Anemia: How to recognize symptoms and treat it effectively

What is anemia, and why does it occur? Explains Maria Dogonova-Lerner, an endocrinologist and gastroenterologist.

Anemia is a condition in which our body lacks red blood cells (erythrocytes), which carry oxygen to cells and are responsible for tissue metabolic activity.

Maria Dogonova-Lerner

Endocrinologist

• Gastroenterologist

How do we feel when we have anemia?

The following symptoms occur due to a lack of oxygen:

• weakness and lethargy;
• constant fatigue;
• lack of strength for usual tasks.

At the biochemical level, the rate of all metabolic processes is inhibited. Without oxygen, cells have no energy source and cannot function normally. This is literally oxygen starvation of each cell.

Types of anemia

To understand the nature of the disease, it is worth dividing it into types depending on the factors of occurrence:

1. Posthemorrhagic anemia — occurs due to blood loss.

2. Anemia of chronic disease — appears against the background of oncological processes or chronic diseases of the kidneys and liver.

• In liver diseases, protein formation is disrupted.
• In kidney diseases, the synthesis of erythropoietin is disrupted — a molecule that stimulates the formation of red blood cells.

3. Deficiency anemias (the most common):

• iron deficiency;
• folate-B12 deficiency;
• Mixed.

It is also important to note that protein deficiency plays a key role in the development of the pathology. The hemoglobin molecule itself consists of heme (an iron particle) and globin (a protein). Without sufficient protein, the body cannot build a transport system for oxygen.

What degrees of anemia exist?

Depending on the level of hemoglobin decrease, there are three degrees of anemia severity:

• Grade I (mild anemia) — hemoglobin level is lower than normal, but higher than 90 g/l;
• Grade II (moderate anemia) — hemoglobin within 90–70 g/l;
• Grade III (severe anemia) — hemoglobin level is lower than 70 g/l.

What are the most common symptoms of anemia in adults?

Symptoms of anemia can be very unexpected: shortness of breath during physical exertion. When there is a load, our cells literally lack oxygen. We can feel a headache, dizziness, nausea. Most often, tachycardia occurs, but it can also be at rest because, in the presence of anemia, low blood pressure is more common. To compensate for low blood pressure, the heart beats faster so that blood reaches all organs equally and there is no dizziness.

If we talk specifically about iron deficiency anemia, we often observe external manifestations such as hair loss, hair becoming dull and brittle; skin that is pale and dry; nails that are brittle and thin; cracks that may appear in the corners of the mouth, which is also a characteristic sign of iron deficiency.

What is the connection between anemia and iron deficiency? What does ferritin show, and why is it more important than just “iron in the blood”?

To assess anemia, we evaluate more than just a complete blood test. We evaluate serum iron, ferritin, transferrin as a carrier, the degree of iron saturation with transferrin, the iron-binding capacity of serum, in the complete blood test — expanded indicators of erythrocyte heterogeneity, and the coefficient of saturation of erythrocytes with hemoglobin.

Why is the ferritin indicator important?

It shows the depot (reserves) of iron. Serum iron shows the iron that is currently in our blood. This is not enough to assess the body`s iron reserves. Read more about ferritin in the article.

Anemia is an extreme state of iron deficiency in which compensatory mechanisms are unable to meet the demand, disrupting d homeostasis. If the organs can no longer cope with this, anemia will result, not hidden (latent) iron deficiency.

Is it possible to have normal hemoglobin and low ferritin?

It is very common to have normal hemoglobin and low ferritin because compensatory mechanisms can keep hemoglobin normal for a very long time and deplete our iron stores. This condition is called latent anemia.

It is worth noting that people who have chronic diseases, hypertension, obesity, and vascular pathology may a priori have elevated hemoglobin. It is also worth evaluating C-reactive protein, blood clotting, and ferritin. After all, hemoglobin will be falsely elevated in these diseases, whereas ferritin will reflect iron reserves. In addition, ferritin may be falsely elevated as a pro-inflammatory marker. In such a situation, you need to check C-reactive protein levels to determine whether there is inflammation. A doctor’s diagnosis is very important. Self-diagnosis and self-treatment for deficiencies should not be undertaken.

What blood tests are basic for an accurate diagnosis of anemia? Why is hemoglobin alone not enough to assess the condition?

The basis for diagnosing anemia is a complete blood count (CBC), ferritin, serum iron, serum iron binding capacity, C-reactive protein, folic acid, vitamin B12, and total blood protein. Also, transferrin and the degree of transferrin saturation with iron.

If we see anemia, we must definitely refer the patient to a gastroenterologist to rule out gastrointestinal pathology. Because, in addition to gastrointestinal bleeding, this is actually a very common situation: Helicobacter pylori infection, inflammatory bowel diseases, and low stomach acidity — all of this, if it continues for a long time, can lead to anemia.

There is a very illustrative clinical case: a patient came to me for a completely different reason, but I see that her hemoglobin is 84. I look and say: “How do you live with this?” She replies: “It’s normal, I’ve had it my whole life.” I say: “This is not normal!” We examined her and found Helicobacter pylori. We treated Helicobacter. The patient took a course of iron therapy, and we addressed other issues (she has chronic diseases). Now her hemoglobin is excellent and has never dropped below 120.

A fairly common condition in children is anemia, namely, iron deficiency due to an unbalanced diet. This happens because children are very picky about food: for example, a child may eat only pasta with sausages for a whole month.

I believe that parents should be more attentive to the diversity of children’s diets, enrich them with iron-rich foods, such as legumes, and introduce children to a variety of foods. Offal, liver, sauerkraut, and bell peppers — all of these foods will improve iron absorption.

And, of course, if there is already a significant iron deficiency, it is worth taking the child to a doctor. If it is not iron deficiency, but we see a decrease in hemoglobin, it is necessary to identify the cause.

What causes anemia if left untreated for a long time?

In the worst case, in the absence of therapy, severe anemia can lead to death. In addition, long-term ignoring of the problem causes:

• Heart failure: due to constant tachycardia (the heart works to exhaustion), the heart muscle wears out.
• Cerebral hypoxia: deterioration of memory, cognitive functions, and constant dizziness.
• Critical decrease in immunity: the body becomes defenseless against any infections.

Anemia: Where to start a treatment plan? When should a person expect to feel better?

Treatment should be started when you have an accurate diagnosis of the cause that led to anemia. Of course, if it is moderate or severe iron-deficiency anemia, then you need to immediately put an iron drip. Because most likely, you will have to stabilize the person in the hospital, he may simply faint.

If this applies, for example, to people with chronic diseases (such as anemia of chronic disease), you need to start treatment immediately. Don’t expect that suddenly you will start eating more liver, sauerkraut, and lentils — and everything will pass. Anemia is not treated with diet. Anemia is treated with medication.

If iron deficiency is mild, you can still try to restore it through diet. But in 9 out of 10 cases, if you do not get treatment, your condition will not improve. Therefore, consult a doctor in time — it can really save your life.