Health: Anemia is a complicated condition with many causes

Just what is anemia? Anemia is when the number of red blood cells in the body is low.

Red blood cells carry oxygen to the various organs and parts of the body so they can function properly. The consequences of anemia are a result of lower delivered oxygen. Fatigue is a common symptom, and shortness of breath with or without exertion are particularly noted in people with underlying lung disease.

Many people assume they are anemic if they are experiencing a lot of fatigue. However, fatigue is a common symptom of many disorders.

Often, people who develop anemia assume that they have iron deficiency, but anemia can be caused by a variety of causes. If there is not enough iron, then the body cannot make as many red blood cells.

Red blood cells live about 120 days and then are broken down by the body. The inner structure of those cells contains iron as an essential ingredient, and it is recycled to make more red blood cells.

We need to measure the storage iron in the body (ferritin) to determine if someone is iron-deficient. If someone is not iron-deficient (and not losing blood), then we do not recommend supplemental iron without checking ferritin levels, because too much iron in the body can be dangerous.

People become iron-deficient by losing blood, predominantly. Blood loss commonly occurs through the gut and microscopic amounts lost slowly over time from an ulcer or even a cancer eventually add up to result in anemia.

Of course, women lose blood every month during their menses throughout their lives until menopause and it is very common to see iron deficiency in this setting.

Vitamin B12 deficiency and folic acid deficiency are other nutritional causes of anemia. Even people who are taking B12 supplements can become deficient if they are not absorbing the vitamin through their gut. B12 injections or B12 drops under the tongue are recommended for those not absorbing it well orally.

Since red blood cells are made in the bone marrow, any disorders of the bone marrow such as leukemia, myelodysplastic syndrome (MDS), myeloma, etc., can cause anemia. Various toxins or drugs can stun the bone marrow temporarily or permanently and result in anemia - this is frequently called aplastic anemia.

There are a variety of inherited anemias, such as the Thallasemias. Chronic diseases can also affect bone marrow production of red blood cells, such as diabetes, thyroid disorders and kidney disease.

The bottom line is that anemia is not a single disorder. It is a complicated condition that can be caused by many things - and many times more than one thing.

Valerie Israel is a hematologist-oncologist at the Kingman Regional Medical Center Cancer Center.