ANEMIA

By: Dirk Davidson, M.D.
Medical Oncologist

Anemia is a medical condition that most everyone has heard of, but few understand very well. The word is derived from the Greek language and means “without blood.” Patients with anemia have reduced numbers of red blood cells (RBCs). The hemoglobin in blood cells carries and delivers oxygen. Therefore, people with anemia develop symptoms consistent with decreased oxygen levels.

There are over 100 causes of anemia, but all fit into one of two categories – either decreased production or increased loss. Blood loss obviously includes bleeding, but also includes hemolysis, or internal destruction of RBCs. The causes of decreased blood production are many and include things as simple as iron deficiency and as serious as leukemia.

“In difficult cases, patients usually need to see a blood specialist or hematologist. This doctor is usually an oncologist, or cancer doctor, since those two specialties go hand in hand,” said Dr. Dirk Davidson, Medical Oncologist on staff at Cumberland Medical Center.

Fortunate patients are found to have anemia in the very early stages – before it is severe enough to cause symptoms. This is found on a routine blood test – the CBC or complete blood count.

Less fortunate patients do not realize they are anemic until they develop symptoms. Again, the symptoms are due to decreased oxygen in their bodies. Shortness of breath, weakness, fatigue, chest pain, rapid heart beat, dizziness, and even depression can all be symptoms of anemia.

The most common cause of anemia is iron deficiency. A person becomes iron deficient by bleeding. Not surprisingly, therefore, iron deficiency is most common in menstruating females. However, this type of anemia can also be seen in men and post-menopausal women. In this population, the site of blood loss is usually the stomach or the bowels. Possibilities include gastritis, ulcers, polyps, diverticular disease or even cancer. Because of the small possibility that the slow bleeding came from a cancerous polyp, all of these patients should undergo a colonoscopy. Keep in mind that the bleeding is usually just a few drops per day so the patient may have no idea that he or she is bleeding.

Vitamin B12 deficiency is another relatively common cause of anemia. The true form of the disease is call pernicious anemia, but other patients can have a deficiency of B12 after stomach surgery or due to poor diet.

“Both iron and B12 deficiencies are easy to treat. B12 is usually given as a monthly shot and iron is usually given in pill form. Some formulations of iron are much better absorbed than others. Over the counter multi-vitamins with iron are often not sufficient. Some patients absorb iron poorly or cannot ‘stomach’ it; these patients require iron infusions,” said Dr. Davidson.

When a patient has anemia that is not due to a vitamin deficiency, the diagnosis is more difficult to make. Sometimes, in these cases, the anemia is an indication that there is a more serious underlying problem. People with kidney or liver disease are often anemic. Others have changes in their bone marrow that prevents them from producing blood sufficiently. Usually the diagnosis can be made through blood tests, but sometimes the physician has to sample the bone marrow. The bone marrow examination can be performed in the doctor’s office and usually takes about ten minutes. It is sometimes the only means to tracking the cause of a patient’s anemia.

In the past, many anemic patients had to be hospitalized periodically to undergo blood transfusions. Over the past 5-10 years though, many people have avoided transfusions by taking injections of a synthetic growth factor for blood called erythropoietin. This injection is given every 1-4 weeks and often eliminates the need for blood transfusions altogether. Erythropoietin is also given regularly to dialysis and cancer patients. It is completely safe and usually has no side effects.

“Most cases of anemia are fairly simple to diagnose and treat. More unusual cases can usually be diagnosed easily by a hematologist/oncologist,” Dr. Davidson concluded.