Articles from prior issues of The Advocate

January/February, 1998

Anemia: It's More Than Just Too Little Iron
from Mayo Clinic Health Letter, November, 1995

Iron poor blood. This simple phrase describes the most common type of anemia in the world. Yet, iron deficiency is only one cause. Anemia can result from a number of problems that reduce your blood’s ability to transport oxygen. It’s not a natural consequence of aging, but older adults tend to develop anemias more often than any other blood disorder.

BLOOD LACKS OXYGEN

Red blood cells are formed in bone marrow where they accumulate iron rich hemoglobin. When the cells are released into your blood, hemoglobin attaches to oxygen from your lungs and carries it to your tissues and organs. As red blood cells circulate, mature cells are continuously destroyed and replaced by new cells. The average life of a red blood cell is about four months. Anemia can occur when red blood cell production or maturation is inadequate or destruction is early. As a result, your blood can’t carry adequate oxygen. At first, the effect may be unnoticeable. As anemia progresses, you may feel tired and look pale. Severe anemia may lead to an irregular or increased heart rate as your heart pumps more blood to compensate for the lack of oxygen.

IRON-DEFICIENCY ANEMIA: WHEN PRODUCTION FALLS SHORT

This anemia develops if not enough iron is available to bone marrow to make hemoglobin. It occurs for two main reasons: *Increased iron losses - In older adults, iron deficiency usually results from chronic bleeding. Blood loss often stems from a digestive or intestinal lesion, such as an ulcer, a polyp, or cancer. Frequent or excessive use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) can irritate your stomach lining and also cause bleeding. Usually, bleeding is slow and unapparent. When severe, you may pass black tarry or bloody stools. In premenopausal women, iron-deficiency anemia typically results from excessive menstrual bleeding. Treating the anemia involves locating and stopping the bleeding. If the source can’t be found or is menstrual, periodic iron supplementation helps build up depleted stores. *Not enough iron - a less common cause of iron-deficiency anemia is too little iron in your diet. Nutritional surveys show older Americans seem to meet or exceed the recommended dietary allowance for iron. Also, no evidence suggests your ability to absorb iron is reduced with age. Rarely, surgical removal of your stomach or an intestinal disorder, such as celiac disease, can prevent you from absorbing adequate iron.

MEGALOBLASTIC ANEMIA: WHEN PROPER MATURATION FAILS

This anemia can occur when red blood cells don’t mature normally. The cells formed in bone marrow are enlarged with a reduced capacity to carry oxygen. The anemia is almost always caused by a vitamin deficiency. *Deficiency of vitamin B-12 - Shortage most often results from inadequate absorption of vitamin B-12 from your intestine. This condition, called pernicious anemia, occurs when intrinsic factor made by cells lining your stomach is lacking. Intrinsic factor is essential to absorption of vitamin B-12. In pernicious anemia, an autoimmune process reduces intrinsic factor production and prevents vitamin B-12 from attaching to intrinsic factor. The condition tends to be inherited and to occur in adults older than 60, especially of northern European heritage. The anemia was named pernicious (meaning destructive or deadly) because it was once untreatable and always fatal. However, death from pernicious anemia is now rare and the disorder is uncommon. Lifelong injections of vitamin B-12 correct the anemia. Rarely, vitamin B-12 deficiency results from not eating enough meat or dairy products, which contain plentiful amounts of vitamin B-12. *Deficiency of folic acid - In the United States, this vitamin deficiency is typically limited to adults who abuse alcohol. It usually occurs because alcohol is substituted for a varied diet containing adequate amounts of folic acid. Alcohol also reduces folic acid levels by interfering with the vitamin’s metabolism. Less often, deficiency results from an inability to absorb folic acid due to celiac disease or tropical sprue. Treatment involves eating a healthful diet and taking folic acid supplements as prescribed.

HEMOLYTIC ANEMIA: WHEN DESTRUCTION OCCURS EARLY

This is an uncommon anemia that develops when red blood cells are destroyed faster than bone marrow can replace them. The result is a shortage of red blood cells to transport oxygen. Early destruction can result from: *Genetic defects - A defect in the cell’s physical or chemical makeup can lead to a rigid or elongated shape. The deformity causes red blood cells to become trapped in your spleen, where most are destroyed before the end of their normal lifespan. More commonly, defective hemoglobin causes red blood cells to develop a crescent (sickle) shape. Sickle cells lodge in small arteries, causing acute pain and blood clots. Sickle cell anemia most often affects African and Hispanic Americans. Medications and blood transfusions help relieve symptoms. Hydroxyurea, a drug used to treat other blood disorders, may help reduce occurrence of acute attacks. *Acquired defects - Some infections or use of antibiotics or anti-inflammatory drugs can break down red blood cells. Occasionally, you may acquire a mild form of hemolytic anemia through an autoimmune process. Some artificial heart valves also increase the risk of red blood cell destruction by directly injuring cells. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking immunosuppressive drugs such as corticosteriods. Sometimes, removing your spleen is needed. SOLUTION NOT ALWAYS SIMPLE

Although common, anemia can be a complex problem to diagnose and treat because of its many causes. If you feel unusually tired, don’t assume you have “tired blood.” Anemia often leads to fatigue, but fatigue seldom signals anemia. Simply taking an iron supplement or eating a more healthful diet may not address the underlying problem causing your anemia. And left untreated, the disorder may lead to serious illness.