What is Anaemia? Anaemia is derived from Greek meaning lack of blood.

It is a process, not a disease, and is the most common disorder of the blood. It occurs when the amount of red blood cells or haemoglobin (oxygen-carrying protein in the blood) in the blood becomes low, causing the tissues of the body to be deprived of oxygen-rich blood. Anaemia is characterised by a reduction in size, number, or colour of red blood cells (RBC) which results in reduced oxygen-carrying capacity of the blood. The blood of an anaemic person has trouble carrying oxygen to tissues and organs, in a sense, become "starved" of oxygen and without oxygen, the tissues cannot produce energy to function. In order for the body to stay healthy, organs and tissues need a steady supply of oxygen. Anaemia is the most common disorder of the blood. The number of red blood cells can drop if there is:

a reduction in the number of red blood cells produced an increase in the loss of red blood cells. When the body has sufficient iron to meet its needs (functional iron), the remainder is stored for later use in the bone marrow, liver, and spleen.

There are several kinds of anaemia produced by a variety of underlying causes, but the most common and most severe type of anaemia, iron-deficiency anaemia (IDA). Just as the name implies, this form of anaemia is due to insufficient iron. The principal cause of irondeficiency anaemia in premenopausal women is blood lost during menstruation. During their reproductive years, women are at an increased risk of iron deficiency because they lose the iron their body retains per month during the menstrual cycle. Inadequate iron needs to be replenished through a well balanced diet. Iron balance is maintained through the absorption mechanism of the gastrointestinal tract. Other common causes of anaemia include: eating inadequate amounts of iron-rich foods, a deficiency of Vitamin B-12, a deficiency of folic acid, or poor iron absorption by the body. What is the role of iron in the body? Iron is responsible for the transport and storage of oxygen within working muscle cells including the heart. Within each red blood cell are proteins called haemoglobin and embedded in each haemoglobin protein are four iron particles. These iron particles give the red blood cell the ability to transport oxygen. Iron binds to oxygen in the lungs and then circulates the oxygen-rich blood to the tissues of the body. Inadequate iron availability results in reduced production of red blood cells. Consequently, the red blood cells that do form are small, with less haemoglobin and a decreased oxygen-carrying capacity. The total amount of iron in the body is dependent on intake, loss, and storage of the mineral.

What causes this type of anaemia? Most childhood cases are caused by a poor diet that contains little iron. In adults the most common cause is losing blood faster than the body can replace it.

A lack of iron in the diet is common in vegans and vegetarians because the main dietary source is red meat. Babies can develop iron deficiency, especially if they are premature. Storing iron is not usually completed until the final stages of pregnancy. The body needs more iron when a large amount of cell divisions occur, such as in pregnancy and during periods of rapid childhood growth. Loss of blood through heavy menstruation can deplete iron stores. Diseases of the small intestine such as gluten intolerance (coeliac disease) and Crohn's disease (inflammation of the intestine) can reduce its ability to absorb iron. If there seems to be no cause for the iron deficiency, consult your doctor. Less commonly, small ruptures in the intestine due to cancer or polyps (small growths), and ulcers in the stomach and small intestine can cause iron deficiency anaemia. The loss of blood from the digestive tract may be so slight as to be undetected on its own.

Signs and symptoms Anaemia goes undetermined in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the anaemia itself, or the underlying cause. Most commonly, people with anaemia report non-specific symptoms of a feeling of weakness, or fatigue, general malaise (a general feeling of illness or sickness) and sometimes poor concentration. They may also report dyspnoea (shortness of breath) on exertion. Severe anaemia may cause a condition called high-output heart failure, where the heart must work harder to provide enough oxygen to the brain and other internal organs. The heart beats faster and increases the amount of blood that is delivered per minute. When this condition occurs in individuals that have existing heart disease, the heart may be unable to keep up with this increased demand, and symptoms of heart failure such as difficulty breathing and leg swelling may occur. Individuals, who have coronary artery disease, or narrowing of the blood vessels supplying blood to the heart, may develop symptoms of angina, the pain associated with an insufficient blood flow to the heart muscle. On examination, the signs exhibited may include pallor (pale skin, mucosal linings and nail beds) but this is not a reliable sign. Pica, the consumption of non-food based items such as dirt, paper, wax, grass, ice, and hair, may be a symptom of iron deficiency, although it occurs often in those who have normal levels of haemoglobin.

How is anaemia diagnosed? A blood sample is taken and sent off to the laboratory. An analysis of the red blood cells is usually included with the result of the test. In pronounced iron deficiency the red blood cells will be small and pale. Otherwise, further analysis is needed to examine the proteins called ferritin and transferrin that are involved in the storage and transport of iron through the body. How is it treated? Iron tablets (supplements) will rapidly reverse anaemia, so long as any underlying cause of blood loss has been treated. The tablets can irritate the stomach and should be taken after food to prevent this. Iron tablets may colour the stools black and cause constipation or diarrhoea. There may be a need for intramuscular iron injections to be given instead of tablets, but this is far less common. What can be done to avoid anaemia?

Eat a varied, well-balanced diet that contains foods from all the food groups (protein, carbohydrate, fat, fruit and vegetables). Good sources of iron include liver, beef, wholemeal bread, cereals, eggs and dried fruit. If you often get heavy periods, it's a good idea to seek medical advice because you may be at risk of anaemia. If you are pregnant or planning to become pregnant, talk to your doctor about iron supplements.

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