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

NEED TO DETERMINE TYPE OF ANEMIA BEFORE DECIDING ON TREATMENT

Question: I went to the doctor for my physical last month, and my blood work shows that I am anemic. My hemoglobin level was 10.5 -- whatever that means. My doctor wants to do more tests, but my mother says all young women are anemic and that it is normal to be anemic. I feel fine, so maybe I should do what my mother says instead of what my doctor says. What do you think?

Answer: I don’t want to get in the middle of a family problem, but in this case your mother should leave the medical care and advice to your doctor. Anemia is not normal for anyone, and the cause should be determined so it can be treated properly.

Anemia is defined as having less hemoglobin than normal in the blood or fewer red blood cells than expected. In women the normal hemoglobin level is 12.1 to 15.1 grams per deciliter (gm/dl). Your level of 10.5 is too low.

Basically there are three processes that can lead to anemia: (1) blood loss, either acute or chronic, (2) under-production of red blood cells by the bone marrow or (3) increased destruction of red blood cells, a process called hemolysis. Each of these types of anemia is diagnosed and treated differently.

When your mother suggests that all women are anemic, she probably refers to monthly blood loss from menstrual periods. The fact is that normal menstrual blood loss does not generally cause anemia. However, some women -- especially those who experience heavy periods -- can develop a specific type of anemia as a result of menstrual blood loss. In these cases, the menstrual blood loss depletes a woman’s iron stores, which causes her body to under-produce red blood cells. This is referred to as iron deficiency anemia and is treated by taking an iron supplement.

Iron deficiency anemia is diagnosed by blood tests to determine your iron levels. These are probably some of the additional tests your doctor wants to run. They may include a serum iron test that measures the amount of iron in the blood, and a serum ferritin test that looks for a special protein that helps store iron in the body. These tests can help your doctor get an estimate of your body’s iron reserves.

There are also a number of causes of underproduction of red blood cells that are unrelated to blood loss. One of these is low levels of vitamin B-12 and folate. Another is a hereditary type of anemia called thalassemia. This disorder, which can run in families, is caused when you inherit a genetic tendency to under-produce red blood cells. Some medications can also suppress red blood cell production.

Hemolytic anemias are caused by destruction of red blood cells. This can be due to genetic problems like sickle-cell disease, trauma, infection, and artificial heart valves.

So as you can see, there are many types of anemia. Treatment of each is based on the specific cause. That is why it is important to find out which type of anemia you have so that your doctor can prescribe the correct treatment.

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.