Anemia: What It Means, Symptoms, Treatment and Prevention

Anemia is a condition characterized by an abnormal decrease in hemoglobin concentration in the blood resulting from a lack of one or more essential nutrients. Obstetrician and gynecologist Cassiana Giribela explains that anemia occurs when, whatever the cause, blood hemoglobin levels are below: <12g / dL in women; <13g / dL in men and <11g / dL in pregnant women.

"Most of the time, anemia develops by insufficient iron intake (iron deficiency anemia)," says the doctor. However, it may come from a deficiency of various nutrients such as zinc, vitamin B12 and protein.

Rodolfo Cançado, prof. assistant and head of the discipline of Hematology and Oncology of the School of Medical Sciences of Santa Casa de São Paulo and hematologist at Hospital Samaritano / São Paulo, points out that anemia is not? normal? in any age group. "It's always a warning sign that something is not going well with that person's health," he says.

It is estimated that iron deficiency is present in 1/3 of the world population. That means that about 2 billion people have iron deficiency ?, points out Cançado.

Are there any risk groups?

Cassiana points out that there are some situations more conducive to the development of anemia:

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• Insufficient amount of iron in the diet, or forms difficult to absorb.
• Increasing needs: childhood, adolescence and pregnancy.
• Situations that make iron absorption less effective: gastrectomies, bariatric surgery, cancer, celiac disease.
• Blood loss, physiological (menstruation) or postpartum, or pathological.
• Any bleeding, either acute or chronic.

Cançado points out that the people most likely (most vulnerable) of iron deficiency are: children (especially under three years old), women of reproductive age and pregnant women.

The main symptoms of anemia

Cassiana explains that anemia is associated with depression, poor performance at work and sports, and impairment of cognitive and intellectual functions. "Insufficient iron levels were associated with symptoms such as apathy, irritability, fatigue and difficulty concentrating," he says.

Tired points out that the person with iron deficiency can feel: easy and constant tiredness for no apparent reason, headache, dizziness, irritability, inattention.

• Children may have learning disabilities, not doing well in school; infections more often and growth retardation. Adults tolerate exercise less, have lower work performance, may have palpitation, shortness of breath, discouragement, sometimes simulating even depression. Hair loss, weaker and brittle nails are also symptoms ?, adds Canhado.

The hematologist also comments that the iron-deficient person may have an appetite for non-food things or substances such as dirt, ice, raw pasta, lemon, chalk etc.

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Anemia Diagnosis

The diagnosis of anemia is generally made by observing laboratory (hematological) indicators.

Cassiana explains that you can dose several parameters:

• Hemoglobin dosage is the main parameter.
• Ferritin: Evaluates iron levels in your deposit.
• Transferrin saturation index: amount of iron that is attached to transferrin (iron transport protein). Indicates whether iron mobilization by the body is efficient.
• MCV (mean corpuscular volume) indicates the size of circulating red blood cells. If the size is small, there is little hemoglobin inside.
• Free Iron: Indicates free iron levels in the blood. It may be helpful in determining the cause of anemia.

Cançado comments that the investigation of anemia is as important as its treatment. Because, remember, anemia is always a warning sign that something is wrong with one's health. Often the first sign of a stomach or intestinal tumor (colon) is anemia. Therefore, if we do not investigate the person with anemia, we may be missing the chance to diagnose a tumor at a still potentially curable stage?

• One needs to seek help from the doctor. The diagnosis of anemia is important, but should not be quiet until the cause of anemia is clarified ?, warns Cançado.

Possible complications

Cassiana highlights as possible problems arising from anemia:

• In the central nervous system: irritability, emotional lability, decreased concentration and memory, headache, ataxia (loss or irregularity of muscle coordination), paresthesias (abnormal and unpleasant skin sensation that takes many forms) and sleep disturbances.
• Skin and mucous membranes: fragility of nails and hair and oral fissures.
• Circulatory system: tachycardia and dyspnea.

Anemia during pregnancy: what are the risks?

Cassiana highlights as maternal repercussions of anemia:

• Impairment of physical and mental performance and emotional instability;
• Preeclampsia, cardiovascular changes;
• Decreased immune function;
• Changes in thyroid function and catecholamines;
• Hair loss, weakening nails;
• Risk of postpartum anemia.

Regarding fetal involvement, the following can be highlighted, according to the doctor:

• Gestational losses (miscarriages, intrauterine death);
• Fetal hypoxemia, prematurity, premature rupture of membranes;
• Infectious pictures;
• Fetal growth restriction;
• Anemia in the first year of life due to low iron stores in the newborn.

Cançado comments that the person with iron deficiency (DF) is about to have iron deficiency anemia. For example, in a pregnant woman with DF, the chance of developing anemia in the last 3 months of pregnancy reaches 70%. Because? Why does the child need a lot of iron to grow inside his mother and obviously he takes everything he has from his mother?

Anemia in pregnancy is severe? According to the hematologist, yes. "It increases the risk of miscarriage, prematurity, low birth weight of the child and, in some cases, even causes death risk for both mother and child," he says.

How to treat anemia

The best iron replacement option is orally, according to Cassiana. There are several products on the market for oral administration with different iron salts, differences in absorption and tolerability. The four main iron supplements marketed in Brazil are: ferrous sulfate, polymaltose iron complex (ferripolimaltose), amino chelated iron (bisglycinate iron) and carbonyl iron. These last three in the form of ferric salt. And currently, the most modern is liposome iron ?, he says.

For Cançado, two most important issues that should be discussed are: the length of treatment and side effects of iron-based medicines. • Treatment takes at least 90 days and may extend up to 6 months. This is why some people who get better symptoms stop taking the medicine after 20 or 30 days; and so the anemia comes back soon?

And why do some people stop treatment? • People treated by SUS receive ferrous sulfate, which is a very good, effective medicine, but with many side effects (nausea, vomiting, diarrhea, constipation), which causes the person to stop treatment ahead of time. In these cases, ferric salts, such as ferripolimaltosate, have fewer side effects, which determines better treatment adherence and therefore better results ?, he says.

For this reason, the best treatment, taking into account the particularities of each case, should naturally be indicated by the doctor; and it is essential that the patient follow the guidelines given by the professional to the letter.

Cançado comments that the bioavailability of iron is the efficiency with which the body uses iron in the diet. • There is much talk about improving the diet, ie providing a richer diet; But very little is said about the use of iron-based drugs, which are crucial. Diet is important for the prevention of iron deficiency, but for those who already have iron deficiency and especially for those with iron deficiency anemia, does diet help, but do iron medicines help much more?

Prevention

Cassiana points out that in women, especially losses should be treated when excessive menstruation. "In pregnant women, iron supplements should be used, especially from the 20th week of pregnancy," he says.

Yes, diet is also important for prevention. "A diet rich in iron (sources of iron) means greater intake of meat-based foods, which are rich in heme iron, such as viscera (liver), heart, fish (canned sardines) and chicken," says Cançado.

Non-heme iron in beans, lentils and dark vegetables (kale, broccoli, watercress, arugula, spinach, beets) is much less absorbed (5-10%) than meat iron (30%), but also help ?, highlights the hematologist.

What can enrich and improve iron absorption, according to Cançado, is: cooking in an iron pan and having a glass of citrus juice (orange, lemon, acerola) before or during food.Vitamin C contributes to increase non-heme iron absorption and nullify the effect of iron absorption inhibiting factors. The addition of 50 mg of vitamin C can double the absorption of non-heme iron present in the same meal, he says.

But, remember, anemia should be treated with medical advice. Because diet is really important for prevention, but those who already have iron deficiency and those who already have iron deficiency anemia must also rely on treatment with iron medications, as pointed out Cançado.

Being mindful of health as a whole, taking care of food in general, and whenever you notice symptoms, seek medical help, is the best way to prevent anemia and any other health problem.

What is Anemia? (Lack of Blood) (April 2024)