Connect With A Hematologist Near You
Introduction
Anemia is an 8 hour seminar at best. So I’ve condensed the topic to include only superficial considerations of first exposure, risk, screening, and basic lab interpretation.
Disclaimer
A good internist or pediatrician works up anemia while they treat the most likely causes. Rule out the bad, treat the likely as you do so. Trust your doc unless it really looks like she is just throwing dirt in a hole without asking why it’s there. If you suspect that, you could miss something. In that case, get the second opinion of hematologist.
Discussion
We look at the CBC (complete blood count) when we say you have anemia. Your H&H (hemoglobin and hematocrit) is down. Hemoglobin is the protein in your red blood cells (RBCs) that carries oxygen. Hematocrit is a reflection of RBC count. Either tells a physician your oxygen carrying capacity in terms of a ratio. So, if there is certain blood loss, even severe, your hemoglobin and hematocrit are going to look great. So, H&H are absolutely worthless in that setting. With sudden blood loss, you have to instead follow things like blood pressure and heart rate. In sudden blood loss situations, blood pressure would drop. Heart rate would go up. Correct those and you’re getting control of that kind of anemia.
So, back to more gradual blood loss types of anemia. Those things will gradually drop your H&H, Especially if your body is ability to produce RBCs can keep up with the loss. To get a handle on the bodies ability to reproduce but bottles, we look at the image of her blood cell count in the bloodstream. They are called reticulocytes. A high reticulocyte count means the body is cranking out new blood cells. If you have anemia with a high reticulocyte count, the body production is not the problem. If you have an anemia with a low retic count, that may be a large part of your problem. Doctors can order your retic count in addition to the CBC.
Also in the CBC are these measurements called indices. Complicated. But these are the big pearls for the biggest causes of poor RBC production anemias: low iron and low folic acid, two key ingredients for healthy RBC production. If iron is low, if supplies of it or access to it are the problem, your RBCs come out too little. So, your mean corpuscular volume (MCV) will be small. Supplementing iron (fairly constipating stuff so often done with buffers to minimize this) may be the answer. And this is often prescribed while the anemia is worked up. It takes 90 days to make an RBC, so the response to iron in an iron deficiency anemia may be this slow.
If your MCV is normal or large, that tends to rule out low iron – it’s not an iron problem. If your MCV is normal or large and you are anemic, it’s most commonly associated with low folic acid. Supplementing folic acid may be the answer. And this is often prescribed while the anemia is worked up.
Iron studies are followed to see if you have enough iron supplies. These iron associate studies are thus also part of the assessment of RBC production. Iron binding capacity, specifically, is followed more often because it’s easier to track how saturated your blood proteins are with iron than to simply measure iron levels. That is, iron binding capacity is more sensitive to poor iron storage problems than just iron levels. So, it starts getting kind of complicated.
I’ll try to simplify it a bit. For the slow causes of anemia, you can guess that the big groups are probably problems of production and problems of destruction. Well, you’re right.
Problems of production are further broken down into problems your bone marrow (where most blood is made) has making the RBCs and problems your bone marrow has in getting the blood it makes out of the marrow. The biggest clue to the latter being your problem is that all your blood cell lines (so not just the RBCs, but also white blood cells and platelets) are down. All seen in the CBC folks. So, not rocket science there. These are things like cancer bogging down the marrow so outflow of all cell lines goes down. Make sense?
Problems of destruction are generally broken down into autoimmune and non-autoimmune. In autoimmune conditions, your body has in error and often in response to drugs (go drugs!) started making antibodies against your RBCs. The antibodies attach themselves to your RBCs and make your body destroy them. Not good, right?!
Non-autoimmune destruction of RBCs is broken down into two other big groups, genetic disorders and non-genetic.
Conclusion
The nuances aren’t important. But it’s important to elucidate exactly what your anemia is caused by in order to find the correct care. If that is wrong or doesn’t match your actual need or is delayed, that’s… Bad.
Here’s where the correct diagnosis is… Key.
Stay well!
