Anemia

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Deficiency of red cells, or hemoglobin, in the blood.

Anemia is a medical condition in which the quantity of red blood cells falls below an acceptable level. Red blood cells, produced in the bone marrow, contain hemoglobin, the component of blood that carries oxygen from the lungs to the body's tissues. Red blood cells circulate in the blood for about 120 days and are then filtered out by the lymphatic system and destroyed, usually in the spleen. When more cells are destroyed than are produced, anemia can result.

Anemia can range from mild to life-threatening in severity, and has a number of causes. The disease can be caused by a single significant blood loss or from a long-term chronic illness. Fetal anemia can develop when the mother's and fetus's blood have Rh factor incompatibility. During prenatal tests and newborn examinations, the mother and infant are routinely tested for anemia.

The most common form of anemia results from a deficiency of iron, a key component for the production of hemoglobin. In infancy, iron-deficiency anemia is a problem for infants who are not breastfed, or who are born in developing countries where adequate nutrition ormedical attention may not be available. Researchers have discovered that one technique to prevent iron-deficiency anemia among newborns is to wait for about one minute after birth before clamping the umbilical cord. This enables more blood to flow from mother to infant.

Toddlers and young children may develop anemia when they are introduced to solid foods and the variety of their diet becomes important. According to Ibrahim Parvanta, a nutritionist with the Centers for Disease Control and Prevention in Atlanta, Georgia, children ages 6-24 months may have insufficient iron stored in their systems to meet their bodies' needs during this phase of rapid physical growth. He estimates that approximately 9% of children in this age group have at least mild iron deficiency. Symptoms of iron-deficiency anemia are fatigue, paleness, headaches, dizziness, and lowered immunity. In infants and children, iron-deficiency anemia can be a serious condition, resulting in impaired physical and mental development.

Iron requirements increase during periods of rapid growth and at the onset of menstruation in girls. Anemia in adolescence is most commonly iron-deficiency anemia. Teenage girls, concerned about their weight, often have diets that are inadequate in iron; an estimated one in four adolescent girls has iron deficiency.

Treatment of iron deficiency usually begins with a doctor's recommendation to increase iron in the diet, or perhaps with a prescription for iron supplements. Iron-rich foods are of two types. The first type of food contains heme iron, which is easier for the body to absorb. These include liver, red meat, poultry, and fish. The second type contains nonheme iron, less easily absorbed by the body, and includes dried apricots, prunes, dates, raisins, beans, tofu, nuts, and leafy green vegetables, such as spinach. Absorption of iron by the body is aided by vitamin C, so adding citrus fruits to an iron-rich meal improves the body's ability to make use of the iron. Using iron cookware to prepare foods also increases the iron content of foods. In general, it is preferable to treat anemia by adding iron-rich foods to the diet, since some people experience nausea when taking iron supplements.

Iron in large quantities is also toxic. The National Capital Poison Control Center at Georgetown University in Washington, DC, reports that from 1988-1992, accidental poisoning from overdose of iron supplements accounted for about 17% of all children's deaths reported to poison control centers. Iron supplements should be considered poisonous, and kept out of the reach of children.

Thalassemia is a genetic disorder of the blood in which the red blood cells are small and fragile. Thalassemia is found among people of Mediterranean, Middle Eastern, or Southeast Asian descent, and is sometimes referred

Note: Because iron is stored in the body, the RDAs represent the recommended average intake, not the recommended amount of iron to be consumed daily.
Infants up to 6 months:	6 mg
Children 6 months to 10 years:	10 mg
Females ages 11 to 50:	15 mg
Pregnant women:	30 mg
Women 60 and over:	10 mg
Males ages 10 to 18:	12 mg
Men 18 and over:	10 mg

to as "Mediterranean anemia." The most severe form, known as beta-thalassemia, thalassemia major, or Cooley's anemia, develops during infancy with slow physical growth and jaundice. The spleen and bone marrow may become enlarged, causing abnormal skeletal development. If untreated, thalassemia leads to death in later childhood or adolescence. Treatment includes blood transfusions or bone marrow transplants. However, a dangerous side effect of transfusions is build-up of excess iron in the system.

Sickle-cell anemia is a genetic disorder that most commonly affects African Americans, but is also found among those of Mediterranean descent. Victims of the disorder have crescent-shaped red blood cells. The unusual shape prevents the cells from carrying oxygen efficiently and causes the cells to become lodged in the capillaries, causing a person intense pain.

Aplastic anemia is characterized by an insufficient supply of all blood cell types, including an abnormal or insufficient production of red cells in the bone marrow. Aplastic anemia, diagnosed in 5,000-6,000 Americans a year, can result from severe viral infections, diseases of the immune system, and hepatitis. It is also associated with cancer therapies such as chemotherapy or radiation therapy, both of which adversely affect the bone marrow's ability to produce red blood cells. If not successfully treated, aplastic anemia results in death for about 85% of those afflicted by the condition.

Aplastic anemia is considered a medical emergency, and a bone marrow transplant is performed as quickly as possible after diagnosis. Bone marrow transplantationfrom a family member is most successful and is recommended for younger patients. Transplantation from unrelated donors has only been achieved in very small children.

Megaloblastic anemia is due to a deficiency of certain vitamins, notably vitamin B₁₂ and folic acid, which causes the marrow to produce red cells that are larger than normal and have reduced oxygen-carrying ability. These abnormal red blood cells are called macrocytes. Sometimes the deficiency occurs when the person's diet is deficient. Vitamin B ₁₂ is found in foods of animal origin, such as meat, fish, and dairy products; folic acid is found in green vegetables and liver. In other cases, the deficiency occurs because the person's body is unable to absorb the B₁₂, a condition known as pernicious anemia.

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