Harnessing Health: Understanding Anemia And Its Impact On Well-being

Human blood carries oxygen from the lungs to all tissues of the body. The red blood cells – the erythrocytes – are necessary for this. But sometimes, there are not enough erythrocytes in the body to transport the oxygen in sufficient quantities: you have anaemia (low blood count). But how does this happen, and what does it mean for those affected?

How is blood made in the body?

Red blood cells, or erythrocytes, transport oxygen to our bodies. They contain a certain amount of haemoglobin. This protein can bind and release oxygen via an iron ion. The erythrocytes, including haemoglobin and iron ions, must be intact for the oxygen transport to work.

The bone marrow forms the red blood cells. Blood formation is also called hematopoiesis in medicine. It is stimulated by the hormone erythropoietin, mainly produced in the kidneys. Erythropoietin is secreted when the tissues have less oxygen than usual and necessary. It then stimulates blood formation in the bone marrow. For this to run smoothly, various substances – especially iron, vitamin B12 and folic acid – must be available in sufficient quantities.

How does anaemia develop?

Anaemia occurs if there is a problem in one step of blood formation or its regulation. The medical term for anaemia is anaemia. It occurs when there is too little haemoglobin and too few erythrocytes in the blood. Few erythrocytes can be recognized in the blood count by a low hematocrit. The hematocrit indicates the proportion of different blood cells in the blood. Blood cells include red blood cells (erythrocytes), platelets and white blood cells (leukocytes).

However, the number of thrombocytes and leukocytes does not significantly influence the hematocrit because they occur in proportion to much less in the blood than the erythrocytes. For this reason, the hematocrit is used to assess the erythrocyte value.

Anaemia can have different causes, such as iron or vitamin B12 deficiency or internal bleeding. The doctor can already get an indication of the possible underlying problem from a blood count.

Where can anaemia come from?

The causes of anaemia are diverse, but three main mechanisms lead to anaemia.

bleeding (acute or chronic)
an increased breakdown of the red blood cells (enzyme errors, medication )
reduced formation of haemoglobin or red blood cells ( iron deficiency, chronic diseases)

Depending on what is causing anaemia, different changes in the blood appear. From there, the doctor can not only identify the cause. These changes can also be used to classify the various types of anaemia.

How do you recognize anaemia?

The signs of anaemia are caused by the low level of oxygen in the tissues due to reduced oxygen transport. The body tries to compensate for the low haemoglobin level and still get enough oxygen to all body tissues by increasing the heart and breathing rates. However, this is only possible up to a certain point.

Those affected notice the following symptoms:

low physical endurance
tachycardia and shortness of breath (especially under stress)
fatigue
weakness
Pallor is particularly visible on the mucous membranes (e.g., eyelids).

Most anaemias are chronic, meaning they develop over a long period. This allows the body to start compensatory mechanisms; those affected do not notice anything about the anaemia at first. Young people, in particular, can live unrestrictedly even with quite severe anaemia.

Which blood values are essential in anaemia?

The diagnosis of anaemia is based on blood values. Anaemia is often discovered incidentally when a blood count is done for another reason. This blood count shows that the haemoglobin value (Hb) is too low. According to the WHO definition, the lower limit is 120 g/l blood for women and 130 g/l for men.

In the next step, the doctor looks at the blood count’s mean corpuscular volume (MCV) and the mean corpuscular haemoglobin (MCH). These two values show how big a single red blood cell is and how much haemoglobin it contains. Depending on how these values turn out, the doctor can draw initial conclusions about the underlying problem.

The average values of the blood parameters differ from person to person. For example, they are influenced by:

Alter
gender
pregnancy
Smoking
stays at a high altitude

In the blood test, attention is also paid to iron levels ( ferritin, transferrin, serum iron), signs of increased breakdown of erythrocytes (signs of haemolysis) and changes in blood formation, as well as folic acid and vitamin B12, which can also point the way for a diagnosis.

Which examinations confirm the diagnosis?

After an abnormal blood test, another conversation to clarify the history of the disease and a physical examination will help the doctor determine the causes of the anaemia. The following physical examinations can be carried out:

Assessment of the skin and mucous membranes
listening to the heart
blood pressure measurement
Examination of the abdomen
digital rectal exam
for women, a gynaecological examination
cancer screenings

Which examinations are carried out strictly depending on the history of the disease and the suspected cause of the anaemia?

Anaemia: what types are there?

There are many types of anaemia, each with different causes and effects. Based on the mean corpuscular volume (MCV) and the mean corpuscular haemoglobin (MCH), a classification into three classes is possible:

microcytic, hypochromic anaemias
normocytic, normochromic anaemias
macrocytic hyperchromic anaemia

Microcytic, hypochromic anaemias

The erythrocytes are too small in these anaemias and contain too little haemoglobin. Microcytic hypochromic anaemias include:

iron deficiency anaemia

Iron deficiency is the most common cause of anaemia. Iron is the central component of haemoglobin, which enables oxygen transport. If too little iron is in the body, less haemoglobin can be formed, and oxygen can be transported accordingly.

Iron deficiency anaemia is significantly more common in women (five times more common) than in men. Iron deficiency is usually caused by heavy menstrual bleeding or malnutrition.

Those affected receive iron supplements for therapy to enable the body to produce sufficient blood again.

Anaemia of chronic disease

Chronic diseases are the second most common cause of anaemia. Anaemia occurs because the underlying disease disrupts iron metabolism and red cell production. Diseases leading to anaemia include tumours ( cancer ), inflammation and autoimmune diseases such as Crohn’s disease.

of Thalassam

Thalassemia is an inherited form of anaemia in the Mediterranean region. Those affected cannot produce normal haemoglobin due to a genetic defect.

Normocytic, normochromic anemias

Here, the erythrocytes are of average size and contain normal haemoglobin. Only their number is reduced, resulting in anaemia. Below, we present the different forms of normocytic and normochromic anaemia.

Normocytic, normochromic anaemia due to acute bleeding

Anaemia with acute bleeding can quickly become life-threatening. It is essential that the bleeding is stopped as soon as possible and that the person’s circulation is stabilized.

Hemolytic anaemias

In this form, the red blood cells are destroyed or broken down too early (average lifespan: 120 days). The reason for the hemolysis can lie within the cells (changed haemoglobin, broken membranes) or be caused externally (vascular damage, heart valve defects, infections).

There is also an autoimmune hemolytic anaemia, in which the body’s antibodies bind to the erythrocytes and thus cause them to be broken down.

Another unique form of hemolytic anaemia is sideroblastic anaemia. It is inherited via the X chromosome and mainly affects men since, in women, a healthy X chromosome can compensate for a diseased one and thus prevent the onset of the disease.

The so-called spherical cell anaemia or spherocytosis also belongs to the haemolytic anaemias. It is caused by a genetic defect that damages the structure of the red blood cells.

renal anaemias

When the kidneys are no longer working correctly, doctors speak of renal insufficiency. In chronic renal insufficiency, renal (ren = kidney) anaemia occurs because the kidneys release little or no erythropoietin, and blood formation is no longer sufficiently stimulated. In addition, red blood cells break down more quickly due to renal insufficiency.

Aplastic anemias

A disorder in the bone marrow causes aplastic anaemia. An immune reaction destroys the blood-forming cells of the bone marrow. This means that not enough blood can be regenerated. Not only are there fewer erythrocytes, but the number of other blood cells is also reduced.

There are both congenital and acquired forms of aplastic anaemia. The congenital forms include Fanconi anaemia, which is associated with malformations and an increased risk of cancer.

A unique form of aplastic anaemia is pure red cell anaemia. It only affects the red blood cells. The number of other cells is not affected. The congenital form of this condition is called Diamond-Blackfan anaemia.

Macrocytic, hyperchromic anaemias

In macrocytic, hyperchromic anaemia, red blood cells are reduced. To compensate, each red blood cell is loaded with more haemoglobin. As a result, the erythrocytes are more significant than usual. However, it is impossible to completely compensate for the low erythrocyte count, which is why anaemia occurs.

Megaloblastic anemia

A vitamin B12 or folic acid deficiency leads to a disruption in DNA production. As a result, red blood cells can only be produced in smaller quantities. However, these are balanced with more haemoglobin, making them larger than usual.

A risk factor for a vitamin B12 deficiency is a vegetarian or vegan diet, whereby an adequate intake of the vitamin is possible through a conscious diet or the intake of vitamin preparations without animal products. Sufficient vitamin B12 is stored in the body for several years, so anaemia often occurs late.

A unique form is a pernicious anaemia. Vitamin B12 is absorbed in the stomach via a glycoprotein, the intrinsic factor. There is an autoimmune disease in which the body’s antibodies prevent the intrinsic factor from binding to vitamin B12. As a result, the vitamin can no longer be absorbed, and anaemia occurs.

Myelodysplastic Syndrome

The myelodysplastic syndrome often affects older people. In the bone marrow, some defective cells begin to increase. As a result, the standard, blood-forming cells are displaced, and normal hematopoiesis can no longer occur. Despite appropriate therapy, this syndrome can progress to acute myeloid leukaemia, which significantly worsens the prognosis.

anaemia in old age

Many older people suffer from anaemia. Up until a few years ago, this was considered normal. However, anaemia in the elderly as well as in younger people can be a sign of illness, internal bleeding or cancer.

Even if this is not the case, the symptoms of anaemia limit the daily life of those affected and can promote mental and physical problems. For this reason, clarification and, if necessary, treatment of anaemia are now also carried out in older people with low haemoglobin levels.

anaemia in pregnancy

During pregnancy, the female body drastically adapts to the new circumstances. During this time, a lower hematocrit and haemoglobin are considered normal. In addition, the expectant mother needs significantly more iron, vitamin B12 and folic acid.

Insufficient intake of these substances can lead to anaemia during pregnancy, which is why most women are provided with appropriate dietary supplements as a precaution.

Anaemia during pregnancy poses a risk of complications such as premature birth and placental insufficiency (inoperable placenta).

anaemia and sports

Endurance athletes often have low hematocrit and haemoglobin levels. However, this is not a true anaemia. Training increases blood volume, although the proportion of blood plasma (the liquid part of the blood without cells) increases more than the proportion of cells. The blood, therefore, becomes thinner, and the hematocrit falls.

Nevertheless, athletes should ensure a good iron intake because they lose more iron through sweat and urine. Iron loss through the urine during exercise can have various triggers. These include, for example, minor injuries to the bladder caused by vibrations or drinking too little. This causes very light bleeding within the bladder, which in turn results in iron loss.

If there is anaemia, the body is less resilient. Even everyday stress, such as cycling to work and walking to the bus stop, presents the body with a task that otherwise only represents pronounced sports training. It is, therefore, important not to overload yourself and to listen to your own body when the limit of resilience has been reached.

What to do if you have anaemia?

Treatment for anaemia depends on its cause. Unfortunately, there is no panacea for anaemia. It is essential to identify and treat the cause of the anaemia. For example, iron supplements are given to those affected by iron deficiency anaemia, bleeding is stopped in the case of bleeding, and an attempt is made to prevent the disease in the case of chronic diseases.

Very severe anaemia may require hospitalization to stabilize circulation and monitor people. Blood may also need to be transfused. Various factors, such as the duration of the anaemia, age, previous illnesses and the symptoms of the person concerned, influence the decision to do this.

What to look out for if you have anaemia

It is essential to follow the therapy prescribed by the doctor and not to overload your body. Ensuring a balanced diet with sufficient iron intake and healthy food also makes sense. Foods containing iron are, for example, meat products and offal, green vegetables, legumes and whole grain cereal products.

Vegans or vegetarians are best advised to consume iron-rich foods with vitamin C (such as a glass of orange juice), improving the body’s absorption of plant-based iron.

How dangerous is anaemia?

Anaemia is a severe symptom. It indicates an underlying disease and is, therefore, not an independent disease. These underlying diseases, such as iron deficiency, can usually be treated harmlessly and well. But they can also be complex and even life-threatening, such as cancer or untreated thalassemia.

The haemoglobin value at which anaemia becomes critical, i.e., organ functions are restricted by the lack of oxygen supply, and it depends on the patient and his physical conditions. The crucial value in young, healthy people is lower than that for older people with, for example, heart disease. In extreme cases, anaemia can be fatal if left untreated. Treatment is usually possible, however, so that most anaemias do not restrict life expectancy. An exception is some congenital anaemias, which can only be treated purely symptomatically and cannot be cured.