1.09.2012

Something more about my anemia

In my New Year Resolutions I wrote I am determined to heal and the first stop is to find out what exactly I have got. My doctor is great but unfortunately - for both of us - she's very sick too at the moment and it isn't sure she can even come back, not soon that's sure. I am... or used to be a very healty person so went to see her after a long time and found a young male doctor instead. He looked cleaver and scrupulous, ordered me many tests and honestly told he wasn't going to stay till the new year. He had the time to see my first results, diagnosed me a severe anemia but failed to find out its cause. He was very impressed: some of my blood results were so below the normal values it's a miracle I went there walking. Ok, that explains something!
According to Wikipedia "Anemia from Greek ἀναιμία anaimia, meaning lack of blood) is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency.
Because hemoglobin normally carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs. Because all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.
There are several kinds of anemia, produced by a variety of underlying causes. The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis)." The last one is probably my case.
Reading about the symptoms of anemia I jumped on my chair more then once: many of them are way too familiar to me but referred to other - some times weird - causes: allergy, stress... I have been treated for allergy and asthma since when I can remember and before, then decided that I prefered to have dry lips and hay fever then to take cortisone and with age I got much better.  I always did sport: artistic gymnastic, ski, alpinism, cycling and traveled a lot skiping lots of meals. My iron stock finished and my body isn't very good in assimilate it. That's why I started feeling so weak all the time: "Most commonly, people with anemia report non-specific symptoms of a feeling of weakness, or fatigue, general malaise and sometimes poor concentration. They may also report dyspnea (shortness of breath) on exertion. In very severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. The patient may have symptoms related to this, such as palpitations, angina (if preexisting heart disease is present), intermittent claudication of the legs, and symptoms of heart failure."
One of the thing that impressed me more there is that: "Pica, the consumption of non-food based items such as dirt, paper, wax, grass, ice, and hair, may be a symptom of iron deficiency. Restless legs syndrome is more common in those with iron-deficiency anemia. Iron deficiency is sometimes the cause of abnormal fissuring of the angular (corner) sections of the lips (angular stomatitis)." Well, when I was a child I used to eat paper, suffered of 'angular stomatism' (dry lips with cracks at the corners) and still have sometimes that 'restless legs syndrome'. No doctors ever thought it could be anemia.
It's very surprising also that they didn't find it while my pregnancy, when every month I did a blood test. But how do they find it? "Anemia is typically diagnosed on a complete blood count. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. 
In modern counters, four parameters (RBC count, hemoglobin concentration, MCV and RDW) are measured, allowing others (hematocrit, MCH and MCHC) to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements.
WHO's Hemoglobin thresholds used to define anemia (1 g/dL = 0.6206 mmol/L)
Age or gender group Hb threshold (g/dl) Hb threshold (mmol/l)
Children (0.5–5.0 yrs) 11.0 6.8
Children (5–12 yrs) 11.5 7.1
Teens (12–15 yrs) 12.0 7.4
Women, non-pregnant (15yrs) 12.0 7.4
Women, pregnant 11.0 6.8
Men (>15yrs) 13.0 8.1
When the cause is not obvious, clinicians use other tests: ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12, hemoglobin electrophoresis, renal function tests (e.g. serum creatinine). When the diagnosis remains difficult, a bone marrow examination allows direct examination of the precursors to red cells."
I know what I have more or less: an iron defincency anemia. But causes aren't clear yet. I must do more tests. "Iron deficiency anemia is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope. Iron deficiency anemia is caused by insufficient dietary intake or absorption of iron to replace losses from menstruation" a large part of women is anemic, 20% in USA it seems! "or losses due to diseases. Iron deficiency anemia can also be due to bleeding lesions of the gastrointestinal tract. Fecal occult blood testing, upper endoscopy and lower endoscopy should be performed to identify bleeding lesions. In men and post-menopausal women the chances are higher that bleeding from the gastrointestinal tract could be due to colon polyp or colorectal cancer. Worldwide, the most common cause of iron deficiency anemia is parasitic infestation (hookworm, amebiasis, schistosomiasis and whipworm)."
The problem is that some of those tests are incompatible with iron treatment and first of all I need to reintegrate tons of iron, infact "mild to moderate iron-deficiency anemia is treated by oral iron supplementation. When taking iron supplements, it is very common to experience stomach upset and/or darkening of the feces. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit. In severe cases of anemia, or with ongoing blood loss, a blood transfusion may be necessary." NO THANKS!
In the next days I'll do another blood test to see if my values are geting normal. After that I must stop the iron treatment in order to do a fecal occult blood testing (nice eh? :P ) to exclude bleeding lesions of the gastrointestinal tract and tests to find any parasits (BLEAGH).
Meanwhile I can say I feel much better, stronger finally and able to train again at the gym and by bike. Nothing more then half an hour and suffering, be sure. Anyway it's great to feel your body react and you can become sweaty without geting ill. Very often I think about athletes who had to stop because of a serious crash or sickness and start again preparing to compete: they are very motivated and motivation makes them work hard in spite of pain and frustration. We all need motivation to do things. My big problem at the start of this 2012 is a slight lack of motivation... let me see... ah yes I must be healty and fit to be where I want to be :)

2 comments:

Shane said...

Try to check and see if you have a wheat/gluten allergy. My grandmother was iron deficient for decades, then finally was diagnosed as coeliac. She stopped eating wheat, her stomach healed and her body absorbed iron once again.

It meant that after getting regular iron injections for many, many years, she was able to give them up and have normal blood values via her food alone.

Good luck!

Shane

Ilaria said...

Thank, it could be and I have also that test in my list. I really hope to find out something clear, no matter if I have to change my diet :)