conjunctiva of the eyes. An increased pulse or heart murmur are other possible signs. Symptoms of iron deficiency can also be confirmed by a laboratory blood test. However, in many cases anemia shows up by chance when the blood is tested for other reasons.

The diagnosis of “anemia” is confirmed with a so-called blood count, which among other things provides information about the number of red blood cells and the amount of red blood pigment. The next step is to clarify the cause of the anemia. Certain clues as to the origin of the disorder can already be found in the blood count. Once a blood test has been completed analysis can point to specifics and provide an indication for necessary further examinations.

Examination of the blood in the laboratory

To diagnose anemia, your blood sample will be tested in the laboratory first conducting a small blood count. This includes the following values, which can indicate not only anemia but also its origin:

• Number of red blood cells: If there are too few erythrocytes, this indicates anemia.
• The amount of red blood pigment (hemoglobin level, Hb): This is an important parameter in diagnosing anemia. Because the red blood pigment plays the decisive role in the transport of oxygen. If it is reduced, it means that there is anemia
• Hematocrit (Hct): It quantifies the proportion of the solid components of the blood, i.e. the cells, in the total blood volume. Since most of the cells in the blood are red blood cells, the hematocrit also provides indirect information about the amount of erythrocytes. However, the hematocrit is also decisively influenced by changes in the fluid balance. A reduced hematocrit can indicate anemia, but there can also be other causes.
• Mean erythrocyte hemoglobin (MCH): MCH is a value that indicates how much red blood pigment is on average in an erythrocyte. If the value is lower, this indicates that a disruption in the formation of the red blood pigment is responsible for the anemia. If the MCH is normal, it is called normochromic anemia. If it is reduced, one speaks of hypochromic anemia, i.e. anemia with reduced hemoglobin content in the erythrocytes. If the MCH is increased, it is a hyperchromic anemia, anemia with increased hemoglobin content in the erythrocytes.
• Mean erythrocyte volume (MCV): The MCV quantifies the mean size or volume of the individual red blood cells. If the MCV is normal, it is referred to as normocytic anemia; if it is reduced, it is referred to as microcytic anemia – i.e. anemia with cells that are too small. If the MCV is increased, it is a macrocytic anemia, an anemia with enlarged cells.
• White blood cells (leukocytes), blood platelets (thrombocytes): The number of white blood cells and platelets is also determined as part of a small blood count. These values ​​are important for assessing anemia. In the case of infections or some chronic diseases, for example, there is an increase in leukocytes; in the case of bleeding, as part of the recovery of the blood values, the platelets are often also increased; in diseases of the bone marrow, not only the red blood cells but also the other cell types are often in their number changed so that these findings can point the way for further clarification.

Clarify the cause

•  a possible iron deficiency
•  a folic acid and / or vitamin B12 deficiency
•  kidney-related anemia
• a stem cell disease or bone marrow infestation
• a possible bleeding
• a possible enlargement of the spleen
• a possible hemolysis
• other causes

If the laboratory results show that the problem is anemia, the next step is to clarify the cause. MCH and MCV can already provide initial indications. If the red blood cells are reduced in size (MCV low) and if they show a low mean erythrocyte hemoglobin concentration (MCH), this can indicate an iron deficiency, for example. However, other diseases such as thalassemia (a genetic defect in hemoglobin) are also possible.

If the erythrocytes are enlarged (MCV high) and the mean erythrocyte hemoglobin concentration (MCH) is increased, a vitamin B12 or folic acid deficiency, for example, but also certain bone marrow diseases may be the cause.

For further clarification, a differential blood count (complete blood count) is necessary, in which the cells are viewed under the microscope. In diseases with typical forms of red blood cells, such as spheroid cell anemia or thalassemia, this examination provides the decisive diagnostic information.

The number of reticulocytes is determined in order to clarify whether it is a production disruption or an increased breakdown of red blood cells. These are immature precursors of the erythrocytes in the blood. To remedy a lack of erythrocytes in the blood, the body first releases red blood cells from its reserves in the bone marrow. If there are not enough mature erythrocytes available, the not completely mature precursors, the reticulocytes, are also released into the blood.

So, a high number of reticulocytes in the blood indicates that many red blood cells are being lost, and the body is trying to replicate them quickly. The main cause is bleeding or an increased breakdown or disintegration of the blood cells.

On the other hand, a low number of reticulocytes in the blood combined with anemia indicates that not enough red blood cells can be produced. The cause of this can, for example, be a disease of the bone marrow. Another possibility is a lack of erythropoietin (EPO). The hormone is normally made in the kidneys and helps make red blood cells in the bone marrow.

Therapy options

How your doctor or naturopath treats the anemia depends on the underlying cause. The therapy for some common forms of anemia is briefly outlined below.

Therapy for bleeding anemia In the case of anemia resulting from blood loss, the source of bleeding should be eliminated or stopped as quickly as possible. Acute bleeding, for example after an accident, must be treated immediately. In the case of particularly extensive blood loss, a blood transfusion from donated blood can be vital.

Therapy for iron deficiency anemia If an iron deficiency is due to insufficient intake of the trace element with the food, the person affected should change their diet so that enough iron is absorbed. Meat, fish, poultry and nuts are rich in iron. Lower amounts of iron are also found in milk, eggs, legumes, and grains. The iron contained in meat is in a form that we can process particularly well. Vegetable iron, on the other hand, is more difficult to utilize.

If a change in diet is not enough, iron in the form of tablets can help. Iron supplements should be taken daily or every other day on an empty stomach. After three to six months, the body’s iron stores are usually replenished. The most commonly described side effects include gastrointestinal complaints. People with sensitive stomachs take iron supplements best during or after a meal – even if it is then more difficult to absorb than on an empty stomach. Sometimes changing your iron supplement can also help. Iron supplements are tolerated differently. They can also turn the stool black and, when dissolved in the mouth, turn the tongue black. Iron should not be taken at the same time as certain antibiotics or drugs that neutralize stomach acid (antacids). Inform your naturopath, doctor or pharmacist about possible interactions.

If the cause of iron deficiency anemia is a disturbance in the absorption of the trace element in the intestine, as in inflammatory stomach and intestinal diseases, or if severe side effects occur during therapy with iron tablets, there is the option of iron therapy via the vein.

Therapy for folic acid or vitamin B12 deficiency In the diet, folic acid is mainly found in green vegetables or whole grain products. Folic acid can also be taken in tablet form. Malnutrition, which is often found as a result of too one-sided diet or alcohol abuse, should be avoided. Some medications can also cause folic acid deficiency – for example methotrexate, which is used to treat rheumatoid arthritis.

The body only needs very small amounts of vitamin B12. Therefore, it rarely happens that the food does not meet the needs. This only happens occasionally with very strict vegetarians or vegans. But even after extensive operations – for example stomach operations – or parasitic diseases (infestation by fish tapeworm), a deficiency in vitamin B12 can arise.

In these cases, the diet must be changed or vitamin B12 must be added according to the naturopath’s instructions – preferably by injections. If the vitamin B12 deficiency is due to a reduced absorption of the vitamin in the intestine, high-dose oral preparations can also help. On the other hand, it is of little use if vitamin B12 is taken with food or in the usual tablet form.

Treatment options for other forms of anemia

There is often an efficient treatment for the other types of anemia, depending on the cause. For example,  hormone erythropoietin for kidney diseases can be used with accompanying renal anemia. It stimulates blood formation.

There are also special therapies for various stem cell diseases such as aplastic anemia or paroxysmal nocturnal hemoglobinuria. Special therapeutic options are also available for diseases with increased cell breakdown. If the anemia arises from another underlying disease, this must first be treated.

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This three segment article should provide you with a good background for understanding Anemia. All leading to a better understanding of a complex subject. Thank you for using our Vitalis Health Library.

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