Anemia

What Is Anemia?

Anemia is a relatively common health problem that is characterized by a lack of red blood cells. Red blood cells are cells found in the blood. Among other things, they are used to bring oxygen to tissues and organs. The World Health Organization defines anemia as a hemoglobin level of less than 13 g/dL in adult men, and less than 12 g/dL in women.

Main Causes

To produce red blood cells, the body needs various elements provided by the diet: iron, vitamin B12 and vitamin B9 (or folates). Millions of new red blood cells are produced every day to replace those that are normally destroyed. They are made by the bone marrow.

Decreased iron & vitamin stores

A lack of iron, vitamin B12 or B9, which are essential for the production of hemoglobin. This is the most common cause of anemia and the easiest to treat.

Renal insufficiency or hormone problems

Erythropoietin (EPO) deficiency. This hormone that activates the bone marrow is normally made by the kidneys. Anemia can therefore be linked to renal insufficiency.

Manufacturing issue

A malfunction of the bone marrow, the tissue in the bone where red blood cells and hemoglobin are formed. This bone marrow insufficiency can be caused by a toxic product or a drug. It can also occur as a result of cancer or during natural aging.

Bleeding

A large or small but prolonged loss of red blood cells through bleeding (or hemorrhagia) is responsible for anemia. The cause may be:

• Gynaecological: very heavy periods, uterine fibroids, etc.
• Digestive: gastrointestinal bleeding (peptic ulcer, hemorrhagic rectocolitis, etc.)
• Urological: bladder cancer for instance

Abnormal destruction of red blood cells or hemolysis

This is called hemolytic anemia, a rarer form of anemia. Several causes are possible because it can be genetic and therefore hereditary. Among the hereditary diseases are sickle cell disease or thalassemia. It can also be autoimmune, meaning that the body produces antibodies against its own red blood cells.

How to Treat Anemia?

The treatment of anemia depends on the hemoglobin level in the blood and the symptoms the patient is experiencing. When the hemoglobin level is below 8 g/100 ml, anemia must be treated fairly quickly. This is because it can have serious consequences. In most cases, a blood transfusion is considered.

Iron treatment

To treat iron deficiency anemia, the doctor prescribes an iron-based medication to be taken by mouth and outside of meals. It may cause abdominal pain and black stools, which are not serious and disappear when the treatment is stopped. An iron infusion may be necessary if the losses are important or if the treatment is badly tolerated.

Vitamins B9-B12 - Folates

Treatment differs according to the cause. For example, in pregnant women, a supplementation is systematically prescribed as part of the monthly monitoring of the pregnancy because its needs in vitamin B9 are increased, especially in the first weeks.

EPO, anemia hormone

In some situations, the doctor may prescribe erythropoietin (or EPO) injections. This hormone is naturally produced by the kidney and stimulates the bone marrow to produce red blood cells. It is recommended before an operation because it can limit the risk of transfusion.

Transfusion (as a last resort only)

This is a last resort treatment that should be limited, as it can lead to multiple complications, and is sometimes indispensable. Some surgical procedures may cause bleeding and require you to receive a transfusion. However, the decision to transfuse may be made while you are under anesthesia. Therefore, this information is widely disseminated pre-operatively, and the fact that it is communicated to you does not necessarily mean that you will receive a transfusion. If you had to receive a transfusion during anesthesia, you will be informed of this upon waking up.

Other treatments

Depending on the context and the cause of the anemia, other treatments may be suggested by your doctor. 

Risky Situations

According to the WHO, 25% of the world's population suffers from anemia. Half of these cases are attributed to nutritional iron deficiency. Women with heavy menstrual periods, preschoolers and pregnant women are most at risk for anemia.

Patients at risk: pregnant women, cancer, chronic pathology...

Pregnant women are particularly affected, especially at the end of pregnancy. Indeed, their iron needs increase considerably, due to the growth of the foetus and the placenta, as well as the significant increase in blood volume.

Before a surgical intervention

Anemia must be diagnosed preoperatively and treated in the context of surgery at risk of bleeding. Among the deaths attributable at least partially to anesthesia, "imperfections" in the management of blood loss were noted in nearly one hundred cases per year out of a total of 419 in a study on mortality, i.e., more than 20% of the deaths are attributable to anesthesia over a period of 3 years.

The results of this study show that the risk of non-transfusion or, above all, of transfusion delays is much higher than that of transfusion-related accidents.