Understanding Iron Deficiency and Pernicious Anaemia
What is anaemia?
When we hear the term anaemia we automatically think about being pale and taking iron tablets. However, as always with the human body, it's not that simple. For a start iron-deficiency anaemia is only one kind - there are many different forms. All are serious and some potentially life-threatening. In this article we'll concentrate on two of the best known: iron deficiency and pernicious anaemia.
The NHS UK gives the following definition for anaemia:
"Anaemia is a condition where the amount of haemoglobin in the blood is below the normal level, or there are fewer red blood cells than normal.
There are several different types of anaemia and each one has a different cause, although iron deficiency anaemia is the most common type."
As we can see from this definition, anaemia can be more complex than first thought, so let's have a look at this condition in a little more depth.
Our blood and anaemia
Iron deficiency anaemia is the most common form. In order to understand more about the complaint we'll first of all take a look at our blood and how anaemia affects it.
The blood is made up of certain elements:
- Proteins and various other chemicals that have important functions.
- White blood cells - they fight off infections and pathogenic organisms.
- Platelets - these clot the blood when we get an injury such as a cut.
- Red blood cells - that take oxygen around the body.
- Plasma - is a yellowish fluid and is the largest component of the blood. Other substances within the blood such as the cells, nutrients etc., are carried within the plasma, so transported throughout the body.
It is the red blood cells that are our main concern when talking about anaemia.
Red Blood Cells
These are by far the biggest group of blood cells and they are also called erythrocytes. They are so small that one drop contains millions of these tiny cells. However, their role in the body is crucial for health and for life. Their main function is to deliver oxygen to body tissues and to take away waste such as carbon dioxide.
The cells are coloured red because of a special protein called haemoglobin which contains iron. The mineral iron is essential to help the body make the haemoglobin. If we didn't have haemoglobin then oxygen taken into the body wouldn't be transferred around the body. In addition, the waste product carbon dioxide attaches to the haemoglobin as soon as it releases the oxygen. The carbon dioxide will then be taken to the lungs to be expelled.
Red blood cells last about 120 days and then die off but the body keeps a constant supply going by continually making new red cells in bone marrow. In order for the body to be able to do this we must take essential nutrients in our diet. In particular:
- Vitamin A
- Vitamins - B2, B9, B12,
- Vitamins C and E
These minerals and vitamins have a particular role to play in the health and production of red blood cells. You can have a look at the table in this hub for a better idea of what these nutrients do.
Let's now look at the different types of anaemia and their causes.
Preventing and treating anaemia
Vitamins & Minerals For Iron Deficiency Anaemia
Iron - a mineral required to make haemoglobin.
Vitamin B2 (riboflavin) - has many roles including blood cell production.
Vitamin B12 (cyanocobalamin) - making red blood cells, DNA, RNA and helps to keep the nervous system healthy.
Vitamin B9 (folic acid) - has a role in making DNA, RNA and red blood cells but contributes to many more body activities.
Vitamin C - helps iron to be absorbed into the body more easily. Also for healing and overall health.
Vitamin E - helps to keep red blood cells healthy.
Iron deficiency anaemia
Iron deficiency anaemia is obviously the most common form of anaemia, and depending on the cause it can develop rapidly. In other words, it's not just lack of minerals such as those named earlier in the diet there can be other causes such as:
- Heavy menstrual periods - women should take additional nutrition as well as iron at these times.
- Growth spurts in young people - it's important to ensure that growing youngsters have all the nutrients they need at these times and extra when required.
- Pregnancy - taking a balanced diet packed with nutrients is the best way to avoid anaemia in pregnancy.
- Medical conditions where there is poor absorption of iron such as Crohn's Disease.
- Internal bleeding especially from the gastrointestinal tract.
- Diseases of the blood such as thalassaemia. This is the name for a group of inherited blood disorders where the body's ability to make red blood cells is affected.
- Bone marrow problems
- Other medical conditions such as kidney disease, leukaemia.
As we can see there are a number of factors that may contribute towards iron deficiency anaemia other than diet. In addition, having anaemia can lead to other medical complications such as being more prone to viruses and infections. In severe cases anaemia can even lead to disruption in the heart's rhythm and heart failure.
The main symptoms of iron deficiency anaemia are caused by a lack of oxygen getting to the body tissues and are described as:
- Being constantly tired and lethargic - some people also feel a little breathless at times.
- Some people look pale. When anaemia occurs the body keeps blood for essential organs and reduces the amount to less important areas such as the lower, inner eye. When you go for an examination and your doctor suspects anaemia, they will probably look inside your lower eyelid to see how pale it is. This is a classic symptom of anaemia.
- Other symptoms may develop but are less common such as palpitations, headaches, lack of taste and tinnitus.
The most common reason for people having a lack of vitamin B12 in their body - apart from dietary deficiency or medical disorders - is due to pernicious anaemia. This is an auto-immune condition affecting the stomach. An auto-immune condition is one where your body's immune system, for some reason, starts to attack healthy cells somewhere in your body.
Vitamin B12 is absorbed into the body from the stomach. The stomach has specialised areas called the parietal cells that excrete a unique protein called the 'intrinsic' factor. This chemical helps to take out the B12 contained in food and absorbs it into the body. With pernicious anaemia this protein is destroyed by the body's own immune cells.This leads to a deficiency in vitamin B12. Why this condition arises is not yet known. However, according to NHS UK and other medical institutions there are certain factors that increase the chances of developing pernicious anaemia:
- Female - the chances of having pernicious anaemia are slightly higher than for men.
- Age - this condition usually starts at about the age of 60 years old.
- Family history/genetics - if the condition runs in the family you are more likely to develop it.
- Other medical conditions - in particular if a person has another auto-immune disorder - for example Addison's Disease - medical research has shown a link with them and pernicious anaemia.
In order to replace the vitamin B12 that can't be absorbed into the body, an injection has to be given - usually B12 is given in a form called hydroxocobalamin. Administering the B12 in this way by-passes the stomach ensuring that the vitamin gets into the body systems.
What does Vitamin B12 do?
Vitamin B12 carries out a lot of work in the body such as:
- keeping nerve cells in good condition and helping to make DNA. However, in relation to anaemia it's vital role is to help keep blood cells healthy. Lack of vitamin B12 in the diet or the inability to absorb it through the stomach can have serious health consequences. Another type of anaemia can also be caused by vitamin B12 deficiency and this is called Megaloblastic anaemia. This is where the blood cells are slightly enlarged and fewer in number than the normal count. This leads to less oxygen being carried around the body - vitamin B12 helps to rectify this condition.
- Helps to make red blood cells, DNA & RNA
- Works with folate to regulate blood cell production
- Helps iron to work more efficiently
For most people, B12 deficiency shouldn't be a problem as the body stores large amounts of this vitamin. However, foods that are good sources for B12 are - meat, fish, dairy products and fortified cereals.
Signs and symptoms
- People can experience a variety of neurological symptoms for example, tingling, numbness - usually in the legs or arms. Other symptoms include being clumsy, uncoordinated movements, personality changes. This is in addition to the usual signs and symptoms of anaemia such as lethargy, tiredness, etc.
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Food and anaemia - what should you be aware of
There are particular foods that, when taken with others that are rich in certain nutrients, can actually block them being absorbed into the body. To explain this further I've given brief descriptions of what foods shouldn't be eaten together when preventing or treating anaemia.
Foods to avoid taking together if you have anaemia
Iron deficiency anaemia - when taking foods that are rich in iron be careful about having high fibre foods at the same time. Fibre can cause iron absorption problems. However medical researchers are divided on the subject of just how much fibre can influence nutrient absorption.
Taking high fibre foods and iron rich foods at different times is much better for treating and preventing iron-deficiency anaemia. However, as always, speak to a medical professional first. This article is for information only. In addition, the Canadian School of Natural Nutrition, (CSNN), recommend also that people with iron deficiency should avoid drinks such as tea, coffee and soft drinks, as well as foods with lots of additives as these can all block absorption of iron.
B12 deficiency - As with iron rich foods, don't eat B12 rich foods at the same time as high fibre items.
B9 (Folic Acid Deficiency anaemia) - this is another common form of anaemia and is usually caused by lack of vitamin B9-folic acid in the diet. Since the body cannot store folic acid a fresh supply is needed frequently. Folic acid is essential for helping the body make new cells including blood cells and a lack of this in the diet can lead to anaemia. The symptoms are usually the same as those for iron deficiency anaemia. Other causes of this type of anaemia can be pregnancy - where the supplies of folic acid are used to help the growing baby. Some medical conditions and medicines can also cause this type of anaemia.
When preparing food avoid over cooking as this can destroy folic acid. Eating vegetables raw are one of the best sources of folic acid.
I hope this article has been of some use to everyone who has anaemia. However, this article is for information only. If you suspect you have anaemia you should speak to your doctor as soon as possible.