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What is Anaemia?
Anaemia is a general term referring to a shortage of red blood cells or a reduction in their haemoglobin content. Haemoglobin is the pigment in the blood that carries oxygen in the red blood cells. A shortage of these red blood cells means that the blood is unable to carry adequate amounts of oxygen to all parts of the body. The subsequent reduction in oxygen in the tissues can cause severe damage.

Good sources of iron include liver, beef, wholemeal bread, cereals, eggs and dried fruit.
You get anaemia when you don't have enough red blood cells. This makes it difficult for your blood to carry oxygen, causing unusual tiredness and other symptoms.

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.

Red blood cells and oxygen
Term watch
Artery: takes blood from the heart to the body.
Vein: takes blood back to the heart.

Through its pumping action, the heart propels blood around the body through the arteries.
The red blood cells take up oxygen in the lungs and carry it to all the body's cells. Your cells use this oxygen to fuel the combustion (burning) of sugar and fat which produces the body's energy.
During this process carbon dioxide is created as a waste product. It binds itself to the red blood cells that have delivered the oxygen.
The red blood cells then transport the carbon dioxide back to the lungs. We exchange this carbon dioxide for fresh oxygen by breathing.
This process is called oxidation.

Why does a lack of iron cause anaemia?
Red blood cells are made in the bone marrow and circulate in the blood. They only have a life expectancy of about four months.
The body needs iron, vitamin B12 and folic acid (one of the B group of vitamins) to produce more red blood cells. If there is a lack of one or more of these nutrients, anaemia will develop.
Iron deficiency anaemia is the most common type of anaemia. In the UK 8 per cent of women have this type of anaemia.
Iron deficiency is more frequent in women who smoke, eat a diet low in iron and have heavy periods. It is also common in vegetarians.

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 asin 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.

What are the symptoms of iron-deficiency anaemia?
If a person is otherwise healthy, it can take some time for the signs of anaemia to appear.
The first symptoms will be tiredness and palpitations (awareness of heartbeat).
Shortness of breath and dizziness (fainting) are also common.
If the anaemia is severe, you may experience angina (chest pain), headache or leg pains (intermittent claudication).

Besides these general symptoms of anaemia, in pronounced and long-term cases of iron deficiency there may be:
burning sensation in the tongue
dryness in the mouth and throat
sores at the corners of the mouth
altered sense of touch
brittle, spoon-shaped nails with vertical stripes and a tendency to fray
pica (an insatiable craving for a specific food, eg liquorice)
brittle hair
difficulty swallowing.

In rare cases, iron deficiency can cause permanent changes to the soft lining in the throat (Plummer-Vinson syndrome). This condition is a preliminary stage to cancer of the oesophagus.

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.


Anaemia in cancer
Anaemia has been reported to affect over 50 percent of cancer patients. Numerous factors are involved, the most significant of which are shortened red blood cell life span, blood loss and suppression of production of red blood cells.

In addition to fatigue, many of the other consequences of cancer-related anaemia, namely cardiovascular, gastrointestinal and vascular symptoms, can adversely affect the quality of life of patients and possibly alter their response to cancer treatment. Studies have shown that the symptoms of cancer-related anaemia are exacerbated by commonly used cancer treatments, particularly platinum-based chemotherapy.

Management of anaemia in cancer
Anaemia in cancer used to be left largely untreated and was regarded by many physicians as a minor aspect of the disease and associated therapy. Nowadays, however, recognition of the severity of the negative impact of anaemia on quality of life, through fatigue, depression, nausea and the inability of patients to work or fulfil their social roles, has led to anaemia management becoming an integral part of quality treatment for cancer patients.

Previously, blood transfusions were the mainstay of treatment for cancer-related anaemia. However, approximately 20 percent of blood transfusions are associated with adverse reactions, some of which may be severe and/or life threatening. Nowadays recombinant human erythropoietin (rh-EPO) is used to treat anaemia. Erythropoietin acts by stimulating the production of red blood cells and prolonging their survival.

Anaemia in chronic renal disease (renal anaemia)
Anaemia is extremely common in chronic renal disease (CRD), affecting up to 90 percent of patients. Renal anaemia is found not only in patients with end stage renal disease (ESRD) receiving dialysis treatment, but also in patients who are not yet on dialysis. One of the most obvious consequences of renal anaemia is impaired function of the heart and blood vessels (cardiovascular dysfunction).

Management of renal anaemia
The extent of the devastating consequences of renal anaemia was not fully revealed until the development of recombinant human erythropoietin (rh-EPO). Following treatment with rh-EPO, patients showed improvements in many areas, including physical performance, contractility of skeletal muscle and overall well being. Nowadays, rh-EPO together with iron therapy is a standard treatment for hemodialysis patients with renal anaemia. However, treating renal anaemia in patients not yet receiving dialysis is extremely important in order to avoid cardiovascular dysfunction in the long term.
 

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