Anemia: The Loss of Red Blood Cells

April 19, 2017

Anemia, a condition in which the body does not have enough healthy red blood cells, is one of the most common blood disorders. The body needs healthy red blood cells to carry an adequate amount of oxygen to tissues throughout the body, so a person with anemia can suffer physically as well as be at risk for more serious health conditions. Anemia is usually a warning sign of a more serious underlying health issue, so it’s not something that should be ignored.


Why We Need Red Blood Cells

Red blood cells are one of three types of blood cells that the human body needs – the other two being white blood cells and platelets. White blood cells fight infection, platelets help blood clot, and red blood cells have the responsibility of carrying oxygen throughout the body.

Contained in red blood cells is hemoglobin, which is an iron-rich protein. There are different kinds of hemoglobin, and depending on the type, they enable the red blood cells to carry oxygen from the lungs to the other parts of the body, or to carry carbon-dioxide from other parts of the body to the lungs so that it can be exhaled.

To summarize, hemoglobin make up red blood cells, and red blood cells are needed to carry oxygen throughout the body in order for a person to live.

Some Types and Causes of Anemia

There are different types of anemia, with the most common type being iron deficiency anemia, which occurs due to a shortage of iron in the blood. Iron is necessary for bone marrow to produce hemoglobin. Without iron, the body isn’t able to produce enough hemoglobin for red blood cells.

Anemia of chronic disease is anemia resulting from other diseases such as cancer, kidney disease, Crohn’s disease, and HIV/AIDS, etc. which all reduce red blood cell production.

The body also requires vitamin B-12 and folate to produce healthy red blood cells. A lack of vitamin B-12 and folate will also cause a decrease in red blood cell production.

Sickle cell anemia is a serious condition caused by a defective form of hemoglobin which causes red blood cells to form an abnormal shape (sickle shape), in which cells die prematurely and result in a chronic shortage of red blood cells.

Hemolytic anemias are anemias that occur when red blood cells are destroyed faster than they are being produced. Hemolytic anemias can be either inherited or acquired. In inherited hemolytic anemias, the genes which control how red blood cells are produces are defective; in acquired hemolytic anemias, a disease, condition, or other external factor destroys the cells.

Aplastic anemias are a rare form of anemia. They occur when the body stops producing enough red blood cells due to viral infections, drugs, autoimmune diseases, and exposure to toxic chemicals.

Risk Factors for Anemia

There is a wide range of different risk factors for anemia, such as a poor diet, heavy alcohol consumption, infections, and intestinal disorders. However, people who have a high risk of anemia – as previously mentioned – are people with chronic medical conditions such asrheumatoid arthritis, kidney disease,liver disease, thyroid disease,inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and cancer. Women who are menstruating or pregnant and people over the age of 65 are also at an increased risk.

Exposure to toxic chemicals and the use of certain medications, a family history of the condition, can also be the cause of anemia.

Often, though people may be suffering from diseases which are risk factors for anemia, they may overlook the fact that they may have anemia, only learning that they may have it when they are informed of after a blood test.

Also, people who travel to certain areas in the world, where there is the risk of contracting malaria is high, should make sure to get tested – as malaria, already being a dangerous disease, can also lead to severe anemia .

Diagnosing Anemia

Diagnosing anemia involves the doctor first examining the patient’s medical and family medical history, and performing a physical check-up. The doctor will then perform blood tests, including a complete blood count (CBC) and a blood smear to determine the size and shape of red blood cells in the body; the presence of irregular shaped red blood cells may indicate the cause of anemia.

A CBC determines the total number of blood cells from a patient’s blood sample. In diagnosing anemia, the doctor will check for the level of red blood cells and hemoglobin in the blood. The amount of red blood cells determined from a test called the hemoglobin and hematocrit, which is done as part of a CBC.

If anemia is diagnosed, the doctor may perform additional tests to find the underlying cause of the anemia – and to get the appropriate treatment for both the anemia and the underlying condition as soon as possible. For example, iron deficiency anemia may be the result of tumors or kidney problems.


Anemia in Pregnant Women

Anemia in pregnant women is a very serious condition. Along with the complications that any person with anemia will experience, the complications may go further and affect the mother’s unborn child as well. When a pregnant woman has anemia, she does not have enough healthy red blood cells to carry oxygen to the baby.

This may lead to complications such as premature birth, low-birth-weight, child developmental delays, or the baby suffering from anemia itself. With anemia, if the mother loses a significant amount of blood during her delivery, a blood transfusion may be required.

Iron-deficiency is the most common cause of anemia during pregnancy. All pregnant women are at a risk of anemia due to needing more iron and folic acid than usual. The risk is even higher for women who are pregnant with more than one child, have two pregnancies close together, are a teenager, do not eat enough iron-rich foods, vomit often due to morning sickness, or were already suffering from anemia prior to becoming pregnant.

Some women may not realize that they have anemia, so it’s vital to be tested during their first prenatal visit. The doctor may even recommend a second blood test in either the second or third trimester if it is not detected earlier.

During pregnancy, folate requirement is increased. Folate deficiency can increase the risk of the child being born with a serious neural tube defect – a birth defect of the spine or brain.

Generally, during the first prenatal appointment, an expectant mother will have a blood test to check for anemia, which includes a hemoglobin test and hematocrit test.

Anemia Treatment

Treatment of anemia depends on its cause. Generally, if the cause of the anemia is due to a chronic disease, treating the disease will usually improve the anemia as well. But in cases of, for example, aplastic anemia, in which bone marrow stops producing red blood cells, medications and blood transfusions may be required to treat the anemia.

For iron-deficiency anemia, which occurs due to blood loss, doctors may perform tests to see where blood is being lost and prescribe iron supplements. Or with vitamin deficiency anemia, treatment involves the patient changing their diet and taking dietary supplements.

If Left Untreated

If anemia is left untreated, serious health problems can arise. The first and most recognizable symptom is severe fatigue, making everyday function very difficult. Heart complications such as arrhythmia (rapid or irregular heartbeat) may also develop, which may lead to an enlarged heart or even heart failure.

Certain anemia conditions, such as inherited anemias, can also be life-threatening if they become severe.


Although many types of anemia are unable to be prevented, having a healthy diet can help avoid iron and vitamin deficiency – which can lead to anemia in the future. Make sure to have a diet which includes the essential vitamins and nutrients, such as iron, folate, and vitamin B-12, as well as vitamin C.

Dietary supplements may also be taken; however, older adults should consult their doctor before doing so.

If you feel you are at risk of anemia or are already suffering from anemia, please consult your doctor as soon as possible to receive the appropriate treatment.

By Dr . Pairaya Rujiroindakul , Hematologist, Horizon Cancer Center, Bumrungrad Hospital

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