By Tedler D. Depaynos, MD
Anemia is simply a deficiency of red blood cells or RBCs. The blood is made up of a liquid component called “plasma” and a solid component which are the RBCs. The RBCs which are produced by the bone marrow carries O2 and distributes it in our body. With severe deficiency, aside from paleness, lack of O2 to the muscles may produce easy tiredness or even numbness when oxygenation of the nerves is affected. Most of the time, however, palpitations are more experienced because the heart has to work double time in pumping the blood and breathlessness because the lungs has to exert extra effort in taking in O2 which may eventually be taxing. This of course occurs in severe anemia or in cases where anemia develops within a short period of time. In gradual appearance, the body adapts to the deficiency so that the manifestations may not be so obvious initially.
There are various causes of RBC deficiency. It may be the bone marrow not producing enough because it is diseased. It may also be due to defective RBCs which do not last long. RBCs usually survive for 120 days but certain diseases may shorten their life span. Some of the causes may be congenital and some may be classified as malignant with various names sometimes derived from the blood specialists that discovered them or simply given terminologies that describes the pathology.
In the manufacture of the RBCs by the bone marrow, the mineral iron is a must. It is the raw material and without it, the so called iron deficiency anemia occurs. Adults that eat a regular diet rarely encounter this problem because iron is admixed in small amounts with the meat and vegetables which are eaten daily. It is the babies or children which depend mostly on the milk given to them that usually develop this pathologic entity. Hence, most of the time experienced pediatricians prescribe iron as a food supplement.
When this pathologic entity occurs gradually in an adult, there must be a chronic and undetected loss of blood or bleeding. Sudden appearance implies significant bleeding within a short period of time and this is easily noticeable. If negative, the other etiologies should be ruled out. Blood experts or Hematologists may be needed.
In the stomach hyperacidity may destroy the iron chemicals and strong analgesics may neutralize it. Hyperacidity however is easily controlled and the intake of analgesics is only taken when needed and usually for a short time.
Chronic bleeding may also occur in the gastro-intestinal tract or GIT. In the stomach, bleeding ulcers which maybe benign or malignant are entertained. In the lower GIT, bleeding may come from lesions which may likewise be benign or malignant. In the colon, however, malignancy appears to predominate as a cause. They maybe unnoticeable because the bleeding are in small amounts and admixed with stools. Hence a work-up is routinely recommended in these cases.
We were reminded of one of the patients we had recently. He is a taxi driver and his wife is an OFW in Hongkong. It was the wife who noticed that the husband appeared significantly pale and obviously anemic when she came home for vacation after 2 or 3 years. He never underwent any check-up until she firmly insisted that he should go perhaps with the words “or else”. He was confirmed severely anemic and his stools tested positive for occult blood. When he underwent “colonoscopy”, a bleeding lesion was seen at the proximal large colon which turned out to be “malignant”. Surgery was eventually done and after a few weeks of rest, he went back driving his taxi. His wife went back to Hongkong hoping that her employees would be understandable and would still take her back because of her extended vacation. She promised however that she would only be away for a year and would be back permanently. She was confident she could buy another “taxi”.
It is a silent rule that in treating severe anemia, the etiology must be determined! **
