By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ANEMIA TREATMENTS VARY -- ONE SIZE DOESN’T FIT ALL

Question: My doctor says I am anemic, and now she wants to do a bunch of tests. I thought all women were anemic from their periods. Why can’t I just take some iron without having more tests?

Answer: Contrary to popular beliefs, most women do NOT become anemic from their periods. And it sounds like you have a very good doctor who wants to be thorough. There are many different types of anemia, all with different causes. To treat it properly you have to know the kind of anemia you are dealing with.

It might help to start out with a simple definition. Anemia occurs when your blood doesn't have enough hemoglobin -- a substance your body manufactures from the iron in your diet. The hemoglobin in your blood helps red blood cells carry oxygen from your lungs to all parts of your body.

The symptoms of anemia vary depending on the type and severity. They can include: fatigue, weakness, not doing well in work or school, low body temperature, pale skin, rapid heartbeat, shortness of breath, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, and headache. Not everyone with anemia will have all these symptoms, but if untreated, you may develop more of them with the passage of time, and they may be more pronounced.

Now, let’s look specifically at some of the causes and types of anemia. The most common type of anemia in adults is iron deficiency anemia (IDA). While it can sometimes be caused by very heavy menstrual bleeding, it can occur as the result of any type of blood loss. To make this diagnosis, your doctor may ask for blood tests to determine the amount of iron in your blood. She may also want you to test your stool to see if you are having bleeding from your gastrointestinal tract.

People with ulcers can lose enough blood to develop IDA. This type of anemia is also seen in people with very poor dietary habits who do not eat enough foods that are high in iron, like dark green vegetables, red meat, dried fruits (apricots, prunes and raisins), lentils and beans.

Another type of anemia is macrocytic anemia. This is caused by a deficiency of either vitamin B-12 or folic acid. Low B-12 anemia is also called pernicious anemia. Two common causes of this are an extremely poor diet and gastric bypass surgery. The B vitamins are absorbed in the gastrointestinal tract, so if a large part of your intestine has been bypassed, you will not absorb enough B vitamins. Low B-12 levels are also sometimes seen in those who follow a strict vegetarian diet. On the other hand, low folic acid is caused by not eating enough fruits and vegetables.

Anemia can be caused by chronic disease. Chronic renal disease, some connective tissue disorders, cancer, and low thyroid hormones frequently are associated with anemia. Also, there are some uncommon types of anemia that occur when your body breaks down its own red blood cells. Finally there is a type of anemia that is genetic and can be inherited.

So as you can see, treating anemia is not a “one size fits all” proposition. Knowing the type and cause of your anemia is crucial for proper care. Once your test results are back, your physician can counsel you about dietary adjustments and other treatment options.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.