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Anemia

Description

An in-depth report on the types, diagnosis, treatment, and prevention of anemia.

Alternative Names

Iron Deficiency; Pernicious Anemia

Complications

Most cases of anemia are mild, including those that occur as a result of chronic disease. Nevertheless, even mild anemia can reduce oxygen transport in the blood, causing fatigue and a diminished physical capacity. Moderate to severe iron-deficiency anemia is known to reduce endurance. (Some studies indicate that even iron deficiency without anemia can produce a subtle but still lower capacity for exercise.)

Complications of Severe or Prolonged Anemia

Because a reduction in red blood cells decreases the ability to absorb oxygen from the lungs, over time serious problems can occur in prolonged and severe anemia that is not treated. Anemia can lead to secondary organ dysfunction or damage, including heart arrhythmia and congestive heart failure.

Certain inherited forms of anemia, including thalassemia major, pernicious anemia, and sickle-cell anemia can be life threatening. Thalassemia major and sickle-cell anemia affect children and are particularly devastating.

Effects of Anemia in Pregnant Women

Pregnant women who are anemic have an increased risk for poor pregnancy outcomes, particularly if they are anemic in the first trimester.

Complications from Anemia in Children and Adolescents

One study reported a higher incidence of ear infections in infants with iron deficiency anemia.(On the other hand, some experts have identified an anemia in children that may be caused by inflammation from infections such as ear infections, urinary tract infections, or others. More research is needed on this finding.)

In children, severe anemia can impair growth and motor and mental development. Proof is lacking, but one small, well-conducted trial suggested that iron therapy in anemic children under two may help reverse some of these problems. (Iron deficiency in vegetarian children without anemia may cause mental impairment, but it appears to be temporary.)

A long-term 2000 study reported that 11- to 15-year old children who had been severely iron-deficient during their infant years scored lower than normal children in all subjects, but particularly in written expression. They also tended to have more behavioral, general health, and emotional problems. Another study reported that teenage girls with iron deficiency, even without anemia, may have temporary memory and concentration loss.

Effects of Anemia in the Elderly

Anemia is common in older people and can have significantly more severe complications than anemia in younger adults. A 1999 study reported higher mortality rates in anemic individuals 85 and older compared to their nonanemic peers. (The rates were higher in anemic men than in women.) The following are examples of its effects from different studies:

  • Anemia has adverse effects on the heart and increases the severity of cardiac conditions, including reducing survival rates from heart failure and heart attacks. Elderly patients who are anemic for more than two days before heart surgery also have a greater risk for complications and death. A 2002 study further suggested that anemia might even be a risk factor for heart disease itself.
  • One study found that anemia was a strong predictor of other serious problems that were not present at the time anemia was first detected. For example, 13% of elderly people with anemia developed cancer over a ten-year period compared to 5% of nonanemic individuals. Rates of infection and peptic ulcer rates were also higher in anemic patients.
  • Anemia is associated with higher mortality rates and possibly heart disease in patients with kidney disease (regardless of age).
  • A strong association was noted between an increased incidence of falls and the presence of anemia.
  • One 1999 study also found an association between anemia and vascular dementia. (This form of dementia is caused by lack of oxygen to the brain. It is not related to Alzheimer's disease.)

Effects of Vitamin B12 Deficiencies and Pernicious Anemia

In addition to anemia, vitamin B12 deficiency can cause neurologic damage, which can be irreversible if it continues for long periods without treatment. People with pernicious anemia, which results in an inability to absorb the vitamin, are not only at risk for neurologic damage, but also have a higher risk for stomach cancer and possibly cancer of the throat and mouth.

Anemia in Cancer Patients

Anemia is particularly serious in cancer patients. In people with many common cancers, the presence of anemia is associated with a shorter survival time. Anemia may exacerbate the toxicity of chemotherapy in elderly cancer patients.

Effects of Excess Iron

High iron stores can be dangerous and may be overlooked as a problem, particularly in industrialized nations.

Excess Dietary Iron

High-meat intake in Western countries has been associated with excess iron stores. In fact, one study found that 91% of the older American population had an iron intake that was higher than recommended. It is not clear if this posses any significant danger or not. Although a 2000 study found no higher risk for heart disease in Caucasian males with high iron stores, more research is needed to see if these results can be confirmed, especially in women and other population groups.

Hemochromatosis

Hemochromatosis is a condition in which excessive iron stores causes damage in the body. Very high amounts of iron from hemochromatosis have been associated with an increased risk for cirrhosis, cardiomyopathy (a disease of the heart muscles), infections, diabetes, and certain cancers. Causes of hemochromatosis the following:

  • In some cases, hemochromatosis can develop in patients with bone marrow failure.
  • Treatments for anemia, particularly transfusions, can cause hemochromatosis (iron overload). Patients with ineffective erythropoiesis (red blood cell production) are particularly at risk for excess iron stores from transfusions.
  • Heredity hemochromatosis is a condition in which the intestinal tract absorbs too much iron from food. Over time this condition leads to damaged organs and joints. About 10% of Caucasians carry the gene. Progression is very slow, however, and the disease is treatable if diagnosed before it has caused internal injury.

Treatments for hemochromatosis include phlebotomy (removal of blood) and chelation therapy (removal of iron), which typically employs the agents deferiprone, desferoxamine, or both.

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