FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

ANEMIA'S CAUSE NEEDS TO BE IDENTIFIED BEFORE TREATMENT CAN BEGIN

Question: I recently had a blood count that was 8.8. I know this is low, but on a relative scale is it a little low or dangerously low?

Answer: First, I want to comment on blood tests in general. Many people think that every time their doctor orders a blood test that the sample is checked for every known malady. As an example, many of my patients have asked me what their blood type is because they have previously had a "blood test" done or, alternatively, they ask if HIV was checked for. Blood typing into the simple A, B, O and Rh groups are of no immediate benefit to the individual unless they are either giving or receiving blood. Consequently, the test isn't done unless there is a specific need for it. HIV testing is unique in that it requires the patient's written consent before it can be done. Therefore, even though blood tests have been done, a "blood type" or HIV test isn't done without a specific reason.

We physicians only order the tests that have a high probability of benefiting the patient. We make these decisions based upon the current symptoms, the history of health problems, the health history of blood relatives, and upon the prevalence of disorders within the society at the person's current age. This process of only ordering tests that have a high probability of identifying problems helps hold health-care costs at a reasonable level. In addition, it reduces the amount of blood that must be taken from the patient to perform these tests.

Now to address the question of your 8.8 lab value. This value is for the concentration of hemoglobin, the oxygen carrying part of the red blood cells. Hemoglobin is usually in the range of 13.5-15 for men and 12-14 for reproductive age women. Therefore, your value of 8.8 is somewhat low. As you probably know, the name for your condition is anemia. In addition to the below normal concentration of hemoglobin that you have, the label anemia also applies to situations where the total number of red blood cells is less than normal.

Your condition falls into the category of mild anemia. Typical symptoms of this condition include fatigue and shortness of breathe with mild exertion. Sometimes, however, a person can have mild anemia with no symptoms at all. The most common reason for anemia is blood loss. A severe injury that produces bleeding is obvious, but that is unlikely to be the culprit or you would have said something about that injury. More likely is a slow but persistent blood loss at a rate that is greater than the rate at which the body is able to make new blood cells. In women this often occurs from heavy menstrual periods.

Bleeding in the digestive tract is also a common cause of anemia in both men and women. This occurs for a variety of reasons including chronic use of aspirin and other NSAIDS, ulcers and cancer. Low iron levels -- either from an inadequate supply of dietary iron or an inability to absorb iron -- can also produce anemia. The inability of the body to absorb iron can be due to disease or the use of certain medications.

And, there are yet other causes of anemia. These include chronic illness such as kidney failure, disorders of the blood cell forming system or exposure to toxic substances.

The issue, therefore, isn't the mild anemia you currently have, but rather, why you have an anemia in the first place. Your doctor will help you identify the cause of your mild anemia and then instruct you in the proper treatment for it.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.